SlideShare a Scribd company logo
1 of 18
Download to read offline
CORPORATE
COMPLIANCE
PROGRAM
HISTORY
• Center for Medicare & Medicaid (CMS)
paid $20,000,000,000 in error !
• Improper payment due to:
CODING & BILLING ERRORS
FRAUD & ABUSE
• Enormous financial losses for
government
PASSAGE OF HIPAA 1996
Government $$$$ for resources
to detect fraud & abuse
Criminal Offense
OIG strongly recommends
Corporate Compliance
HEALTHCARE FRAUD n.[<Lat. Fraus,
deceit.] 1. Any scheme to obtain money or
property of any healthcare benefit plan by
means of false or fraudulent pretenses,
representations or promises. 2. A deliberate
deception practiced so as to secure unlawful
gain.
.
HEALTHCARE FRAUD = A CRIMINAL OFFENSE
This applies to all claims under health benefit programs
Fines
Prison
Restitution
Sanctions
Corporate Probation
CORPORATE COMPLIANCE
PROGRAM
• Designed to detect and prevent violations
of law by employees & physicians
• Offer a framework of ethical guidelines
and expectations for the workplace –
standards of conduct
• Goal is to ensure that the employees &
physicians comply with applicable laws
and regulations
• Essential to any organization committed
to ethical conduct and sound business
practices
GOALS
• Improve Quality of Care
• Improve Documentation
• Minimize Billing Mistakes
• Increase Awareness > Decrease Risk
• Reaffirm Commitment to Our Mission
BENEFITS
• Established high ethical standards
• Improved financial performance
• Improved quality care
• Improved documentation
• Early detection of potential problems
7 BASIC ELEMENTS OF A
COMPLIANCE PROGRAM
1. Standards of conduct
2. Designated Compliance Officer
3. Effective education and training
4. Audits and other evaluation techniques
5. Internal reporting processes
6. Disciplinary mechanisms
7. Investigation and remediation
CORPORATE COMPLIANCE:
AN ONGOING PROCESS
1.Prevent
2. Detect/Correct
3. Defend/Mitigate
RISK
THE 3C DECISION
MAKING MODEL
Compliance:
• Violation of a law, regulation or internal law or procedure
Conscience:
• Violation of an ethical principle
Conduct:
• Decide on appropriate course of action with which to resolve
the situation
Guides To Determine
Appropriate Behavior
• Integrity
• Common Sense
• Sound Judgment
Ask Yourself These
Questions…
• Are my actions legal?
• Is it fair and honest?
• Is this in the best interest of the
Center and the patients we serve?
• Will my actions stand the test of time?
• How will I feel about myself afterwards?
• Will I sleep soundly tonight?
• What would I tell my child to do?
• How would my words and actions look if
reported in the newspaper?
Examine Your Conscience - If You Think or
Hear…
• “Shred that document.”
• “No one will get hurt.”
• “You never heard me say
that.”
• “It can’t hurt just this once…”
• “No one will ever find out…”
• “Everyone does it.”
REPORTING A VIOLATION
TSC Hotline 973 477-7217
Anyone can report a violation without fear of
ANY retaliation by:
Phone
Verbal
E-mail
Written
CORPORATE COMPLIANCE PROGRAM
1. Written Policies and Procedures
2. Quality Care and Services
3. Reporting and Communication Policy
4. Compliance with Laws and Regulations
5. Medical Records
6. Personnel
7. Safe Work Environment
8. Conflicts of Interests
9. Coding, Billing and Documentation
10.Protecting Property
HINT HINT HINT HINT
• Corporate Compliance is NOT a
JCAHO requirement
• Corporate Compliance is NOT
just for healthcare industries
• ANYONE can report a violation
• Corporate Compliance Officer is
Meg Oser

More Related Content

What's hot

Compliance framework
Compliance frameworkCompliance framework
Compliance frameworkManoj Agarwal
 
Great ISO 14001 Compliance Obligations and Legal Requirements
Great ISO 14001 Compliance Obligations and Legal RequirementsGreat ISO 14001 Compliance Obligations and Legal Requirements
Great ISO 14001 Compliance Obligations and Legal RequirementsNimonik
 
Governance, Risk & Compliance Management Solution
Governance, Risk & Compliance Management SolutionGovernance, Risk & Compliance Management Solution
Governance, Risk & Compliance Management SolutionRishabh Software
 
Hr code of conduct (Safety book for employee)
Hr code of conduct (Safety book for employee)Hr code of conduct (Safety book for employee)
Hr code of conduct (Safety book for employee)Imran Iftikhar
 
Function of board committee
Function of board committeeFunction of board committee
Function of board committeeMohd Younus
 
Procurement audit training course- Procurement Training
Procurement audit training course- Procurement TrainingProcurement audit training course- Procurement Training
Procurement audit training course- Procurement TrainingSheila Elliott
 
Evaluation of internal control system
Evaluation of internal control systemEvaluation of internal control system
Evaluation of internal control systemVadivelM9
 
Corporate compliance powerpoint
Corporate compliance powerpointCorporate compliance powerpoint
Corporate compliance powerpointsmcmanus3
 
Ethical practices by indian corporate sector
Ethical practices by indian corporate sectorEthical practices by indian corporate sector
Ethical practices by indian corporate sectorSiddharth Anand
 
IT ACT, 2000 (Information Technology Act, 2000)
IT ACT, 2000 (Information Technology Act, 2000)IT ACT, 2000 (Information Technology Act, 2000)
IT ACT, 2000 (Information Technology Act, 2000)Ms. Parasmani Jangid
 
Ethics in Accounting
Ethics in AccountingEthics in Accounting
Ethics in AccountingAnjiyaa
 
Best practice for anti corruption
Best practice for anti corruptionBest practice for anti corruption
Best practice for anti corruptionEthical Sector
 
Hrm Ethics
Hrm EthicsHrm Ethics
Hrm Ethicsajithsrc
 
Information Technology Act 2000
Information Technology Act 2000Information Technology Act 2000
Information Technology Act 2000Vijay Dalmia
 
Ppt On Legal Compliances
Ppt On Legal CompliancesPpt On Legal Compliances
Ppt On Legal Compliancesspatward
 
Service focus and service encounters
Service focus and service encountersService focus and service encounters
Service focus and service encountersAamir chouhan
 
Statutory Compliance Audit Process
Statutory Compliance Audit ProcessStatutory Compliance Audit Process
Statutory Compliance Audit Processashwiniarondkar
 
Mkt 350, ch 5, consumer perceptions of service
Mkt 350, ch 5, consumer perceptions of serviceMkt 350, ch 5, consumer perceptions of service
Mkt 350, ch 5, consumer perceptions of serviceFardeen Ameen
 

What's hot (20)

Compliance framework
Compliance frameworkCompliance framework
Compliance framework
 
Great ISO 14001 Compliance Obligations and Legal Requirements
Great ISO 14001 Compliance Obligations and Legal RequirementsGreat ISO 14001 Compliance Obligations and Legal Requirements
Great ISO 14001 Compliance Obligations and Legal Requirements
 
Governance, Risk & Compliance Management Solution
Governance, Risk & Compliance Management SolutionGovernance, Risk & Compliance Management Solution
Governance, Risk & Compliance Management Solution
 
Hr code of conduct (Safety book for employee)
Hr code of conduct (Safety book for employee)Hr code of conduct (Safety book for employee)
Hr code of conduct (Safety book for employee)
 
Code of Conduct
Code of ConductCode of Conduct
Code of Conduct
 
Function of board committee
Function of board committeeFunction of board committee
Function of board committee
 
Procurement audit training course- Procurement Training
Procurement audit training course- Procurement TrainingProcurement audit training course- Procurement Training
Procurement audit training course- Procurement Training
 
Evaluation of internal control system
Evaluation of internal control systemEvaluation of internal control system
Evaluation of internal control system
 
Corporate compliance powerpoint
Corporate compliance powerpointCorporate compliance powerpoint
Corporate compliance powerpoint
 
Ethical practices by indian corporate sector
Ethical practices by indian corporate sectorEthical practices by indian corporate sector
Ethical practices by indian corporate sector
 
IT ACT, 2000 (Information Technology Act, 2000)
IT ACT, 2000 (Information Technology Act, 2000)IT ACT, 2000 (Information Technology Act, 2000)
IT ACT, 2000 (Information Technology Act, 2000)
 
Ethics in Accounting
Ethics in AccountingEthics in Accounting
Ethics in Accounting
 
Best practice for anti corruption
Best practice for anti corruptionBest practice for anti corruption
Best practice for anti corruption
 
Hrm Ethics
Hrm EthicsHrm Ethics
Hrm Ethics
 
Information Technology Act 2000
Information Technology Act 2000Information Technology Act 2000
Information Technology Act 2000
 
Ppt On Legal Compliances
Ppt On Legal CompliancesPpt On Legal Compliances
Ppt On Legal Compliances
 
Legal Ethics
Legal EthicsLegal Ethics
Legal Ethics
 
Service focus and service encounters
Service focus and service encountersService focus and service encounters
Service focus and service encounters
 
Statutory Compliance Audit Process
Statutory Compliance Audit ProcessStatutory Compliance Audit Process
Statutory Compliance Audit Process
 
Mkt 350, ch 5, consumer perceptions of service
Mkt 350, ch 5, consumer perceptions of serviceMkt 350, ch 5, consumer perceptions of service
Mkt 350, ch 5, consumer perceptions of service
 

Viewers also liked

Compliance ppt
Compliance pptCompliance ppt
Compliance pptAlok Yadav
 
Statutory compliances for companies in India
Statutory compliances for companies in IndiaStatutory compliances for companies in India
Statutory compliances for companies in Indiakborah
 
Statutory Compliance for HR
Statutory Compliance for HRStatutory Compliance for HR
Statutory Compliance for HRshreyasawanto7
 
Governance, risk and compliance framework
Governance, risk and compliance frameworkGovernance, risk and compliance framework
Governance, risk and compliance frameworkCeyeap
 
Compliance under labour laws in india
Compliance under labour laws in indiaCompliance under labour laws in india
Compliance under labour laws in indiaAmrik Singh
 
Labour law presentation
Labour law presentationLabour law presentation
Labour law presentationMalik Sheraz
 
Court Cases and Healthcare Valuation
Court Cases and Healthcare ValuationCourt Cases and Healthcare Valuation
Court Cases and Healthcare ValuationCurtis Bernstein
 
Πώς τα Κοινωνικά Δίκτυα επηρεάζουν το SEO της ιστοσελίδας σας
Πώς τα Κοινωνικά Δίκτυα επηρεάζουν το SEO της ιστοσελίδας σαςΠώς τα Κοινωνικά Δίκτυα επηρεάζουν το SEO της ιστοσελίδας σας
Πώς τα Κοινωνικά Δίκτυα επηρεάζουν το SEO της ιστοσελίδας σαςSkourlis Dimitris
 
Horizon 2013 P2P Re-imagined: No User Pain, but Real Compliance Gains, A Cas...
Horizon 2013 P2P Re-imagined:  No User Pain, but Real Compliance Gains, A Cas...Horizon 2013 P2P Re-imagined:  No User Pain, but Real Compliance Gains, A Cas...
Horizon 2013 P2P Re-imagined: No User Pain, but Real Compliance Gains, A Cas...Zycus
 
Compliance report format (Corporate Governance) to be submitted to Stock Exc...
Compliance report format  (Corporate Governance) to be submitted to Stock Exc...Compliance report format  (Corporate Governance) to be submitted to Stock Exc...
Compliance report format (Corporate Governance) to be submitted to Stock Exc...GAURAV KR SHARMA
 
Medicare-AHS-Fuller-P6
Medicare-AHS-Fuller-P6Medicare-AHS-Fuller-P6
Medicare-AHS-Fuller-P6evanlack
 
False Claims Act & Physicians - Basic Primer
False Claims Act & Physicians - Basic PrimerFalse Claims Act & Physicians - Basic Primer
False Claims Act & Physicians - Basic PrimerT Anthony Howell
 
Health Care Fraud Investigations: What to Do When the Government Knocks
Health Care Fraud Investigations: What to Do When the Government KnocksHealth Care Fraud Investigations: What to Do When the Government Knocks
Health Care Fraud Investigations: What to Do When the Government KnocksEpstein Becker Green
 
Fico unleashes new analytics for fighting america's $700+ billion healthcare ...
Fico unleashes new analytics for fighting america's $700+ billion healthcare ...Fico unleashes new analytics for fighting america's $700+ billion healthcare ...
Fico unleashes new analytics for fighting america's $700+ billion healthcare ...aldrencarlo
 

Viewers also liked (20)

Compliance ppt
Compliance pptCompliance ppt
Compliance ppt
 
Statutory compliances for companies in India
Statutory compliances for companies in IndiaStatutory compliances for companies in India
Statutory compliances for companies in India
 
Statutory Compliance for HR
Statutory Compliance for HRStatutory Compliance for HR
Statutory Compliance for HR
 
Governance, risk and compliance framework
Governance, risk and compliance frameworkGovernance, risk and compliance framework
Governance, risk and compliance framework
 
Compliance under labour laws in india
Compliance under labour laws in indiaCompliance under labour laws in india
Compliance under labour laws in india
 
PPT on "Labour Laws in India"
PPT on "Labour Laws in India"PPT on "Labour Laws in India"
PPT on "Labour Laws in India"
 
Labour laws in India- ppt
Labour laws in India-  pptLabour laws in India-  ppt
Labour laws in India- ppt
 
Labour law presentation
Labour law presentationLabour law presentation
Labour law presentation
 
Court Cases and Healthcare Valuation
Court Cases and Healthcare ValuationCourt Cases and Healthcare Valuation
Court Cases and Healthcare Valuation
 
Πώς τα Κοινωνικά Δίκτυα επηρεάζουν το SEO της ιστοσελίδας σας
Πώς τα Κοινωνικά Δίκτυα επηρεάζουν το SEO της ιστοσελίδας σαςΠώς τα Κοινωνικά Δίκτυα επηρεάζουν το SEO της ιστοσελίδας σας
Πώς τα Κοινωνικά Δίκτυα επηρεάζουν το SEO της ιστοσελίδας σας
 
Panos Michalopoulos Presentation
Panos Michalopoulos PresentationPanos Michalopoulos Presentation
Panos Michalopoulos Presentation
 
Internet Marketing
Internet MarketingInternet Marketing
Internet Marketing
 
Horizon 2013 P2P Re-imagined: No User Pain, but Real Compliance Gains, A Cas...
Horizon 2013 P2P Re-imagined:  No User Pain, but Real Compliance Gains, A Cas...Horizon 2013 P2P Re-imagined:  No User Pain, but Real Compliance Gains, A Cas...
Horizon 2013 P2P Re-imagined: No User Pain, but Real Compliance Gains, A Cas...
 
Compliance report format (Corporate Governance) to be submitted to Stock Exc...
Compliance report format  (Corporate Governance) to be submitted to Stock Exc...Compliance report format  (Corporate Governance) to be submitted to Stock Exc...
Compliance report format (Corporate Governance) to be submitted to Stock Exc...
 
Medicare-AHS-Fuller-P6
Medicare-AHS-Fuller-P6Medicare-AHS-Fuller-P6
Medicare-AHS-Fuller-P6
 
False Claims Act & Physicians - Basic Primer
False Claims Act & Physicians - Basic PrimerFalse Claims Act & Physicians - Basic Primer
False Claims Act & Physicians - Basic Primer
 
Effective Compliance Training Program – Ways to Reduce Compliance Risks
Effective Compliance Training Program – Ways to Reduce Compliance RisksEffective Compliance Training Program – Ways to Reduce Compliance Risks
Effective Compliance Training Program – Ways to Reduce Compliance Risks
 
Tips on Polishing Powerpoint Presentations
Tips on Polishing Powerpoint PresentationsTips on Polishing Powerpoint Presentations
Tips on Polishing Powerpoint Presentations
 
Health Care Fraud Investigations: What to Do When the Government Knocks
Health Care Fraud Investigations: What to Do When the Government KnocksHealth Care Fraud Investigations: What to Do When the Government Knocks
Health Care Fraud Investigations: What to Do When the Government Knocks
 
Fico unleashes new analytics for fighting america's $700+ billion healthcare ...
Fico unleashes new analytics for fighting america's $700+ billion healthcare ...Fico unleashes new analytics for fighting america's $700+ billion healthcare ...
Fico unleashes new analytics for fighting america's $700+ billion healthcare ...
 

Similar to Corporate compliance

Hot Topics in Health Care Law
Hot Topics in Health Care LawHot Topics in Health Care Law
Hot Topics in Health Care LawCraig B. Garner
 
Tenet Standards of ConductTogether we’re moving health f.docx
Tenet Standards of ConductTogether we’re moving health f.docxTenet Standards of ConductTogether we’re moving health f.docx
Tenet Standards of ConductTogether we’re moving health f.docxbradburgess22840
 
Corporate compliance annual update
Corporate compliance annual updateCorporate compliance annual update
Corporate compliance annual updateDirkRhodes
 
Emergency medicine, psychiatry and the law
Emergency medicine, psychiatry and the lawEmergency medicine, psychiatry and the law
Emergency medicine, psychiatry and the lawSCGH ED CME
 
ETHICAL LEADERSHIP.pptx
ETHICAL LEADERSHIP.pptxETHICAL LEADERSHIP.pptx
ETHICAL LEADERSHIP.pptxSumalathaB3
 
Jay Keese & Staci Benson, DO - DPC Advocacy Briefing - DPC Summit 2018
Jay Keese & Staci Benson, DO - DPC Advocacy Briefing - DPC Summit 2018Jay Keese & Staci Benson, DO - DPC Advocacy Briefing - DPC Summit 2018
Jay Keese & Staci Benson, DO - DPC Advocacy Briefing - DPC Summit 2018Hint
 
SGUL ArabSoc PPD Semester 3/4 Revision Lecture
SGUL ArabSoc PPD Semester 3/4 Revision LectureSGUL ArabSoc PPD Semester 3/4 Revision Lecture
SGUL ArabSoc PPD Semester 3/4 Revision LectureSGULArabSoc
 
Microsoft Power Point Ethics In Trading 2
Microsoft Power Point   Ethics In Trading 2Microsoft Power Point   Ethics In Trading 2
Microsoft Power Point Ethics In Trading 2ceciliaanthony
 
HIPAA Compliance and Security in a Mobile World
HIPAA Compliance and Security in a Mobile WorldHIPAA Compliance and Security in a Mobile World
HIPAA Compliance and Security in a Mobile WorldRyan Snell
 
USED_IN_TRAININGS_AS_OF_11_1_21_updated_11_5_for_phone_number_on_Slide_35[1]....
USED_IN_TRAININGS_AS_OF_11_1_21_updated_11_5_for_phone_number_on_Slide_35[1]....USED_IN_TRAININGS_AS_OF_11_1_21_updated_11_5_for_phone_number_on_Slide_35[1]....
USED_IN_TRAININGS_AS_OF_11_1_21_updated_11_5_for_phone_number_on_Slide_35[1]....ErnestManigo1
 
HR Insights, 17th Sept, Refreshing Law - Mental Health in the Workplace
HR Insights, 17th Sept, Refreshing Law - Mental Health in the WorkplaceHR Insights, 17th Sept, Refreshing Law - Mental Health in the Workplace
HR Insights, 17th Sept, Refreshing Law - Mental Health in the WorkplaceJames Cheetham
 
Mandatory hippa and information security
Mandatory hippa and information securityMandatory hippa and information security
Mandatory hippa and information securityHiggi123
 
Why good managers make bad ethical decisions?
Why good managers make bad ethical decisions?Why good managers make bad ethical decisions?
Why good managers make bad ethical decisions?Vinayak Nagaonkar
 

Similar to Corporate compliance (20)

Corporate compliance
Corporate complianceCorporate compliance
Corporate compliance
 
Corporate compliance
Corporate complianceCorporate compliance
Corporate compliance
 
Compliance
ComplianceCompliance
Compliance
 
Ethics en
Ethics enEthics en
Ethics en
 
Hot Topics in Health Care Law
Hot Topics in Health Care LawHot Topics in Health Care Law
Hot Topics in Health Care Law
 
Tenet Standards of ConductTogether we’re moving health f.docx
Tenet Standards of ConductTogether we’re moving health f.docxTenet Standards of ConductTogether we’re moving health f.docx
Tenet Standards of ConductTogether we’re moving health f.docx
 
Corporate compliance annual update
Corporate compliance annual updateCorporate compliance annual update
Corporate compliance annual update
 
Emergency medicine, psychiatry and the law
Emergency medicine, psychiatry and the lawEmergency medicine, psychiatry and the law
Emergency medicine, psychiatry and the law
 
ETHICAL LEADERSHIP.pptx
ETHICAL LEADERSHIP.pptxETHICAL LEADERSHIP.pptx
ETHICAL LEADERSHIP.pptx
 
Jay Keese & Staci Benson, DO - DPC Advocacy Briefing - DPC Summit 2018
Jay Keese & Staci Benson, DO - DPC Advocacy Briefing - DPC Summit 2018Jay Keese & Staci Benson, DO - DPC Advocacy Briefing - DPC Summit 2018
Jay Keese & Staci Benson, DO - DPC Advocacy Briefing - DPC Summit 2018
 
SGUL ArabSoc PPD Semester 3/4 Revision Lecture
SGUL ArabSoc PPD Semester 3/4 Revision LectureSGUL ArabSoc PPD Semester 3/4 Revision Lecture
SGUL ArabSoc PPD Semester 3/4 Revision Lecture
 
Ten minutes on system leadership and public health for elected members
Ten minutes on system leadership and public health for elected membersTen minutes on system leadership and public health for elected members
Ten minutes on system leadership and public health for elected members
 
OBAMACARE 101
OBAMACARE 101OBAMACARE 101
OBAMACARE 101
 
Microsoft Power Point Ethics In Trading 2
Microsoft Power Point   Ethics In Trading 2Microsoft Power Point   Ethics In Trading 2
Microsoft Power Point Ethics In Trading 2
 
Ethics and Behavioral Health Care
Ethics and Behavioral Health CareEthics and Behavioral Health Care
Ethics and Behavioral Health Care
 
HIPAA Compliance and Security in a Mobile World
HIPAA Compliance and Security in a Mobile WorldHIPAA Compliance and Security in a Mobile World
HIPAA Compliance and Security in a Mobile World
 
USED_IN_TRAININGS_AS_OF_11_1_21_updated_11_5_for_phone_number_on_Slide_35[1]....
USED_IN_TRAININGS_AS_OF_11_1_21_updated_11_5_for_phone_number_on_Slide_35[1]....USED_IN_TRAININGS_AS_OF_11_1_21_updated_11_5_for_phone_number_on_Slide_35[1]....
USED_IN_TRAININGS_AS_OF_11_1_21_updated_11_5_for_phone_number_on_Slide_35[1]....
 
HR Insights, 17th Sept, Refreshing Law - Mental Health in the Workplace
HR Insights, 17th Sept, Refreshing Law - Mental Health in the WorkplaceHR Insights, 17th Sept, Refreshing Law - Mental Health in the Workplace
HR Insights, 17th Sept, Refreshing Law - Mental Health in the Workplace
 
Mandatory hippa and information security
Mandatory hippa and information securityMandatory hippa and information security
Mandatory hippa and information security
 
Why good managers make bad ethical decisions?
Why good managers make bad ethical decisions?Why good managers make bad ethical decisions?
Why good managers make bad ethical decisions?
 

More from justinschreiber

More from justinschreiber (14)

Laser safety
Laser safetyLaser safety
Laser safety
 
Cultural Diversity and Health Care
Cultural Diversity and Health CareCultural Diversity and Health Care
Cultural Diversity and Health Care
 
Cultural diversity and health care
Cultural diversity and health careCultural diversity and health care
Cultural diversity and health care
 
Infection Control (Physicians)
Infection Control (Physicians)Infection Control (Physicians)
Infection Control (Physicians)
 
Pain Management (Physicians)
Pain Management (Physicians)Pain Management (Physicians)
Pain Management (Physicians)
 
Life Safety (Physicians)
Life Safety (Physicians)Life Safety (Physicians)
Life Safety (Physicians)
 
Cultural Diversity (Physicians)
Cultural Diversity (Physicians)Cultural Diversity (Physicians)
Cultural Diversity (Physicians)
 
Corporate Compliance (Physicians)
Corporate Compliance (Physicians)Corporate Compliance (Physicians)
Corporate Compliance (Physicians)
 
Infection Control (Physicians)
Infection Control (Physicians) Infection Control (Physicians)
Infection Control (Physicians)
 
Safety & security
Safety & securitySafety & security
Safety & security
 
Abuse
AbuseAbuse
Abuse
 
Safety & security
Safety & securitySafety & security
Safety & security
 
Infection control
Infection controlInfection control
Infection control
 
Infection Control
Infection ControlInfection Control
Infection Control
 

Recently uploaded

PDT 88 - 4 million seed - Seed - Protecto.pdf
PDT 88 - 4 million seed - Seed - Protecto.pdfPDT 88 - 4 million seed - Seed - Protecto.pdf
PDT 88 - 4 million seed - Seed - Protecto.pdfHajeJanKamps
 
Project Brief & Information Architecture Report
Project Brief & Information Architecture ReportProject Brief & Information Architecture Report
Project Brief & Information Architecture Reportamberjiles31
 
The End of Business as Usual: Rewire the Way You Work to Succeed in the Consu...
The End of Business as Usual: Rewire the Way You Work to Succeed in the Consu...The End of Business as Usual: Rewire the Way You Work to Succeed in the Consu...
The End of Business as Usual: Rewire the Way You Work to Succeed in the Consu...Brian Solis
 
Slicing Work on Business Agility Meetup Berlin
Slicing Work on Business Agility Meetup BerlinSlicing Work on Business Agility Meetup Berlin
Slicing Work on Business Agility Meetup BerlinAnton Skornyakov
 
Building Your Personal Brand on LinkedIn - Expert Planet- 2024
 Building Your Personal Brand on LinkedIn - Expert Planet-  2024 Building Your Personal Brand on LinkedIn - Expert Planet-  2024
Building Your Personal Brand on LinkedIn - Expert Planet- 2024Stephan Koning
 
מיסוי רילוקיישן לפורטוגל- היבטי מיסוי ישראלי ופורטוגלי
מיסוי רילוקיישן לפורטוגל- היבטי מיסוי ישראלי ופורטוגלימיסוי רילוקיישן לפורטוגל- היבטי מיסוי ישראלי ופורטוגלי
מיסוי רילוקיישן לפורטוגל- היבטי מיסוי ישראלי ופורטוגליBen Shushan & Co. C.P.A (Isr.)
 
A flour, rice and Suji company in Jhang.
A flour, rice and Suji company in Jhang.A flour, rice and Suji company in Jhang.
A flour, rice and Suji company in Jhang.mcshagufta46
 
Developing Coaching Skills: Mine, Yours, Ours
Developing Coaching Skills: Mine, Yours, OursDeveloping Coaching Skills: Mine, Yours, Ours
Developing Coaching Skills: Mine, Yours, OursKaiNexus
 
Upgrade Your Banking Experience with Advanced Core Banking Applications
Upgrade Your Banking Experience with Advanced Core Banking ApplicationsUpgrade Your Banking Experience with Advanced Core Banking Applications
Upgrade Your Banking Experience with Advanced Core Banking ApplicationsIntellect Design Arena Ltd
 
Fabric RFID Wristbands in Ireland for Events and Festivals
Fabric RFID Wristbands in Ireland for Events and FestivalsFabric RFID Wristbands in Ireland for Events and Festivals
Fabric RFID Wristbands in Ireland for Events and FestivalsWristbands Ireland
 
Entrepreneurship & organisations: influences and organizations
Entrepreneurship & organisations: influences and organizationsEntrepreneurship & organisations: influences and organizations
Entrepreneurship & organisations: influences and organizationsP&CO
 
TalentView Webinar: Empowering the Modern Workforce_ Redefininig Success from...
TalentView Webinar: Empowering the Modern Workforce_ Redefininig Success from...TalentView Webinar: Empowering the Modern Workforce_ Redefininig Success from...
TalentView Webinar: Empowering the Modern Workforce_ Redefininig Success from...TalentView
 
Six Sigma Improvement Process: Transforming Processes, Elevating Performance
Six Sigma Improvement Process: Transforming Processes, Elevating PerformanceSix Sigma Improvement Process: Transforming Processes, Elevating Performance
Six Sigma Improvement Process: Transforming Processes, Elevating PerformanceOperational Excellence Consulting
 
AMAZON SELLER VIRTUAL ASSISTANT PRODUCT RESEARCH .pdf
AMAZON SELLER VIRTUAL ASSISTANT PRODUCT RESEARCH .pdfAMAZON SELLER VIRTUAL ASSISTANT PRODUCT RESEARCH .pdf
AMAZON SELLER VIRTUAL ASSISTANT PRODUCT RESEARCH .pdfJohnCarloValencia4
 
NewBase 25 March 2024 Energy News issue - 1710 by Khaled Al Awadi_compress...
NewBase  25 March  2024  Energy News issue - 1710 by Khaled Al Awadi_compress...NewBase  25 March  2024  Energy News issue - 1710 by Khaled Al Awadi_compress...
NewBase 25 March 2024 Energy News issue - 1710 by Khaled Al Awadi_compress...Khaled Al Awadi
 
Intellectual Property Licensing Examples
Intellectual Property Licensing ExamplesIntellectual Property Licensing Examples
Intellectual Property Licensing Examplesamberjiles31
 
Anyhr.io | Presentation HR&Recruiting agency
Anyhr.io | Presentation HR&Recruiting agencyAnyhr.io | Presentation HR&Recruiting agency
Anyhr.io | Presentation HR&Recruiting agencyHanna Klim
 
Cracking the ‘Business Process Outsourcing’ Code Main.pptx
Cracking the ‘Business Process Outsourcing’ Code Main.pptxCracking the ‘Business Process Outsourcing’ Code Main.pptx
Cracking the ‘Business Process Outsourcing’ Code Main.pptxWorkforce Group
 
Borderless Access - Global Panel book-unlock 2024
Borderless Access - Global Panel book-unlock 2024Borderless Access - Global Panel book-unlock 2024
Borderless Access - Global Panel book-unlock 2024Borderless Access
 

Recently uploaded (20)

PDT 88 - 4 million seed - Seed - Protecto.pdf
PDT 88 - 4 million seed - Seed - Protecto.pdfPDT 88 - 4 million seed - Seed - Protecto.pdf
PDT 88 - 4 million seed - Seed - Protecto.pdf
 
Project Brief & Information Architecture Report
Project Brief & Information Architecture ReportProject Brief & Information Architecture Report
Project Brief & Information Architecture Report
 
The End of Business as Usual: Rewire the Way You Work to Succeed in the Consu...
The End of Business as Usual: Rewire the Way You Work to Succeed in the Consu...The End of Business as Usual: Rewire the Way You Work to Succeed in the Consu...
The End of Business as Usual: Rewire the Way You Work to Succeed in the Consu...
 
Slicing Work on Business Agility Meetup Berlin
Slicing Work on Business Agility Meetup BerlinSlicing Work on Business Agility Meetup Berlin
Slicing Work on Business Agility Meetup Berlin
 
Building Your Personal Brand on LinkedIn - Expert Planet- 2024
 Building Your Personal Brand on LinkedIn - Expert Planet-  2024 Building Your Personal Brand on LinkedIn - Expert Planet-  2024
Building Your Personal Brand on LinkedIn - Expert Planet- 2024
 
מיסוי רילוקיישן לפורטוגל- היבטי מיסוי ישראלי ופורטוגלי
מיסוי רילוקיישן לפורטוגל- היבטי מיסוי ישראלי ופורטוגלימיסוי רילוקיישן לפורטוגל- היבטי מיסוי ישראלי ופורטוגלי
מיסוי רילוקיישן לפורטוגל- היבטי מיסוי ישראלי ופורטוגלי
 
Sixth Sense Media Portfolio (Eng Ver) PDF
Sixth Sense Media Portfolio (Eng Ver) PDFSixth Sense Media Portfolio (Eng Ver) PDF
Sixth Sense Media Portfolio (Eng Ver) PDF
 
A flour, rice and Suji company in Jhang.
A flour, rice and Suji company in Jhang.A flour, rice and Suji company in Jhang.
A flour, rice and Suji company in Jhang.
 
Developing Coaching Skills: Mine, Yours, Ours
Developing Coaching Skills: Mine, Yours, OursDeveloping Coaching Skills: Mine, Yours, Ours
Developing Coaching Skills: Mine, Yours, Ours
 
Upgrade Your Banking Experience with Advanced Core Banking Applications
Upgrade Your Banking Experience with Advanced Core Banking ApplicationsUpgrade Your Banking Experience with Advanced Core Banking Applications
Upgrade Your Banking Experience with Advanced Core Banking Applications
 
Fabric RFID Wristbands in Ireland for Events and Festivals
Fabric RFID Wristbands in Ireland for Events and FestivalsFabric RFID Wristbands in Ireland for Events and Festivals
Fabric RFID Wristbands in Ireland for Events and Festivals
 
Entrepreneurship & organisations: influences and organizations
Entrepreneurship & organisations: influences and organizationsEntrepreneurship & organisations: influences and organizations
Entrepreneurship & organisations: influences and organizations
 
TalentView Webinar: Empowering the Modern Workforce_ Redefininig Success from...
TalentView Webinar: Empowering the Modern Workforce_ Redefininig Success from...TalentView Webinar: Empowering the Modern Workforce_ Redefininig Success from...
TalentView Webinar: Empowering the Modern Workforce_ Redefininig Success from...
 
Six Sigma Improvement Process: Transforming Processes, Elevating Performance
Six Sigma Improvement Process: Transforming Processes, Elevating PerformanceSix Sigma Improvement Process: Transforming Processes, Elevating Performance
Six Sigma Improvement Process: Transforming Processes, Elevating Performance
 
AMAZON SELLER VIRTUAL ASSISTANT PRODUCT RESEARCH .pdf
AMAZON SELLER VIRTUAL ASSISTANT PRODUCT RESEARCH .pdfAMAZON SELLER VIRTUAL ASSISTANT PRODUCT RESEARCH .pdf
AMAZON SELLER VIRTUAL ASSISTANT PRODUCT RESEARCH .pdf
 
NewBase 25 March 2024 Energy News issue - 1710 by Khaled Al Awadi_compress...
NewBase  25 March  2024  Energy News issue - 1710 by Khaled Al Awadi_compress...NewBase  25 March  2024  Energy News issue - 1710 by Khaled Al Awadi_compress...
NewBase 25 March 2024 Energy News issue - 1710 by Khaled Al Awadi_compress...
 
Intellectual Property Licensing Examples
Intellectual Property Licensing ExamplesIntellectual Property Licensing Examples
Intellectual Property Licensing Examples
 
Anyhr.io | Presentation HR&Recruiting agency
Anyhr.io | Presentation HR&Recruiting agencyAnyhr.io | Presentation HR&Recruiting agency
Anyhr.io | Presentation HR&Recruiting agency
 
Cracking the ‘Business Process Outsourcing’ Code Main.pptx
Cracking the ‘Business Process Outsourcing’ Code Main.pptxCracking the ‘Business Process Outsourcing’ Code Main.pptx
Cracking the ‘Business Process Outsourcing’ Code Main.pptx
 
Borderless Access - Global Panel book-unlock 2024
Borderless Access - Global Panel book-unlock 2024Borderless Access - Global Panel book-unlock 2024
Borderless Access - Global Panel book-unlock 2024
 

Corporate compliance

  • 2. HISTORY • Center for Medicare & Medicaid (CMS) paid $20,000,000,000 in error ! • Improper payment due to: CODING & BILLING ERRORS FRAUD & ABUSE • Enormous financial losses for government
  • 3. PASSAGE OF HIPAA 1996 Government $$$$ for resources to detect fraud & abuse Criminal Offense OIG strongly recommends Corporate Compliance
  • 4. HEALTHCARE FRAUD n.[<Lat. Fraus, deceit.] 1. Any scheme to obtain money or property of any healthcare benefit plan by means of false or fraudulent pretenses, representations or promises. 2. A deliberate deception practiced so as to secure unlawful gain. .
  • 5. HEALTHCARE FRAUD = A CRIMINAL OFFENSE This applies to all claims under health benefit programs Fines Prison Restitution Sanctions Corporate Probation
  • 6. CORPORATE COMPLIANCE PROGRAM • Designed to detect and prevent violations of law by employees & physicians • Offer a framework of ethical guidelines and expectations for the workplace – standards of conduct • Goal is to ensure that the employees & physicians comply with applicable laws and regulations • Essential to any organization committed to ethical conduct and sound business practices
  • 7. GOALS • Improve Quality of Care • Improve Documentation • Minimize Billing Mistakes • Increase Awareness > Decrease Risk • Reaffirm Commitment to Our Mission
  • 8. BENEFITS • Established high ethical standards • Improved financial performance • Improved quality care • Improved documentation • Early detection of potential problems
  • 9. 7 BASIC ELEMENTS OF A COMPLIANCE PROGRAM 1. Standards of conduct 2. Designated Compliance Officer 3. Effective education and training 4. Audits and other evaluation techniques 5. Internal reporting processes 6. Disciplinary mechanisms 7. Investigation and remediation
  • 10. CORPORATE COMPLIANCE: AN ONGOING PROCESS 1.Prevent 2. Detect/Correct 3. Defend/Mitigate RISK
  • 11. THE 3C DECISION MAKING MODEL Compliance: • Violation of a law, regulation or internal law or procedure Conscience: • Violation of an ethical principle Conduct: • Decide on appropriate course of action with which to resolve the situation
  • 12. Guides To Determine Appropriate Behavior • Integrity • Common Sense • Sound Judgment
  • 13. Ask Yourself These Questions… • Are my actions legal? • Is it fair and honest? • Is this in the best interest of the Center and the patients we serve? • Will my actions stand the test of time?
  • 14. • How will I feel about myself afterwards? • Will I sleep soundly tonight? • What would I tell my child to do? • How would my words and actions look if reported in the newspaper?
  • 15. Examine Your Conscience - If You Think or Hear… • “Shred that document.” • “No one will get hurt.” • “You never heard me say that.” • “It can’t hurt just this once…” • “No one will ever find out…” • “Everyone does it.”
  • 16. REPORTING A VIOLATION TSC Hotline 973 477-7217 Anyone can report a violation without fear of ANY retaliation by: Phone Verbal E-mail Written
  • 17. CORPORATE COMPLIANCE PROGRAM 1. Written Policies and Procedures 2. Quality Care and Services 3. Reporting and Communication Policy 4. Compliance with Laws and Regulations 5. Medical Records 6. Personnel 7. Safe Work Environment 8. Conflicts of Interests 9. Coding, Billing and Documentation 10.Protecting Property
  • 18. HINT HINT HINT HINT • Corporate Compliance is NOT a JCAHO requirement • Corporate Compliance is NOT just for healthcare industries • ANYONE can report a violation • Corporate Compliance Officer is Meg Oser