Why is corporate integrity important?
The answer is simple: without integrity, companies will fail, albeit probably in the medium to long-term. Corporate integrity is therefore vital to corporate success or failure and integral to the due diligence process carried out by any potential investor, acquirer or merger partner.
How long is a corporate integrity agreement?
5 years
What government agencies are involved in corporate compliance?
The U.S. Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG) is the governmental wing responsible for protecting patient privacy, ensuring quality care and combating fraud by ensuring healthcare organizations are compliant with federal healthcare laws and HHS programs.
How does someone get on the OIG exclusion list?
Mandatory exclusions are enforced by law and require the OIG to exclude an individual or entity when they are convicted for committing felony crimes — Medicare or Medicaid fraud, or other felony offenses related to state or federal health care programs; felony convictions related to controlled substances; or …
How does a corporate compliance program differ from a corporate integrity agreement?
How does a corporate compliance program differ from a corporate integrity agreement? By contrast, a corporate integrity agreement is an external document that is imposed upon the health-care entity at the direction of the government.
What is upcoding and unbundling?
Upcoding and unbundling are methods of healthcare billing fraud involving the improper application of codes for medical diagnoses and procedures. When these healthcare providers and facilities improperly code the medical services they’ve provided in order to receive higher reimbursements, they commit coding fraud.
How often does each facility compliance officer develop a compliance audit work plan?
Develop, coordinate and oversee other audit procedures for the purpose of monitoring and detecting misconduct, noncompliance or failure to follow UHS or facility policies. Develop a yearly audit work plan.
What is the OIG self disclosure protocol?
Health care providers, suppliers, or other individuals or entities subject to Civil Monetary Penalties can use the Provider Self-Disclosure Protocol, which was created in 1998, to voluntarily disclose self-discovered evidence of potential fraud.
What is corporate integrity agreement with OIG?
An integrity agreement (IA) is a document that outlines the obligations to which an individual practitioner, small group practice, or small provider agree as part of a civil settlement. Where can I find an entity’s Corporate Integrity Agreement? The OIG Web site contains copies of current CIAs and IAs.
What are the Anti-Kickback safe harbors?
Summary of Safe Harbor Regulations Thus, the regulations are known as “safe harbors.” They specify payment and business practices that are guaranteed to not be considered as kickbacks, bribes, or rebates under the Medicare and Medicaid programs.
What is prohibited by the Anti-Kickback Statute?
The federal Anti-Kickback Statute (AKS) (See 42 U.S.C. § 1320a-7b.) is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business reimbursable by federal health care programs.
Why are kickbacks illegal?
A kickback is an illegal payment intended as compensation for preferential treatment or any other type of improper services received. Paying or receiving kickbacks is a corrupt practice that interferes with an employee’s or a public official’s ability to make unbiased decisions.
What is a kickback violation?
The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of …
What is considered an illegal provider relationship?
Which of the following is considered to be an illegal provider relationship? Any person or entity who knows, or should have known, of the presentation of a false or fraudulent claim to the government for payment or approval is subject to .
What is a qui tam relator?
Definition. In a qui tam action, a private party called a relator brings an action on the government’s behalf. For example, the federal False Claims Act authorizes qui tam actions against parties who have defrauded the federal government.
What is the difference between Stark and Anti Kickback?
Important Differences Source of Prohibited Referrals: Whereas the Stark Law only pertains to referrals from physicians, the Anti-Kickback Statute applies to referrals from anyone. The Anti-Kickback Statute provides for criminal punishment in addition to civil sanctions.
Who does the Anti-Kickback Statute protect?
The AKS is a criminal law that prohibits the knowing and willful payment of “remuneration” to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).
What is Stark II law?
Stark II prohibits a physician or immediate family member who has a direct or indirect financial relationship with an entity from making referrals to that entity to provide designated health services (DHS) payable by Medicare or Medicaid, unless an exception applies.
What is the beneficiary inducement statute?
The federal Beneficiary Inducement Statute (“BIS”) prohibits an individual or entity from providing remuneration to patients who are eligible for Medicare or Medicaid benefits if that individual or entity knows (or should know) that doing so is likely to influence the patient’s decision to order or receive items or …
What are some examples of illegal beneficiary inducement?
Although often well-intentioned, offering free or discounted items or services to patients (e.g., gifts, rewards, writing off copays, free screening exams, free supplies, etc.) may violate federal and state laws governing improper inducements, especially if the patient is a federal program beneficiary.
What does it mean to be a Medicare beneficiary?
Medicare beneficiary means an individual who is entitled to benefits under medicare part A plan and enrolled under medicare part B plan or enrolled in both medicare part A and part B plan and who resides in the U.S. Medicare beneficiaries pay deductibles and 20 percent coinsurance for most services and equipment.
What is patient inducement?
Offering gifts to patients is sometimes referred to as “patient inducement.” There are limited exceptions to this general rule described below. You should avoid offering gifts or discounts to patients except in limited circumstances approved by senior leadership.
Can patients give doctors gifts?
Physicians to whom a patient offers a gift should: Be sensitive to the gift’s value relative to the patient’s or physician’s means. Physicians should decline gifts that are disproportionately or inappropriately large, or when the physician would be uncomfortable to have colleagues know the gift had been accepted.
What is the Civil Monetary Penalties Law?
The Civil Monetary Penalties Law (CMPL) authorizes the HHS to impose civil money penalties and/or exclude from the Medicare and Medicaid programs physicians who commit various forms of fraud and abuse involving Medicare and Medicaid.
How often must employers check the OIG GSA exclusion lists for current employee’s names?
The OIG recommends that Exclusion checks are performed prior to employment and on at least a monthly basis after. Individuals/entities are added and removed from the Exclusion list on a daily basis.
What is Sam watchlist?
System for Award Management (SAM) Screening IdentiFlo allows EVS clients to screen individuals and entities against the active exclusion records of those that are excluded from receiving certain federal assistance, benefits, or contracts.
What is mandatory exclusion?
• Mandatory Exclusions [42 U.S.C. § 1320a-7(a)]: Office of Inspector General (OIG) is. required to exclude the individual or entity for a minimum of 5 years for conviction of certain offenses (e.g., program-related crimes, patient abuse, felony health care fraud, or felony convictions relating to controlled substances) …