Healthcare Compliance and Ethics Program
Who Must Have and What is a Healthcare Compliance and Ethics Program?
Various governmental regulations and acts require that all healthcare organizations and medical practices create, implement and maintain a site-specific fraud, waste and abuse healthcare compliance and ethics program. All healthcare organizations are vulnerable to pitfalls and should have a system set in place to monitor systems and processes to ensure compliance and ethics.
In fiscal year 2019 over $3 billion was recovered by the federal government due to healthcare fraud, waste, and abuse. These pitfalls include but are not limited to patient neglect, misallocation of health resources, wrongful death, wrongful employment termination, failure to comply with health codes, and financial fraud.
A Healthcare Compliance and Ethics Program is the development and use of internal controls to monitor adherence to applicable statutes, regulations, and Centers for Medicare and Medicaid Services Program requirements.
Our Healthcare Compliance and Ethics Program
Med-Net Compliance, LLC works to educate and assist healthcare providers in meeting their obligation to establish and operate an effective fraud, waste and abuse compliance and ethics program.
We develop and implement a healthcare compliance and ethics program to help ensure the creation of a proactive, dynamic program structure to reduce the potential for fraud, waste and abuse and to put in place systems to identify and mitigate efforts to self-correct errors before the Medicare and Medicaid programs are billed.
Elements of Our Healthcare Compliance and Ethics Program
Healthcare Compliance and Ethics Officer, Compliance and Ethics Committee, and Governing Body
The Compliance Officer, with ongoing training and support from Med-Net Compliance, oversees the day-to-day management and improvement of the Compliance and Ethics Program.
Compliance and Ethics Committee.
The Compliance Committee, facilitated by Med-Net Compliance, steers the Compliance and Ethics Program.
Governing Body
The Governing Body, with counsel from the Compliance and Ethics Attorney, oversees the Compliance and Ethics Program.
Enforcement of Standards
Med-Net Compliance supports the Healthcare Compliance and Ethics Officer in appropriately counseling or disciplining covered individuals in accordance with Ethics and Healthcare Compliance and Ethics Program policies and procedures.
Training and Education
To meet regulatory requirements and continuously improve compliance outcomes.
Auditing and Monitoring.
A system for routine identification of compliance risk areas and self-evaluation of risk areas, including auditing & monitoring designed to detect criminal, civil and administrative violations.
Reporting System
Med-Net Compliance provides and operates a Hotline for all covered individuals covered by the Med-Net program to facilitate anonymous communication involving any Compliance and Ethics exposures without fear of retaliation or intimidation.
Response
Med-Net Compliance supports the Healthcare Compliance and Ethics Officer in immediately responding to Compliance and Ethics exposures.
Reassessment/Reevaluation
Med-Net Compliance assists organizations to ensure the Compliance and Ethics program identified issues are brought back into compliance.
Healthcare Compliance and Ethics Acts and Governing Authorities:
Healthcare Fraud, Waste and Abuse Acts
Patient Protection and Affordable Care Act
False Claims Acts
Anti-Kickback Statute
Stark Physician Self-Referral Law
Deficit Reduction Act of 2005
Health Insurance Portability and Accountability Act (HIPAA)
Health Information Technology for Economic and Clinical Health Act
Title VII of the Civil Rights Act of 1967 (Discrimination)
Governing Enforcement Authorities:
Healthcare Fraud, Waste & Abuse:
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- Office of Inspector General (Federal) and State Fraud Units (State)
- Recovery Audit Contractors (RAC)
- Zone Protection Integrity Contractors (ZPIC)
- Centers for Medicare & Medicaid Services (CMS)
- State Departments of Health (DOH)
- Department of Justice
Privacy and Data Security: Office of Civil Rights
Employment:
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- Equal Employment Opportunity Commission
- Departments of Labor
- Federal
- State