Compliance is a comprehensive program that helps institutions, and their employees conduct operations and activities ethically; with the highest level of integrity, and in compliance with legal and regulatory requirements.
To have an effective compliance program, an organization must establish and maintain an organizational culture that “encourages ethical conduct and a commitment to compliance with the law.” U.S. Federal Sentencing Guidelines §8B2.1(a)(2).
• Using the OIG website (https://oig.hhs.gov/) or another of your choosing, select a real-time healthcare fraud news report from your local area to feature
• Develop a 3-5 page white paper using the case as the point of application for the financial compliance process and that provides a succinct overview of the healthcare finance fraud committed applied to the chosen case.
o The potential criminal and monetary fines that can be imposed on the individual and/or organization from the case.
o Explain what financial compliance processes could have prevented the occurrence of this case.
o What loopholes in the applicable law or the system the perpetrators used to commit the fraud.
REVIEW:
● Office of Inspector General – Compliance: https://www.oig.hhs.gov/fraud/docs/safeharborregulations/safefs.htm
● Compliance Program Policy and Guidance: https://www.cms.gov/Medicare/Compliance-and-Audits/Part-C-and-Part-D-Compliance-and-Audits/ComplianceProgramPolicyandGuidance.html
