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The Gentiva Compliance Program

The Gentiva Compliance Program. Introduction. Corporate criminal liability Federal sentencing guidelines Compliance program protection Background Requirements Effect of program HIPPA Introduction Closing comments/questions. Corporate Criminal Liability.

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The Gentiva Compliance Program

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  1. The Gentiva Compliance Program

  2. Introduction • Corporate criminal liability • Federal sentencing guidelines • Compliance program protection • Background • Requirements • Effect of program • HIPPA Introduction • Closing comments/questions

  3. Corporate Criminal Liability • A corporation is liable for any act committed by an employee which has the actual or intended effect of benefiting the company • The act must be within the scope of the employee’s actual or apparent authority

  4. New audit approach focusing on fraud and abuse issues Operation restore trust Auditor focus: recovering funds New emphasis on closing down agencies OIG permitted to refer cases directly to DOJ FBI involvement/ health care fraud teams Health care #3 national priority Increased criminal prosecution Department of Justice/CMS

  5. Federal Sentencing Guidelines

  6. Sentencing Guidelines • Comprehensive crime control act of 1984 enacted guidelines for individuals • Proposed guidelines for sentencing organizations became law in November 1991 • Philosophy : carrot and stick approach • Just punishment • Adequate deterrence

  7. Purpose • Incentives for organizations to maintain internal mechanisms • Preventing • Detecting • Reporting criminal conduct • Standard requirements • Customized to each organization • Each step is valued towards demonstrating effectiveness of program

  8. Mitigating Factors • Compliance program • An effective compliance program to prevent and detect violations of the law, within the meaning set out in the guidelines, is the only mitigating element that can be implemented by a corporation prior to the criminal acts that give rise to prosecution

  9. Compliance Program

  10. Compliance Standards • Medicare fraud and abuse laws • Federal false claims act • Anti-kickback act • Stark I & II (III?) • Conditions of Participation • Wedge audits • Licensure • Labor/ wage and hour • Anti-trust • Etc.

  11. Program Oversight

  12. Employee Training • Compliance policies must be distributed to all employees • Mandatory compliance training: VP’s, Branch Directors, Field Staff • Additional training through in-services, flyers, memorandum, bulletins, newsletters, Gentiva University, etc. • Compliance testing • Managers training series

  13. Delegation of Authority • Monitoring of employees with respect to compliance standards • Employee screenings (in accordance with applicable laws) • Performance evaluation including adherence to compliance standards

  14. Enforcement & Discipline • Penalty matches offense • Range of sanctions • “Due process” • Self-disclosure (mitigating factor) • Management responsible for misconduct of subordinates • See progressive disciplinary policy

  15. Response & Corrective Action • Who’s involved? • What happened? • Who follows up? • Plan of action • Legal counsel? • Notify authorities • Corrective action • Preventive measures

  16. Effect of Program • Reduced risks and exposures • Reduce corporate liabilities • Enhances image with intermediaries • Public image • Increase quality • Increase profitability

  17. Compliance Circle COMPLIANCE Compliance IS Quality in ACTION PROFITABILITY TURNOVER QUALITY

  18. Closing Comments/Questions • Additional Questions • 1-631-501-7390 – Chris Anderson • Chris.Anderson@Gentiva.com

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