Waste, Fraud & Abuse Training

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Multnomah County Health Dept.

Review of regulations for avoiding and reporting waste, fraud and abuse of public healthcare funds.

Health & Medicine

ICS.01.39, Waste, Fraud & Abuse Training This module will present education concerning False Claims Liability, Anti-retaliation Protections as well as detecting and responding to Fraud, Waste and Abuse. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Deficit Reduction Act (DRA) ,[object Object],[object Object],[object Object],[object Object],The DRA indirectly mandates a compliance program which requires that staff must be informed about the False Claims Act, Administrative remedies under the Act, relevant State Laws and Whistleblowers’ protection.

False Claims Act (FCA) ,[object Object],[object Object],[object Object],[object Object],The full text of the False Claims Statutes is located at: http://www.oregon.gov/DHS/healthplan/tools_prov/dra-guide0608.pdf

Some Examples of Healthcare Fraud ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Policies & Procedures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Education on the Fraud and Abuse Program ,[object Object],[object Object],[object Object],[object Object]

The Reporting Process ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Non-Retaliation ,[object Object],Retaliation directed at reporters of fraud, waste and abuse is unlawful; see ORS 659A.203 – http://www.leg.state.or.us/ors/659a.html

This completes the Fraud, Waste & Abuse Training Module ,[object Object],[object Object],[object Object],[object Object]

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1 8 Compliance Policies Name Course Professor Date Compliance Policies In the previous project, two compliance plans were developed and a job description developed for safety and compliance manager. However, strength for any compliance programs depends on compliance policy and procedurals which outlines applicable laws, regulations and standards that should be followed to implement developed plans. Compliance policies should be clear and simple to eliminate confusion or difficulties which may be experienced by implementers of compliance plans. Considering there are two compliance plans, to enhance clarity on the developed compliance, each compliance plan would be considered individually constituting two sections for two compliance policies under each compliance plan. Compliance Plan For Covid protocols The impact of Covid-19 has been felt in all sectors of economies and health sectors is not exceptional. Even though numerous professionals have been affected by the virus, significant healthcare providers have succumbed to the virus on the line of the duty. According to a study conducted that assess the impact of Covid-19 on the health sector, as of April 2020, countries that reported the significant number of healthcare providers that had succumbed to the virus are Italy with 44%, Iran with 15%, Philippines with 8%, Indonesia with 6%, and China, Spain, U.S each with 4% (Iyengar et al…,2020). Healthcare providers are the first line of defense at high risk of infection because they constantly engage and interact with Covid protocols. Given there is no cure for the virus, hospitals are implementing prevention measures to contain the spread of the virus, protect clients and also its staff. However, it has been noticed that staff members have been violating Covid protocols such as washing hands between patients necessitating the development of a Compliance plan for COVID. In the following two sections, compliance policies for the compliance plan for COVID are outlined. Section 1: Compliance Standards for COVID Protocols Healthcare providers should comply with standard precaution practices when treating patients regardless of the nature of diagnosis (Beyamo, Dodicho & Facha, 2019). In the healthcare facility, healthcare workers are at high risk of infection. Covid-19 is an infectious disease which means healthcare workers are at high risk of being exposed to the virus. For example, it is reported that more than 570,000 healthcare personnel had been infected with the virus in America (PAHO, 2020). This underscores need to take standard precaution which constitutes of policies which aimed at reducing the risk of transmitting infection in the healthcare (facility Beyamo et al…, 2019). Standard precautions are not selective to particular diseases because medical personal handles clients with a variety of infections. To minimize the spread of Covid in the healthcare facility, standard precaution policies entail hand hygiene which requ ...

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