Fraud Waste and Abuse Company Training.

Slides:



Advertisements
Similar presentations
The Deficit Reduction Act, Deficit Reduction Act of 2005 In the Deficit Reduction Act of 2005 (DRA) Congress, for the first time, has mandated healthcare.
Advertisements

Our Goals Today To help you feel comfortable with asking questions.
Hill Country CMHMR Center FRAUD & ABUSE Training August 2008.
Fraud, Waste, and Abuse (FWA) Training Program for First Tier, Downstream, and Related Entities UPDATED 4/19/2011.
HIPAA Privacy Rule Training
WHAT IS HIPAA? The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides certain protections for any of your health information.
Corporate Compliance Instructor Notes:
MARKETPLACE FRAUD How the Assistance Network can Prevent, Detect, and Report suspected fraud.
INTRODUCTION o DISCUSS ADOPTION OF FRAUD AND THEFT POLICY o ASSIGNS RESPONSIBILITY FOR REPORTING FRAUD AND THEFT o PROVIDES GUIDELINES FOR INVESTIGATIONS.
BlueCare Tennessee and BlueCare, Independent Licensees of BlueCross BlueShield Association How the Deficit Reduction Act of 2005 Impacts BlueCare Tennessee.
Statement of Ethical Conduct Our Commitment To Integrity And Ethical Conduct 1.
FRAUD DETERRENCE Core Orientation/Core Annual Refresher The following presentation is intended for SCS employees. This presentation will provide a broader.
False Claims Act & Whistleblower Protection. False Claims Act The False Claims Act (FCA) was established in 1863 by President, Abraham Lincoln, to curb.
2010 Region II Conference Corporate Compliance Panel June 3, 2010
Sales & Marketing Compliance Training
Medicare Parts C and D Fraud, Waste, and Abuse Compliance Training
Regulatory Control of Providers Financial Relationships Civil False Claims The Act.
Internal Controls, Fraud and Abuse Awareness presented by South Texas College Business Office Financial Information Services Connecting And Leading.
INTEGRATED CARE ALLIANCE, LLC CORPORATE COMPLIANCE TRAINING DEBRA SCHUCHERT, COMPLIANCE OFFICER.
Fiscal Compliance for Department Heads & Directors Daniel Adams Audit Services.
Fraud, Waste & Abuse DEFICIT REDUCTION ACT OF 2005 Presented by: MARCH Vision Care, 2013.
Program Integrity. The Cost of Fraud, Waste, and Abuse Between July 2012 and January 2013, the North Carolina Division of Medical Assistance collected.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved. 1 McGraw-Hill Chapter 5 HIPAA Enforcement HIPAA for Allied Health Careers.
Copyright© 2011 WeComply, Inc. All rights reserved. 9/6/2015 Whistleblowing.
COMPLIANCE PROGRAM. Agenda  Initial Scenarios  Review of General Compliance Information  Review UCP’s Compliance Program  Questions and Discussion.
Blue Cross of Idaho Medicare Advantage Provider Fraud, Waste and Abuse Training Fall 2009.
Legislation Concerning Disability Employment in Thailand National Office for Empowerment of Persons with Disabilities (NEP.), Ministry of Social Development.
AREF Whistleblower Training AREF Employees January 2009.
Compliance and Ethics Training Overview
Fraud and Abuse in Dentistry. Definition Fraud is the intentional perversion of truth in order to induce another to part with something of value, or surrender.
Corporate Ethics Plan Employee Annual Training. Purpose of the Ethics Plan EMR, acting through its employees, is obligated to comply with federal, state.
Chapter 7 Blowing the Whistle Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent.
SMJ Life Health Annuities/Secure Benefits Alliance 2012.
Welcome….!!! CORPORATE COMPLIANCE PROGRAM Presented by The Office of Corporate Integrity 1.
Welcome General Compliance Training.  To inform you who to contact to ask questions  To let you know that you are responsible to disclose  To share.
Flowers Hospital General Compliance Training-Students 2013.
Jeff Davis County Schools Fraud, Waste, and Abuse Procedures REVISED 7/31/2014.
jasa.org Board of Directors Presentation & Training February 24 th, 2016 Corporate Compliance Program.
Miners Rights Rights & Responsibilities Under the Mine Safety & Health Act of 1977 NC DOL Mine & Quarry Bureau Mine Safety & Health Training Revised 2010.
Fraud Awareness Audit, Business & Technology Committee September 23, 2004.
Ann Williams Investigator Eastern District of Texas.
FRAUD, WASTE & ABUSE WHAT YOU NEED TO KNOW STCHCN – 12/7/2015.
Sub-recipient Monitoring and Contractor Determination
HIPAA Privacy Rule Training
South Texas College Fraud Awareness and Fraud Surveys
We are dedicated to A Healthy Georgia.
GSIL Long Term Support Medicaid Fraud Update Debbie Krider, GSIL COO and Compliance Officer January 17,2017 I wish I did not have to talk to you about.
South Texas College Fraud Awareness and Fraud Surveys
South Texas College Fraud Awareness and Internal Controls
FRAUD, WASTE, ABUSE AND CORRUPTION PROCEDURE
Corporate Responsibility
Chapter 7 Blowing the Whistle.
Chief Compliance Officer
What is HIPAA? HIPAA stands for “Health Insurance Portability & Accountability Act” It was an Act of Congress passed into law in HEALTH INSURANCE.
FRAUD, WASTE, & ABUSE (FWA) 2012
DEVELOPMENTAL SERVICES INC
Refuah Community Health Collaborative (RCHC) PPS
Compliance Program 2018.
Code of Conduct/ Fraud, Waste & Abuse
Disability Services Agencies Briefing On HIPAA
What Every Employee Should Know About Compliance.
LifeBridge Health Sinai Hospital Orientation.
Northern Michigan Regional Entity Region 2
COMPLIANCE PROGRAM.
Fraud & Abuse Prevention
Connections Abuse Prevention Plan 2018.
Annual Compliance Training
Fraud, Waste & Abuse (FWA) Education Related to Sales Activities
Corporate Compliance Board Training 2018
Office of the Inspector General
Presentation transcript:

Fraud Waste and Abuse Company Training

DEFINITIONS Fraud means an intentional deception or misrepresentation knowingly made in order to obtain unauthorized benefit. Waste means thoughtless or careless expenditure, consumption, mismanagement, or squandering of resources owned and operated by an entity. Abuse means actions that are inconsistent with sound fiscal business and that could or do result in an unnecessary cost associated with and/or charged to contractors for unauthorized or unnecessary services. Claim means any request or demand for money that is submitted to the government or its contractors. Knowingly means that a person or organization: has actual knowledge that the information is false, acts in deliberate ignorance as to the truth or falsity of the information, or acts in reckless disregard of the truth or falsity of the information. Fraud means an intentional deception or misrepresentation knowingly made in order to obtain unauthorized benefit. This includes any act that constitutes fraud under applicable Federal or State laws.

Purpose and Background The False Claims Act (FCA) makes it a crime for any person or organization to knowingly make a false record or file a false claim with the government for payment. Skils’kin as contractor, if involved in an FCA claim, may be excluded from participating in federal contract programs, and facing criminal prosecution. Federal and state laws protect those individuals who report fraud to the government. Skils’kin is committed to complying with all applicable Federal and State standards regarding fraud, waste, and abuse. A violation of the FCA may result in penalties of up to three times the value of each false claim, plus $11,000 per claim filed. Federal law also imposes civil penalties of up to $5000 per claim and twice the value of the claim when a person supports the claim with a false statement or omission of a material statement. Washington State has similar legislation found in the Health Care False Claim Act (Revised Code of Washington (RCW) 48.80), and the Medicaid Fraud False Claims Act (Revised Code of Washington (RCW) 74.66). Like the federal laws, the RCW penalizes false claims as well as false records or statements material to the false claim with civil fines between $5-11,000 plus triple the damages incurred. Skils’kin as contractor, if involved in an FCA claim, may be required to enter into a Corporate Integrity Agreement with the government. FCA claims may result in being excluded from participating in federal contract programs, and facing criminal prosecution Under both federal and state law, an individual may initiate a lawsuit under the FCA on behalf of the government. If the government recovers money based on that lawsuit, the whistleblower may receive a portion of the recovered dollars. Federal and state laws protect those individuals who report fraud to the government. In the case of employees, employers may not retaliate against an employee who raises concerns or reports fraud to the government. If a court finds that an employer has retaliated, the court can order the employer to make the employee whole or even rehire the employee, and to pay the employee two times the amount of back pay plus interest and legal fees. Skils’kin is committed to complying with all applicable Federal and State standards regarding fraud, waste, and abuse. This includes whistleblower provisions. This policy provides information regarding the laws prohibiting false claims for reimbursement from federal and local government organizations. Additionally, this policy sets forth expectations of employees in regards to ethical business practices and prudent use of company resources to reduce waste. The Board of Directors and all employees of Skils’kin will make every effort to ensure that no fraud, waste, or abuse occurs. All Skils’kin employees who interact with our customers and partner organizations must be alert to the fact that many organizations and agencies that Skils’kin conducts business with have internal policies that regulate fraud, waste, and abuse including accepting of gifts. It is incumbent that Skils’kin employees are sensitive to this fact in order to ensure full compliance with other organizations or agencies internal policies.

Purpose and Background Fraud, waste, and abuse run counter to Skils’kin’s values. Fulfilling Skils’kin’s mission and vision requires trust. Therefore, it’s important that the organization, discourage, guard against, report, and take corrective action as necessary concerning fraud, waste and abuse. Employees are expected to report to Skils’kin any concerns about all suspected forms of fraud, waste, and abuse, or any other issue they feel is illegal, unethical, or otherwise inappropriate. Fraud means an intentional deception or misrepresentation knowingly made in order to obtain unauthorized benefit. This includes any act that constitutes fraud under applicable Federal or State laws.

Examples A business under-reporting its worker hours. Billing for services not performed. An injured worker collecting time-loss compensation benefits while working at another site. Forgery or alteration of documents (checks, contracts, purchase orders, etc…) Misrepresentation of information on documents (employment history, time sheets, leave records, etc…) Theft, unauthorized removal, or willful destruction of records. Misappropriation of funds, equipment, supplies, or any other asset. Improprieties in the handling and reporting of financial transactions. Are there other examples you can think of? People who commit fraud don’t fit a single profile. Opportunity + Motivation = Fraud

How to Report You may go to your manager directly. You may contact our Corporate Compliance Officer, Gayle Lawrence: glawrence@skils-kin.org | (509) 326-6760 x 2300 You may contact our President / CEO, Brian Behler: bbehler@skils-kin.org | 509-326-6760. You may contact our Board President by email at SkilskinBoardofDirectors@gmail.com Any of the above can be contacted by US Mail at: 4004 East Boone Ave, Spokane, WA 99202-4509 You may contact the Department of Defense, Office of Inspector General Hotline to report suspected fraud, waste, and abuse regarding a Service Contract Agreement at 1-800- 424-9098 (Toll-Free). Are there other examples you can think of? People who commit fraud don’t fit a single profile. Opportunity + Motivation = Fraud

How to Report For reports involving SourceAmerica employees may contact them directly: You may report anonymously When reporting, please include: Reason you believe a violation has occurred When and how the conduct occurred or is occurring Information regarding the specific nature of the incident and/or conduct Name of individual and/or group you suspect of committing the violation Date the situation occurred Other information you may have to help with the investigation or understanding of the situation Are there other examples you can think of? People who commit fraud don’t fit a single profile. Opportunity + Motivation = Fraud Skils’kin encourages persons making anonymous reports to maintain contact with the CCO, so that the CCO may obtain any additional information needed to properly investigate the report.

Final Thoughts Skils’kin will take reasonable steps to maintain confidentiality of the identity of any person providing information to Skils’kin to the fullest extent possible. Due to Skils’kin obligations to investigate, report certain issues to state and/or federal authorities, and take appropriate action to correct violations or misconduct, Skils’kin cannot guarantee complete confidentiality of the identity of persons who make reports. Additionally, Skils’kin cannot make promises regarding a person’s liability or what steps Skils’kin may take in response to the report. Are there other examples you can think of? People who commit fraud don’t fit a single profile. Opportunity + Motivation = Fraud Skils’kin encourages persons making anonymous reports to maintain contact with the CCO, so that the CCO may obtain any additional information needed to properly investigate the report.

Questions? Are there other examples you can think of? People who commit fraud don’t fit a single profile. Opportunity + Motivation = Fraud Skils’kin encourages persons making anonymous reports to maintain contact with the CCO, so that the CCO may obtain any additional information needed to properly investigate the report.