Staff Resources

Education on Fraud, Waste and Abuse Laws

Background

Section 6032 of the Deficit Reduction Act of 2005 requires healthcare providers like Parker Personal Care Homes, Inc. to educate employees and contractors on federal and state laws concerning the submission of false and fraudulent claims for payment to the government. These laws play a central role in the government’s efforts to prevent and detect fraud, waste and abuse in federal health care programs.

Scope

This policy applies to all directors, officers, administrators, managers, staff, employees, contractors and agents that provide billing or health care services on behalf of Parker Personal Care Homes, Inc. (PPCH). It has long been the policy of PPCH to comply with all applicable federal and state laws and regulations, including those related to the submission of claims and other documentations to state and federal health care programs. To further this policy, and to comply with Section 6032 of the Deficit Reduction Act of 2005, PPCH shall ensure that all employees, including management, along with the PPCH’s contractors and agents, are provided with information regarding the federal and state false claims statutes, and the role of such laws in preventing and detecting fraud, waste and abuse in federal health care programs.

Procedure

PPCH will educate employees, including management, and any contractors and agents that provide billing or health care services on behalf of PPCH, on the federal and state false claims statutes and the role of such laws in preventing and detecting fraud, waste and abuse in federal health care programs. The education will be accomplished by disseminating the information contained in Attachment A to this policy, which may be amended as necessary to reflect current laws. All contractors and agents that provide billing or health care services on behalf of PPCH are required to review the policy.

PPCH will ensure that 1) all employees are provided with a copy of Attachment A within 30 days of commencing employment with PPCH, 2) PPCH’s Employee Handbook, when next revised, will incorporate the information contained in Attachment A, and 3) Attachment A will be provided, via email, to all contractors and agents that provide billing health care services on behalf of PPCH. All PPCH employees are responsible for understanding this Policy and directing questions regarding this policy to appropriate management personnel.

Attachment A: Information Concerning State and Federal Laws Related To Fraud, Waste and Abuse representation of a material fact in connection with a Medicaid claim: (2) present or cause to be presented to the state department a false Medicaid claim for payment or approval; (3) present or cause to be presented any cost document required by the medical assistance program that the person knows contains a false material statement; or (4) as to services for which a license is required, make or cause to be a claim with knowledge that the individual who furnished the services was not licensed to provide such services.

Violation of the Colorado Medicaid False Claims Act are civil offenses and are punishable by significant monetary penalties.

Reporting Concerns Regarding Fraud, Abuse and False Claims

Parker Personal Care Homes, Inc. takes issues regarding false claims and fraud and abuse seriously. PPCH encourages all employees and any contractors and agents that provide billing or health care services on behalf of PPCH, to be aware of the laws regarding fraud and abuse and false claims and resolve any issues immediately. Issues are resolved fastest and most effectively when any member of the leadership team is given prompt notice. PPCH, therefore, encourages all employees and any contractors and agents that provide billing or health care services on behalf of PPCH, to report concerns to their immediate supervisor or appropriate contact. If an employee or any contractor or agent that provides billing or health care services on behalf of PPCH does not feel that PPCH has responded quickly and appropriately to the concern, then the individual with the concern is encouraged to discuss the situation with the next level of leadership or the government agency directly.

Parker Personal Care Homes. Inc’s Policies and Procedures

PPCH is committed to conducting business activities in an ethical and forthright manner and within the letter and spirit of all applicable laws and regulations. PPCH has adopted an Employee Handbook that elaborates on its commitment to ethical business practices. PPCH prohibits retaliation against employees for reporting waste, fraud and abuse or for engaging in legal activities related to False Claims Act action.

References:

Colo. Rev. Stat. §§ 25.5.303.5 through 310 (previously codified at Colo. Rev Stat. §§ 26-4-1101 et seq.)

Senate Bill 10-167 (Colo. 2010)

Civil False Claims Act, 31 U.S.C. §§ 3729-33

Deficit Reduction Act of 2005, Sections 6031, 6032 (Public Law No. 109-171)

Parker Personal Care Homes, Inc. Employee Handbook

Parker Personal Care Homes
Lakewood • Aurora • Boulder

303.424.6078
info@parkerpch.com
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