Examples of Compliance Issues include:
- Sales allegations
- Alleged Fraud, Waste, and Abuse (FWA)
- SCAN employee misconduct such as violating the plan’s Code of Conduct
- Potential quality of care or related member quality issues
- Provider network deficiencies
- Regulatory audit finding
- Inappropriate use or disclosure of member protected information
- Privacy or security breaches
What is an example of a compliance issue?
These are examples of issues that can be reported to a Compliance Department: suspected Fraud, Waste and Abuse (FWA); potential health privacy violation, and unethical behavior/employee misconduct. Click to see full answer. Considering this, what are ways to report a compliance issue?
Should you report compliance issues to the board?
Reporting to the Board is a great place to utilize benchmarks, so they can see how the company compares in terms of number of complaints, type of complaint, and other similar metrics. One common mistake when it comes to compliance issues is forgetting about foreign locations.
What are the risks of compliance?
Besides punitive fees, penalties and a sense of professional obligation, there are additional reasons to make your best effort to avoid common compliance risks, which include: Any failure to comply or outright negligence may result in further legal troubles for your business.
What do compliance departments need to know?
Likewise, a compliance department needs policies and procedures, including its process for conducting internal investigations and how it will report out results. Preparing a core set of these is number two on your to-do list.
What should be reported to compliance?
You can report a wide variety of issues, including but not limited to:Conflicts of Interest.Embezzlement or Fraud.Kickbacks.Ethical Standards Violations.Medical Billing Irregularities. Billing for services not rendered or items not provided. ... HIPAA.Patient Privacy Rights / Other Patient Rights.Policy Violations.More items...
What are ways to report a compliance issue include?
Ways to report a compliance issue include: Telephone hotlines. Report on the Sponsor's website. In-person reporting to the compliance department/supervisor....Disciplinary action.Termination of employment.Exclusion from participation in all Federal health care programs.All of the above.
What are core requirements of compliance program?
CMS requires an effective compliance program to include seven core requirements:Written Policies, Procedures, and Standards of Conduct. ... Compliance Officer, Compliance Committee, and High-Level Oversight. ... Effective Training and Education. ... Effective Lines of Communication. ... Well-Publicized Disciplinary Standards.More items...
Which policy protects an employee who in good faith report suspected non-compliance?
HIPAAL. 104–191, 110 Stat, 1936, enacted August 21, 1996, to be referred to as “HIPAA"), the following policy regarding protecting those persons who report in good faith suspected Fraud, Waste, Abuse, Non-Compliance, and/or Privacy (HIPAA) violations.
What is a compliance issue?
A Compliance Issue is a suspected violation of a law, regulation, policy, or contract requirement governing SCAN Health Plan. Examples of Compliance Issues include: Sales allegations. Alleged Fraud, Waste, and Abuse (FWA) SCAN employee misconduct such as violating the plan's Code of Conduct.
What is in a compliance report?
A compliance report is the documented evidence you must produce to auditors to prove your company is compliant with the requirements put in place by a government and regulatory agency under a particular regulation.
What are the 7 elements of compliance?
Seven Elements of an Effective Compliance ProgramImplementing Policies, Procedures, and Standards of Conduct. ... Designating a Compliance Officer and Compliance Committee. ... Training and Education. ... Effective Communication. ... Monitoring and Auditing. ... Disciplinary Guidelines. ... Detecting Offenses and Corrective Action.
What five 5 factors must a compliance plan include?
5 Essential Elements of Corporate ComplianceWith increasing regulation, the need for effective compliance has never been greater. ... Leadership. ... Risk Assessment. ... Policies and Procedures. ... Training and Communication. ... Oversight and Reporting.
What are the five steps to compliance?
We noticed that there are five basic steps every organizations has to take in account to ensure compliance.Stay on track with changing laws and regulations. Compliant is not something your organization just is. ... Involve specialists. ... Ensure employees follow procedures. ... Schedule regular internal audits. ... Use the right software.
Which of the following are possible consequences of non-compliance?
Non-compliance leaves you at risk for financial losses, security breaches, license revocations, business disruptions, poor patient care, erosion of trust, and a damaged reputation.
Who is responsible for compliance?
For larger organizations, the responsibility and oversight of compliance is typically delegated to the person serving as the organization's chief executive officer who, in turn, may delegate some of that responsibility to general counsel or a chief compliance officer.
What happens after non-compliance is detected?
After non-compliance is detected, it must be investigated immediately and corrected promptly. However, internal monitoring should continue to ensure: No recurrence of the same non-compliance; • Ongoing compliance with CMS requirements; • Efficient and effective internal controls; and • Enrollees are protected.