Corporate Compliance
Our Corporate Compliance Program is committed to stopping fraud, abuse and waste in the Medicaid program.
Compliance Program Fact Sheet
The Office of the Medicaid Inspector General (OMIG)
The Bureau of Compliance works to educate, assist, and assess providers of Medicaid billable services in meeting their obligation to establish and operate effective compliance programs that will prevent and/or detect and address fraud, abusive practices and waste within the Medicaid program.
What is the False Claims Act?
It is a federal and state Act that prohibits the following:
- Presenting A False Claim: any person who knowingly submits a false or fraudulent claim for reimbursement for payment or approval.
- False Record or Statement: any person who knowingly makes or uses a false record or statement to obtain payment or approval of a false or fraudulent claim.
- Working with Another To Present A False Claim: any person who works with another to get a false or fraudulent claim paid.
- Reverse False Claim: any person who knowingly makes or uses a false statement to conceal, avoid or decrease an obligation to pay or transmit money or property.
What are the Components of Mercy Haven's Compliance Program?
The Compliance Program consists of audits, policies, procedures, and guidelines with the goal of enforcing regulatory requirements; detecting and addressing compliance and ethical issues; and preventing fraud, abusive practices and waste within the Medicaid program.
The Compliance Program includes but is not limited to the following:
- A Compliance Officer who will work with the Audit and Compliance Committee.
- Policies and procedures.
- Training and education.
- Open lines of communication to the Compliance Officer (Whistle Blowing Program).
- Enforcement of disciplinary standards to encourage good faith participation in the compliance program. Any staff member whose behavior results in Medicaid fraud, abuse or waste will face disciplinary action and possible termination.
- Internal/ external audits and monitoring to routinely identify compliance risk areas.
- Response to detected deficiencies which includes self disclosures to OMIG.
- A policy of non–intimidation and non-retaliation for good faith compliance program participation.
- Review of the state and federal Exclusion lists to ensure that an employee, Board member, referral source or affiliate has not been excluded from participating in the Medicaid program.
