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2950 West 84 St. Bay 7 Hialeah, Fl 33018 305.818.5940 305.827.8678 | |
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PN System.com | |
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2950 West 84 St. Bay 7 Hialeah, Fl 33018 305.818.5940 305.827.8678 | |
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TABLE OF CONTENTS Preventing Fraud and Abuse, Compliance Committee . . . . . . . . . . . . . . . . . . . . . . . . . .5 Identity Theft / Red Flag, Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Identity Theft / Red Flag, Rules Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Exhibit “A” Letter regarding Identity Theft Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Exhibit “B” FTC ID Theft Affidavit, Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 ID THEFT AFFIDAVIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 17Exhibit “C” IDENTITY ALERT FORM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Exhibit “D” Letter Regarding Identity Theft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Exhibit “E” Letter Regarding Patient Misidentification . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Exhibit “F” Checklists of Action Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 Policies and procedures Identity theft prevention and detection and Red Flags Rule compliance Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Fraud Prevention, Billing errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Strategies to Prevent Fraud and Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Examples of Fraud . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .34 Suspension of Provider Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Significant Medicare Fraud and Abuse Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37Making the Fraud Investigation Process Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38Medicare Contractor Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . .41 Acknowledgment of Receipt of description of Medicaid Fraud . . . . . . . . . . . . . . . . . .. . . .43 Patient Brochure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
This service reflects the author’s own opinions about Home Health Care services. Although the information and Policies are from sources deemed very reliable, they are not guaranteed. PN System © owner disclaims any personal liability for loss incurred as a result of the applications of any information offered in this application process, or in the use of our services. If expert, professional, medical, clinical assistance is required, the services of a component professional person should be sought. Your Director of Nursing, MUST review/approve the Policies/procedures/forms, also you and your Agency guarantee to comply with all Federal/Local/State laws to use our services.
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| PN System 2008 copyright. Contact information: 305.818.5940 |
