Policy Manual sample

MDT Home Health Care Agency, Inc. · Attempt to transfer patient to another agency/program without authorization from him/family/agency/physician The report may be anonymous by mail, in the concern clipboard in the Front desk of the Agency, by phone. The Agency will investigate the report, take the necessary measures without any consequence for the reporting person. Partnership to Prevent Fraud and Abuse The effort to prevent and detect fraud is a cooperative one that involves: · Centers for Medicare & Medicaid Services; · Beneficiaries; · Contractors; · Physicians, suppliers, and other providers; · Quality Improvement Organizations (QIOs); and · State and federal law regulatory/enforcement agencies such as the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS), the Federal Bureau of Investigation (FBI), and the Department of Justice (DOJ), AHCA. To report suspect or fraud our patients/staff can call to our Agency, AHCA (1-888 419 3456), or Florida State Attorney General 1 866 966 7226. What Constitutes Fraud Fraud occurs when an individual intentionally deceives or misrepresents the truth, knowing that it could result in some result in some unauthorized benefit to himself or herself or some other individual. The violator may be : · a physician or other practitioner; · a hospital or other institutional provider; · a clinical laboratory or other supplier; · an employee of any provider; · a billing service; · a beneficiary; · a Medicare Contractor employee; or · any individual in a position to file a claim for Medicare benefits. Fraud schemes range from those perpetrated by individuals acting alone to broad-based activities by institutions or groups of individuals. Sometimes these activities employ sophisticated telemarketing and other promotional techniques to lure consumers into serving as the unwitting tools in the schemes. Seldom do perpetrators target only one insurer or the public or private sector exclusively. Rather, most are simultaneously defrauding several private and public sector victims, including Medicare. Home Health Agency Policies A-140