Page 35 - New Employee Orientation Book

WHAT IS COPORATE COMPLIANCE?
Healthcare corporate compliance refers to BMH’s ability to participate within the rules, regula tions and policies created by the government, insurance companies and payers.
WHAT IS FRAUD?
Fraud includes:
• Crimes of guile & deceit
• Material false statements or representations uttered or made to obtain some benefit to
which one is not entitled
• Violations that occur when committed for self or on behalf of another party
• Acts performed knowingly, willfully and/or intentionally
• Violations that warrant criminal, civil or administrative action
• Civil fraud, which has a lower standard of proof and penalties than criminal fraud.
WHAT IS ABUSE?
Abuse includes:
• Practices resulting, directly or indirectly, in unnecessarily increased costs • Overuse of medical services, products or both
• Medically unnecessary services or products
• Failure to conform to professionally recognized code
• Unfair or unreasonable pricing • Restrictions of patient choice • Restrictions on competition
GO THE EXTRA MILE!
What can YOU do to ensure BMH’s culture of compliance?
• Learn how your job is critical to BMH’s compliance efforts. Consider how errors on your part can put BMH at risk.
• Be willing to take extra steps concerning your compliance duties. Ask hard questions and when in doubt, double- check policies or ask your supervisor.
• Discuss and act in accordance with the concepts expressed in the BMH code of conduct.
• Actively request and seek out training and education when needed.
• Know that it is better to ask questions and raise issues than leave matters unresolved.
• When new policies and procedures arrive, take time to study them and incorporate them into your job.
COMPLIANCE
High Quality. High Compassion. 35