Questions and Answers
Ways to report a compliance issue include:
Medicare Parts C and D plan Sponsors are not required to have a compliance program.
False
At a minimum, an effective compliance program includes four core requirements.
False
Once a corrective action plan begins addressing non-compliance or Fraud, Waste, and Abuse (FWA) committed by a Sponsor's employee, ongoing monitoring of the corrective actions is not necessary.
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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.
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Standards of Conduct are the same for every Medicare Parts C and D Sponsor.
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What are some of the consequences for non-compliance, fraudulent, or unethical behavior?
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What is the policy of non-retaliation?
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Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only.
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Correcting non-compliance ______________.
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Study Notes
Reporting Compliance Issues
- Compliance issues can be reported through multiple channels: telephone hotlines, the Sponsor's website, or in-person to the compliance department or supervisor.
Compliance Program Requirements
- Medicare Parts C and D plan Sponsors are mandated to have a compliance program, making the statement that they are not required false.
- An effective compliance program does not only include four core requirements; the statement suggesting this is also false.
Follow-Up on Corrective Actions
- Ongoing monitoring of corrective actions is essential after addressing non-compliance or Fraud, Waste, and Abuse (FWA). The idea that it is unnecessary is false.
Reportable Issues to Compliance Department
- Valid issues to report include suspected Fraud, Waste, and Abuse, potential health privacy violations, and unethical behavior or employee misconduct.
Standards of Conduct
- Standards of Conduct can vary among different Medicare Parts C and D Sponsors, making the notion that they are the same for all false.
Consequences for Non-Compliance
- Consequences of non-compliance or unethical behavior may include disciplinary action, termination of employment, and exclusion from all Federal health care programs.
Non-Retaliation Policy
- The non-retaliation policy protects employees who report suspected non-compliance in good faith.
Responsibility for Compliance
- Compliance responsibility extends beyond just the Compliance Officer, Compliance Committee, and Upper Management; it involves all levels of the organization.
Importance of Correcting Non-Compliance
- Correcting non-compliance is crucial as it protects enrollees, prevents recurrence of similar issues, and promotes overall efficiency.
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Description
Test your knowledge on Medicare Parts C and D compliance requirements, reporting channels for compliance issues, and the importance of monitoring corrective actions. This quiz covers essential topics related to fraud, waste, abuse, and standards of conduct within compliance programs.
