2012 Compliance: Fraud, Waste and Abuse (training - Ubhonline.com
2012 Compliance: Fraud, Waste and Abuse (training - Ubhonline.com
2012 Compliance: Fraud, Waste and Abuse (training - Ubhonline.com
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Seven Elements of an Effective <strong>Compliance</strong> Program<br />
• Federal law requires Medicare Advantage <strong>and</strong> Part D plan sponsors to<br />
implement <strong>and</strong> maintain an effective <strong>com</strong>pliance program that<br />
incorporates measures to detect, prevent, <strong>and</strong> correct fraud, waste, <strong>and</strong><br />
abuse.<br />
• The Health & Human Services (HHS) Office of Inspector General (OIG) has<br />
identified seven core elements of a <strong>com</strong>pliance program:<br />
1. Written St<strong>and</strong>ards of Conduct – An organization’s Code of Conduct,<br />
policies, procedures <strong>and</strong> other written operating guidelines.<br />
2. High Level Oversight – designate a leader(s), including an established<br />
<strong>com</strong>pliance <strong>com</strong>mittee, responsible for implementing <strong>and</strong> monitoring the<br />
<strong>com</strong>pliance program.<br />
3. Effective Training <strong>and</strong> Education – develop <strong>and</strong> implement regular<br />
<strong>and</strong> effective <strong>training</strong> programs, such as this one.<br />
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.<br />
10
Change language