Developing a Healthcare Finance Fraud, Abuse & Compliance Program Assignment

NLM 570 Duke University Nongovernmental Organizations Discussion
September 9, 2021
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September 9, 2021
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Developing a Healthcare Finance Fraud, Abuse & Compliance Program Assignment

Adopting MedPro Group, Seven Fundamental Steps of a Compliance Plan, create a comprehensive plan that aligns with the following seven steps:Element One: Implementing Written Policies, Procedures, and Standards of ConductDevise at least 3 healthcare finance related fraud and compliance policies and accompanying procedures. Your policies and proceduresMUST…Explain legal requirements so that employees understand their obligations and how to conform their behavior to meet themState your plans on how to encourage managers and employees to report suspected fraud and other improprieties without fear of retaliationShould be made easily available (identify in a written statement where and/or how one can access the above policies and procedure)Element Two: Designating a Compliance Officer and Compliance Committee to Provide Program OversightNote; this task was completed with your initial hiring as the new CFO. However, you are to develop a 1-2 page job description in order to seek a compliance officer that will report directly to you.Develop the proposed overview of the Compliance Committee that will be chaired by the above compliance officer. Identify the proposed frequency of meetings (simple schedule over a calendar year) (the committee is expected to meet monthly), the preferred number of committee members and the various departments/areas that each member will represent, identify at least six purposes/responsibilities that the committee is expected to carry out and outline the proposed method of communication (during the scheduled monthly meetings and outside of scheduled meetings)Element Three: Using Due Diligence in the Delegation of AuthorityThis task is completed, as you are the delegated person of authority that oversees the proposed healthcare finance, fraud, abuse and compliance programElement Four: Educating Employees and Developing Effective Lines of CommunicationNote; this task was partially completed with the above Power Point presentation; however let’s prepare take your work to the next level…Develop clear and practical steps that will be taken in order to  disseminate information about the organization’s compliance program and its policies and processesDevise a training schedule (identify the frequency of the conducted training’s, identify who will be required to attend) along with an assessment to monitor the effectiveness of the training session. Draft a one-page agenda that outline the proposed topics of discussion that will be covered in the training sessionAs a continuation of Element One, discuss how employees can report suspected fraud. For example, you may establish an anonymous reporting contact number or electronic email reporting system. Draft a generic automated response that an individual will receive after submitting a report. This will include a thank you line as a confirmation. The estimated time for a response and a person or number to contact for further assistanceElement Five: Conducting Internal Monitoring and AuditingDiscuss the efforts that will be taken to ensure that the financial practices are compliant and adheres to ethical guidelines and standardsOutline the process of conducting internal monitoring and auditing practicesDesign a healthcare fraud, abuse and compliance calendar template that includes the following:DepartmentRegulation/Statute/LawDepartmentName of the Individual Completing the CalendarDate & Signature LineActions Steps to Compliance: Steps/Description, Responsibility and Completion DateStandards Section that will be evaluated (this should be included as a column): requirement, deadline/due date, responsible office/department and statusElement Six: Enforcing Standards Through Well-Publicized Disciplinary GuidelinesDevelop a generic outline that addresses the following:Explains who is coveredStandards of conductDiscipline and enforcementReporting (obligations), whistleblower, non-retaliationCreate a five (5) Q&A handout for the intent of distributing to employees. Devise questions and answers that are appropriate to healthcare finance, fraud, abuse and complianceElement Seven: Responding Promptly to Detected Offenses and Undertaking Corrective ActionProvide a generic response in terms of responding to detected offenses. Create a four (4) step corrective action approach that aligns with your Human Resource (HR) guidelines and standards as it relates to employee disciplinary actions


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