Compliance Training

INSTRUCTIONS: Take notes with a pen and paper to help you retain information. There will be mandatory questions asked on each section. This module should take no longer than an hour. However, you are not being timed so please feel free to pause as needed to rewatch videos. If you have questions after this training, your direct supervisor will be more than happy to assist you further.

What is fraud, waste, and abuse?

Fraud is defined as the wrongful or criminal deception intended to result in financial or personal gain. Fraud includes false representation of fact, making false statements, or concealment of information.

Waste is defined as the thoughtless or careless expenditure, mismanagement, or abuse of resources to the detriment (or potential detriment) of the U.S. government. Waste also includes incurring unnecessary costs resulting from inefficient or ineffective practices, systems, or controls.

Abuse is defined as excessive or improper use of a thing, or to use something in a manner contrary to the natural or legal rules for its use. Abuse can occur in financial or non-financial settings.

 

Some examples of Fraud, Waste, and Abuse in the home care setting are:

• submitting claims for services that were never performed
• submitting claims for an expensive service when a less expensive one was actually performed
• submitting duplicate claims payments
• billing for services that are not medically necessary

 

Why do we need compliance training?

Compliance training is essential because billions of dollars are improperly spent each year due to fraud, waste, and abuse (FWA). Medicaid requires it, and as employees—whether providers or administrative staff—we are all responsible for combating FWA. It is important to understand that every action we take can potentially impact the Medicaid program. Compliance training teaches us how to detect, correct, and prevent FWA, ensuring that we contribute to being part of the solution. 

Scenario 1: Cash payments are made to a supervisor at a nearby hospital for patient referrals.

Scenario 2: A social worker approaches a marketer and says, "Hey, I often meet people who need home care services. For $500/month, I'll refer them all to you."

Home care agencies receive referrals all the time that are perfectly legal. Referrals become problematic and potentially illegal when an employee receives them in exchange for kickbacks or financial gain to the referral source or to the patient themselves.

Scenario #1: Clocking Out

A patient calls her coordinator to complain that her aide is constantly leaving early. When the coordinator checks the schedule, she sees that the caregiver clocks out at the right time everyday. When asked about this, the patient says, "Oh yes, I clock her out every day from my phone because I don't want her to lose money just because she left early." 

Scenario #2: Billing Errors

A coordinator reaches out to a caregiver to discuss next day’s scheduling, and the caregiver mentions that the patient just left and she is finishing up cleaning the patient’s home. The coordinator asks whether the caregiver clocked out when the patient left, and the caregiver says no, she will clock out when she finishes cleaning, since that is one of the tasks on the patient’s plan of care.

Anti-Kickback Violation

A client approaches the Adult Day Care administrator and says:

“A competing Adult Day Care center told me they would give me $100 and let me stay home if I switch over to their program. Can you match that offer?”

The client is asking whether your ADC can also provide money or incentives in exchange for transferring to your program.

Explanation:

Offering money, gifts, or any item of value to persuade a client to join or switch services is considered an illegal inducement under federal and state anti-kickback laws.

Even if the resident is simply reporting the offer, the activity itself is an example of fraudulent and unlawful inducement.

There are exceptions to anti-kickback laws called “safe harbors.” The safe harbor regulations describe various payment and business practices that, although they potentially implicate the anti-kickback statute, are not treated as offenses under the statute. For example, a bona-fide employee may be paid to act as a marketer for a home care agency.

Explanation:

The Anti-Kickback Statute (AKS) prohibits offering, paying, soliciting, or receiving any form of remuneration to induce referrals or generate business reimbursable by federal healthcare programs. 

Remember: Any short term benefit you think you gain by engaging in improper referral relationships will be offset by the significant civil and criminal penalties that attach to this misconduct.

If you believe that there may be a violation of the anti-kickback statute, talk to your compliance officer about the arrangement. They can help you to determine if it is a violation of the law and whether any safe harbors may apply.

Conflict of interest:

Definition: A conflict of interest in a home care setting is when a caregiver’s or staff member’s personal or financial interests could influence—or appear to influence—their ability to provide objective, client-centered care. This includes situations where personal gain, gifts, relationships, or outside work could affect professional judgment or the quality of care provided.

 

Scenario Example:

A company needs a vendor to process payments. The employee responsible for selecting the vendor has a brother who offers the same service but charges twice as much as comparable vendors. The employee prefers choosing his brother because his brother’s business is struggling.

Anti-Trust Laws: All employees, officers and directors must comply with applicable anti-trust and similar laws that regulate competition where we operate.

Examples of conduct prohibited by such laws include the following:

· Agreements to fix prices, bid rigging, and market allocation and collusion, including price sharing with competitors.

· Agreements with competitors or other companies with whom the Company contracts to fix employee wages.

· “No-poaching” agreements between the Company and competitors or between the Company and other companies with whom the Company contracts.

· Boycotts, certain exclusive dealing arrangements, and price discrimination agreements.

· Unfair trade practices including bribery, misappropriation of trade secrets, deception, intimidation, and similar unfair practices.  

I received a copy of the Compliance Manual and Code of Conduct for Honor Health Network.

I attest that I completed training on the following topics and fully understand my obligations with regards to:

Compliance – I will adhere to the compliance requirements set forth by the Company and by applicable law, and will comply with the Company’s Code of Conduct.

Anti-Kickback Statute – I will not do anything to violate the Anti-Kickback Statute, a law prohibiting financial payments or incentives for referring patients or generating federal healthcare business.

False Claims Act – I understand my obligations under the False Claims Act, a law that imposes liability on people and companies who defraud the federal government.

Fraud, Waste, and Abuse – I have been trained on the meaning and requirements of fraud, waste, and abuse laws, and will strictly adhere to the guidance set forth by the Company and applicable law.

Anti-Trust Laws – I will not engage in any activity that unreasonably restrains trade, promotes monopolization, or restricts employee movement, such as no-poach agreements, price/wage fixing and anti-competitive information sharing.

 

The Company has a strict policy of non-intimidation and non-retaliation. There will be no retaliatory actions or threats of such actions leveled against any person who reports in good faith to the Company or any government official or agency. Retaliation or any form of reprisal based upon a person’s good faith reporting of actual or potential violation of applicable laws, rules, regulations, or the Code of Conduct is strictly prohibited and will not be permitted or tolerated by the Company.

If you suspect fraud or any other compliance issue in the workplace, you can report in the following ways:

Call the compliance hotline - (718)-344-9170

Email Chief Compliance Officer Tova Bernbaum  - tbernbaum@honorhealthnetwork.com

Fill out a complaint form on the company website: https://honorhealthnetwork.com/make-a-confidential-report/ 

 

You can report this anonymously if you choose.