Create a comprehensive Plan- Healthcare Finance Fraud, Abuse and Compliance Program

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Deliverables: The final product to submit is a comprehensive Healthcare Finance Fraud, Abuse & Compliance Program that includes the following listed below. APA format but bullet points can be used

  • 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 Conduct
      • Devise at least 3 healthcare finance related fraud and compliance policies and accompanying procedures. Your policies and procedures MUST…
      • Explain legal requirements so that employees understand their obligations and how to conform their behavior to meet them
      • State your plans on how to encourage managers and employees to report suspected fraud and other improprieties without fear of retaliation
      • Should 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 Oversight
      • Note; 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 Authority
      • This task is completed, as you are the delegated person of authority that oversees the proposed healthcare finance, fraud, abuse and compliance program
    • Element Four: Educating Employees and Developing Effective Lines of Communication
      • Note; 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 processes
      • Devise 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 session
      • As 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 assistance
    • Element Five: Conducting Internal Monitoring and Auditing
      • Discuss the efforts that will be taken to ensure that the financial practices are compliant and adheres to ethical guidelines and standards
      • Outline the process of conducting internal monitoring and auditing practices
      • Design a healthcare fraud, abuse and compliance calendar template that includes the following:
        • Department
        • Regulation/Statute/Law
        • Department
        • Name of the Individual Completing the Calendar
        • Date & Signature Line
        • Actions Steps to Compliance: Steps/Description, Responsibility and Completion Date
        • Standards Section that will be evaluated (this should be included as a column): requirement, deadline/due date, responsible office/department and status
    • Element Six: Enforcing Standards Through Well-Publicized Disciplinary Guidelines
        • Develop a generic outline that addresses the following:
          • Explains who is covered
          • Standards of conduct
          • Discipline and enforcement
          • Reporting (obligations), whistleblower, non-retaliation
        • Create 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 compliance
    • Element Seven: Responding Promptly to Detected Offenses and Undertaking Corrective Action
      • Provide 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


Ethics Resource Center:

Compliance Building:

Office of the Inspector General:

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