2018 Supplemental Fraud, Waste, and Abuse and Compliance Training

Transcription

1 2018 Supplemental Fraud, Waste, and Abuse and Compliance Training Therapy Network of Puerto Rico 2018 Supplemental Fraud, Waste, and Abuse and Compliance Training 1

2 Overview This Supplemental FWA Training is being provided in conjunction with the following CMS training presentations y Combating Medicare Parts C and D Fraud, Waste, and Abuse Web-Based Training Course (January 2018) y Medicare Parts C and D General Compliance Training Web-Based Training Course (January 2018) y This supplemental training is intended to provide you with the methods for reporting Compliance, Ethics, and Fraud Waste and Abuse violations (suspected or confirmed). y You can report these violations to TNPR directly, the Federal Government, or to the affected Health Plan(s). y The methods for reporting to TNPR and the affected Health Plan(s) are contained in the remaining slides of this presentation. àà The methods for reporting to the Federal Government are contained in the CMS training presentations. Therapy Network of Puerto Rico 2018 Supplemental Fraud, Waste, and Abuse and Compliance Training 2

3 TNPR Contact Information Fraud, Waste, and Abuse Hotline (Toll-Free) You can also file an anonymous report, if you want. MAIL your report to: Marjorie Henderson Special Investigative Unit 2001 S. Andrews Avenue Fort Lauderdale, Florida FAX your report to: Attention: Marjorie Henderson (866) This is a dedicated Compliance line your report to: SIU@healthsystemone.com Therapy Network of Puerto Rico 2018 Supplemental Fraud, Waste, and Abuse and Compliance Training 3

4 Humana Contact Information Special Investigations Referral Department: (Toll-Free) MAIL your report to: Humana Special Investigative Unit (SIU) 1100 Employers Blvd Green Bay, WI Fax your report to: Attention: Humana SIU (920) Ethics Help Line: THE-KEY (Toll-Free) your report to: Therapy Network of Puerto Rico 2018 Supplemental Fraud, Waste, and Abuse and Compliance Training 4

5 MCS Contact Information How can you report FWA to MCS internally? y Any person who has suspicion or knowledge of FWA must report it. The MCS Code of Conduct emphasizes on the importance of reporting guarantees that no retaliation will be taken against those individuals who report in good faith. y Once reported, the Compliance Department, through the Special Investigations Unit, will conduct investigations to take the necessary actions, including the referral to applicable agencies. y These mechanisms are accessible for employees, contractors, delegated entities, providers, and beneficiaries. ACTRight Hotline: (Toll-Free) In Person: Special Investigative Unit (SIU)/ Compliance Department Online: MCSCompliance@medicalcardsystem.com Therapy Network of Puerto Rico 2018 Supplemental Fraud, Waste, and Abuse and Compliance Training 5

6 MCS Contact Information (continued) How can you report FWA internally? In addition to the reporting mechanisms indicated previously, you may report situations through: y Your Supervisor, Manager, Director or Vice-President; y Chief Compliance Officer: Maité Morales, Esq.; y Special Investigations Unit Director: Mrs. Elizabeth Roussel; y MCS Compliance Department; y MCS Human Resources Department; y MCS Legal Department. For any questions related to MCS, contact: Elizabeth Roussel, CAMS, CFE SIU Director x 2071 Elizabeth.Roussel@medicalcardsystem.com Therapy Network of Puerto Rico 2018 Supplemental Fraud, Waste, and Abuse and Compliance Training 6

7 MMM Contact Information Informa violaciones eticas, de cumpliento, fraude, perdida u abuso, de manera confidencial, accediendo Myra Plumey - Oficial de Cumplimiento MMM y PMC El Oficial de Cumplimiento tiene la responsabilidad total de los asuntos de cumplimiento y reporta directamente al Dr. Rick Shinto, Principal Oficial Ejecutivo (CEO) y al Lcdo. Orlando González, Presidente. Therapy Network of Puerto Rico 2018 Supplemental Fraud, Waste, and Abuse and Compliance Training 7

8 Triple S Advantage (TSA) Contact Information Ethics Point: (Toll-Free) TSA Compliance tsacompliance@ssspr.com TSA Compliance Officer: Jenny D Cárdenas JennyCar@sssadvantage.com extension 4183 Therapy Network of Puerto Rico 2018 Supplemental Fraud, Waste, and Abuse and Compliance Training 8