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MANDATORY COMPLIANCE ELEMENTS


MPC provides organization compliance elements that many healthcare providers don’t usually even know are required.

For example, third party Medicare Advantage contractors require in-network providers to deliver training to all employees on Fraud and Abuse topics, perform regular exclusion database checks for all employees (for both OIG and SAM federal databases), and give all employees access to an anonymous reporting tool for reporting suspected fraud and abuse.

DATABASE CHECKS

There’s a new reason to ensure your compliance program is performing monthly employee database checks. Government auditors are devoting greater attention to providers who bill for services provided by individuals who have been excluded from Medicare or Medicaid.

Under federal law, your practice is prohibited from billing the government programs “for any item or service furnished by an excluded individual or entity, or at the medical direction or on the prescription of a physician” when the agency knew, or had reason to know, of the exclusion.
 
Moreover, the HHS Office of Inspector General (OIG) and many state Medicaid programs expect you to screen their respective databases for excluded individuals on a monthly basis using www.sam.gov and www.exclusions.oig.hhs.gov.
 
MPC automates this process to help reduce the risk of unknowingly employing excluded individuals.
 
Automatically, without having to remember to regularly do it, MPC checks all employees against the federal OIG and SAM databases, provides the resulting “match” reports to the MPC administrator, and makes a record of each check for each employee in your ECR®. If ever requested to demonstrate your organization’s compliance with exclusions database checks for employees, the record of each check is readily available in your ECR®.
 
As well, for potential new hires, MPC offers an ad hoc database check so you can run a “match” report on those you are considering as new employees.
 

EMPLOYEE HOTLINE

MPC provides each Client with a unique, five-digit Client ID and access to a toll-free hotline (855-MED-PRO5). Employees can call the Hotline 24 hours a day, enter the Client ID, and anonymously record a concern. The audio is automatically forwarded to the MPC administrator for review.

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