What do we mean by Compliance?
Knowing and following Einstein policies and procedures, as well as any state and federal rules and regulations for:
- Patient Privacy
- Documenting and Billing for services
The Federal government pays 40% of all healthcare costs. They pay 100% of Medicare costs and 50% of Medicaid. Estimates are that the government can save $100 billion dollars if it can stop “cheating” in healthcare.
What is Einstein’s responsibility?
The government has asked the healthcare industry to police itself and to institute voluntary and mandatory programs. What is the government focusing on? They seek to prevent payment for such things as:
- Services patient didn’t receive
- Services that weren’t properly ordered
- Unnecessary services
- Unnecessary admission of a patient to the hospital
- Unnecessary medical procedures
- Substandard care
- Excessive charges
- Poor and incomplete medical records
- False billing
There are consequences for not complying with government regulations. They include:
- Jeopardizing patient care
- Civil and criminal fines
- Loss of licensure
- Exclusion from federal programs
- Loss of accreditation
Einstein’s Voluntary Compliance Program
Einstein’s voluntary compliance program is called “Do the Right Thing.” It’s elements include:
- Code of conduct
- Compliance officer
- Training programs
- Anonymous hotline phone number
- Audit program
- Correction of identified problems
- Voluntary repayment (if necessary)
What’s YOUR role in the compliance program?
- Comply with all laws, regulations, rules and policies.
- Keep patient information confidential and comply with Information Services security rules.
- You are OBLIGATED to expose unethical behavior if you are aware of or suspect it. Retaliation is prohibited. Your supervisor cannot retaliate against you for reporting a violation.
You are expected to contact:
- Your supervisor, manager or administrator
- The Residency Program
- Information Security Office (215) 456-3517
- Compliance Office (215) 456-7084
- Office of General Counsel (215) 456-6397
- Joint Commission (as a last resort) 800-994-6610
Our anonymous Comply line number is: