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

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:

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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