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Prohibits a physician from making referrals for certain designated health services (DHS)
payable by Medicare to an entity with which he or she (or an immediate family member) has
a financial relationship (ownership, investment, or compensation), unless an exception
applies.
Prohibits the entity from presenting or causing to be presented claims to Medicare (or billing
another individual, entity, or third party payer) for those referred services.
Establishes a number of specific exceptions and grants the Secretary the authority to create
regulatory exceptions for financial relationships that do not pose a risk of program or patient
abuse.
Medicare Exclusion List
A searchable, online database of individuals who have been barred from receiving payments
for services to Medicare and Medicaid patients
Corporate Integrity Agreement
An agreement that a health care provider or health plan reaches with the OIG of the DHHS as
part of a settlement agreement when allegations of improper reimbursement have been made.
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Q9D6f8bfJ5nKnu /69180600/pozga
Legally Speaking
My philosophical and analytical take on various ethical topics.
https://www.nhcaa.org/resources/health-care-anti-fraud-
resources/the-challenge-of-health-care-fraud.aspx
http://www.cnn.com/2015/07/10/us/michigan-cancer-
doctor-sentenced/
https://www.fbi.gov/about-
us/investigate/white_collar/health-care-fraud
Posted by George Biko at 6:28 PM
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1. Small Business»
2. Business & Workplace Regulations»
3. Workplace Safety»
The cautious handling of workplace ethics issues can resolve personal and business dilemmas.
Related Articles
1. Develop a workplace policy based on your company’s philosophy, mission statement and code of conduct. Incorporate the
policy into your performance management program to hold employees accountable for their actions and alert them to their
responsibilities to uphold professional standards throughout their job performance and interaction with peers and
supervisors. Revise your employee handbook to include the policy and provide copies of the revised handbook to employees.
Obtain signed acknowledgement forms from employees that indicate they received and understand the workplace ethics
policy.
2. Provide workplace ethics training to employees. Utilize varied instruction methods to engage employees in learning how
to address and resolve ethical dilemmas. Experiential learning, or role-play, is an effective way to facilitate workplace ethics
training. Examples of workplace ethics simulations involve scenarios about the misappropriation of company funds, personal
values related to improper workplace relationships and the organization’s compliance with regulatory controls.
3. Designate an ombudsperson in charge of handling employees’ informal concerns pertaining to workplace ethics. Consider
whether your organization also needs an ethics hotline, which is a confidential service employees may contact whenever
they encounter workplace dilemmas that put them into uncomfortable or threatening positions. Confidential hotlines are an
effective way to assure employees’ anonymity, which is a concern for employees whose alerts are considered
“whistleblowing” actions.
4. Research federal, state and municipal labor and employment laws pertaining to whistleblowing. Refrain from making
employment decisions, such as termination or suspension, in connection with whistleblowing or an employee’s right to
protected activity under whistleblowing laws or public policy. Seek legal advice for employee reports of workplace ethics
issues that increase your organization’s liability under federal, state or municipal employment law. Under the Texas
Whistleblower Act, for example, public-sector employees may be entitled to damages if an employer engages in retaliatory
actions based on an employee who, in good faith, files a complaint related to workplace ethics. The Act grants "[a] public
employee who claims that his suspension, termination, or other adverse personnel action was in retaliation for his good faith
reporting of violations of the law the right to sue for damages and other relief."
5. Apply your workplace policy consistently when addressing workplace issues and employee concerns about workplace
ethics. Use the same business principles in every circumstance, regardless of the perceived seriousness or the level of
employees involved. Communicate the same expectations for all employees – whether they are in executive positions or
front-line production roles – and approach every issue with equal interpretation of the company policy.
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References (5)
Resources (3)
Ruth Mayhew has been writing since the mid-1980s, and she has been an HR subject matter expert since 1995. Her work
appears in "The Multi-Generational Workforce in the Health Care Industry," and she has been cited in numerous
publications, including journals and textbooks that focus on human resources management practices. She holds a Master of
Arts in sociology from the University of Missouri-Kansas City. Ruth resides in the nation's capital, Washington, D.C.
Photo Credits
More Articles
[Ethical Issues Within Organizations] | Common Types of Ethical Issues Within Organizations
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you must not get any unauthorised benefit (profit) from your position, even unintentionally; and
you must not place your own interests ahead of the interests of your organisation (avoid conflicts of
interest and duty);
you must not place your duty to anyone else ahead of your duty to your organisation (avoid conflicts
of duty and duty).
To avoid these problems and conflicts, no board or management committee member should take
part in decisions in which he or she has an interest. This is reinforced in most Australian jurisdictions
by the relevant legislation, and penalties can be imposed for breaches of the legislation. There can
also be an action for a civil remedy if an organisation suffers a loss because of breach of fiduciary
duty. For example, a board member found to be in breach may have to pay compensation for loss,
or pay over any unauthorised profit, to the organisation.
formalising the process by which board and senior management identify and notify potential
conflicts;
giving clear guidance about what should be done when any board member has an interest in a board
decision; and
outlining the process to be followed when a board member participates in a decision in which he or
she is not disinterested.
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