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Compliance program

In April 2004, PerformCare, in conjunction with the Pennsylvania Bureau of Program Integrity (Department of Public Welfare), offered training related to corporate compliance issues in Medical Assistance Programs, particularly those related to behavioral health. Handouts from those trainings are available as below:

  • Compliance programs in the Medical Assistance Program
  • Behavioral health services and helpful hints regarding corporate initiatives
  • Compliance training documents
  • Compliance program requirements
  • What is fraud and abuse?
  • Education materials

Compliance program requirements

  • Established written compliance standards, policies and procedures
  • Specific high-level individuals hold responsibility for oversight of Compliance program
  • Do not delegate substantial discretionary authority
  • The agency must have effective internal and external communications
  • The agency must establish monitoring and auditing systems designed to detect criminal activity, as well as other non-criminal incidents of abuse, waste and overpayments
  • Compliance requirements must have consistent enforcement through disciplinary mechanisms
  • Response and corrective action to compliance violations must take all reasonable steps to respond to the offense