Compliance Reporting

What is Corporate Compliance?

Corporate Compliance is a management system which is designed to detect and prevent violations of the law, develop & maintain internal controls to promote adherence to federal, state and local laws, and to ensure employees demonstrate appropriate ethical conduct.  Compliance is important to ensure that illegal activities do not divert Medicaid dollars that could otherwise be spent to safeguard the health and welfare of Medicaid beneficiaries.

What is Fraud, Waste and abuse?
  • Fraud includes billing for services not rendered; performing unnecessary services solely to obtain payment, altering documents to obtain higher payment or deliberate duplicate billing.
  • Waste means over-utilization of services that result in unnecessary costs. Waste can also refer to useless consumption or expenditure without adequate return.
  • Abuse includes submitting claims that do not comply with billing guidelines, providing services that are not medically necessary or do not meet professionally recognized standards, submitting bills to Medicare/Medicaid instead of the primary insurer.
What needs to be reported?

Inappropriate interactions between staff and consumers; Inappropriate business interactions between co-workers; Inappropriately documenting services; Information not related to IPOS or cloned documentation; Billing for services that have not been rendered; Any instance where it appears a staff person is using a consumer for personal benefit – exploitation; Any confidentiality violations of HIPPA, the Michigan Mental Health Code, or 42 CFR Part 2 (Substance Use); and anything that appears irregular, suspiciously inaccurate or inconsistent in regards to regular organizational standards.

What about Reports that aren’t related to Compliance?

Each year the Compliance Office receives a number of complaints that may not be within the scope of Compliance. Please still report your concern in efforts to error on the side of caution; as these complaints will be referred to the appropriate MCCMH Division for handling. The compliance staff will be happy to clarify any questions or concerns at the time of report.

How do I report a Compliance Concern?

Reports can be made multiple ways. If reporting anonymously, the compliance team requests that enough information is provided for an investigation to be thoroughly conducted (names, dates, suspected violation, etc).

  1. Compliance Hotline: 586-469-6481
  2. Compliance Email: [email protected]
  3. Website form
  4. In-person to any compliance staff
  5. Inter-office/ U.S. Mail.
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