Fraud, Waste, and Abuse A-11

PURPOSE:

This policy has been developed to reinforce Sedgwick County Developmental Disability Organization’s (SCDDO) commitment to preventing and detecting fraud, waste, and abuse. SCDDO has zero tolerance for the commission or concealment of acts of fraud, waste, or abuse. Allegations of such acts will be investigated and pursued to their logical conclusion, including legal action where warranted. All employees and community service providers (CSP) are responsible for reporting suspected instances of fraud, waste, and abuse in accordance with this policy.

POLICY:

This policy defines the terms fraud, waste, and abuse. The provisions of this policy apply to any instance of fraud, waste, or abuse involving not only employees of SCDDO, but also external organizations doing business with SCDDO and volunteers at SCDDO-sponsored events.

DEFINITIONS:

Fraud is the intentional misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the misrepresentation could result in some unauthorized benefit to himself or SCDDO for purposes of reimbursement.

Waste is the unintentional misuse of funds through gross negligence or reckless disregard that results in unnecessary cost or consumption of health care resources. This can include incorrect coding or billing.

Abuse is the reimbursement for health care services that are not medically necessary or that fail to meet accepted medical or business practices.

Examples of fraud, waste, and abuse include, but are not limited to:

1. Using resources in a manner contrary to established policies or permissions governing the use of those resources, or that otherwise constitutes fraud, waste or abuse.
2. Obtaining funds or compensation through dishonesty.
3. Manipulating computer files, programs, or data to hide frud.
4. Falsification of costs or expenses.
5. Forgery or alteration of documents.
6. Destruction or removal of records in violation of County records retention policies or organizational policies.
7. Paying of excessive prices or fees to third parties with the aim of personal gain.

PROCEDURES:

These procedures define the management and employee responsibility to prevent, detect, and report fraud, waste, and abuse.

To provide employees, CSPs, and citizens with a confidential, secure means to report suspected fraud, waste, and abuse, SCDDO has established a confidential way for individuals to report information at www.ourworkplace.com (employer ID: SCDDO615) or by calling 316-660-1115.

1. Employees, CSPs, and citizens will report upon discovery, suspected or identified, fraud, waste, or abuse using the following reporting options:
   1. Phone Report: The phone-based reporting system, maintained by SCDDO, is a confidential access point for employees, CSPs, and citizens to share information. Phone reports can be made by calling 316-660-1115
   2. Electronic Report: The web-based reporting system is a confidential and anonymous access point for employees, CSPs, and citizens to share information. All information submitted is transmitted directly to a third-party firm which by contract cannot attempt to identify the sender or even the Internet address from which the information was sent. The third-party firm will not provide any identifying information to SCDDO unless it is voluntarily provided by the reporting individual.
      1. This system can be accessed by visiting www.ourworkplace.com and entering the following employer identification code: SCDDO615
   3. Office of Inspector General: Concerned individuals may also directly report suspected fraud, waste and abuse to the State of Kansas Department of Health and Environment Office of Inspector General at (785) 296-1076, via email at OIG@kdheks.gov or via USPS at 900 SW Jackson Street, Suite 900-N Topeka, KS 66612.
2. SCDDO will:
3. 1. Report to the Community Services and Program Commissioner and Financial Information Services Commissioner, in writing upon discovery, suspected or identified, fraud, waste, or abuse related to funds as identified in the contract with the Kansas Department for Aging and Disability Services (KDADS).
   2. Cooperate with external investigating bodies and recover funds/resources lost through fraud when possible.
   3. Develop and maintain effective controls to prevent fraud, waste, and
   4. Ensure that if fraud, waste, or abuse is suspected, an appropriate investigation takes place.
   5. Review systems and procedures to prevent fraud, waste, or abuse.

1. The CSP will ensure that all employees receive training in fraud, waste, or abuse.