Full compliance with all state and federal healthcare program statutes, regulations, directives and guidelines
Federal and state healthcare programs like Medicare and Medicaid require UMDNJ to comply with all applicable statutes, regulations, directives and guidelines, including the rules of Medicare fiscal intermediaries or carriers, UMDNJ policies and procedures and any agreements that UMDNJ may enter into with state or federal organizations or regulatory agencies (collectively, “Rules”). UMDNJ persons may be required to attest to their and UMDNJ’s compliance with the Rules, because, among other things, failure to fully comply with the Rules could jeopardize UMDNJ’s participation in these healthcare programs.
When providing clinical patient care that may be submitted for payment to private or public payors, persons are required to:
- Provide only such clinical care as is medically necessary;
- Submit timely and accurate bills for payment and accurate cost reports;
- Follow up to make sure that payments to UMDNJ are paid in a timely fashion;
- Report all suspected violations of Rules immediately when there are allegations of patient harm; and
- Report all suspected violation of Rules no later than thirty (30) days.
UMDNJ persons may be subject to disciplinary actions, up to and including termination for failure to comply with the Rules or to report suspected violations of the Rules as well as being subject to fines, penalties, revocation of licenses and accreditation, criminal and civil actions as well as exclusion from federal and state healthcare programs.
UMDNJ persons are subject to periodic background checks. In accordance with Federal law, UMDNJ will not employ or enter into contracts with any individual or entity currently excluded by the Office of the Inspector General (OIG) and/or the General Service Administration (GSA) from participation in Federal health care programs. If it is determined that an employee, a non-employee provider with current clinical privileges, or an individual or entity with a contractual relationship with UMDNJ is on the exclusions lists, the employment and/or contractual relationship shall be immediately terminated.