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Corporate Compliance[1]


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This presentation was used to train staff on Corporate Compliance policies and ethical standards

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Corporate Compliance[1]

  2. 2. <ul><li>Policies Basics </li></ul><ul><ul><li>Purpose of Policy and Procedures </li></ul></ul><ul><ul><li>Parts of policy </li></ul></ul><ul><ul><li>Definitions </li></ul></ul><ul><li>Process Maps Basics </li></ul><ul><ul><li>Purpose </li></ul></ul><ul><ul><li>Definition of shapes </li></ul></ul><ul><ul><li>How to use a process map </li></ul></ul><ul><li>Corporate Compliance Program </li></ul><ul><li>Code of Conduct </li></ul>
  3. 3. <ul><li>All Policies have at least two parts </li></ul><ul><li>the policy </li></ul><ul><li>the procedure </li></ul>
  4. 4. <ul><li>In general, a policy is a guiding or governing principle </li></ul><ul><li>Policies… </li></ul><ul><ul><li>mandate or constrain actions </li></ul></ul><ul><ul><li>have agency-wide application </li></ul></ul><ul><ul><li>change infrequently and set a course for the foreseeable future </li></ul></ul><ul><ul><li>help ensure compliance </li></ul></ul><ul><ul><li>enhance JCCS’s mission and </li></ul></ul><ul><ul><li>reduce agency risk </li></ul></ul>
  5. 5. <ul><li>Interrelated steps that are performed to implement a policy </li></ul><ul><li>THE “ MINIMUM” REQUIRED ACTIONS TO MEET THE STANDARD OF THE POLICY </li></ul>
  6. 6. <ul><li>Definitions </li></ul><ul><ul><li>Given to add to the understanding of the policy </li></ul></ul><ul><ul><li>Provides information on words of phrases used in the policy that are not common in speech </li></ul></ul><ul><li>Purpose </li></ul><ul><ul><li>Gives the reason for the policy </li></ul></ul><ul><ul><li>If needed, in what instance the policy applies </li></ul></ul><ul><li>Processes </li></ul><ul><ul><li>Step by step instructions on how to perform a task or a functions </li></ul></ul><ul><ul><li>Usually a graphic interpretation also called a map </li></ul></ul>
  7. 7. MAP
  8. 8. <ul><li>X Heading </li></ul><ul><li>X.1 Policy </li></ul><ul><li>X.2 Purpose (when applicable) </li></ul><ul><li>X.3 Definitions (when applicable) </li></ul><ul><li>X.4 Procedures </li></ul><ul><li>X.5 Attachment (when applicable) </li></ul>
  9. 9. <ul><li>Many of JCCS policies include process maps. </li></ul><ul><li>Process maps are flowcharts that illustrate the basic steps companies follow for each process. </li></ul><ul><li>These maps provide a quick overview if you are unfamiliar with the way tasks are performed </li></ul>
  10. 10. <ul><li>Why do we use process maps </li></ul><ul><li>To give a graphical interpretation of a written policy and procedure </li></ul><ul><li>To provide ease of use </li></ul><ul><li>To help familiarize staff with the policies </li></ul>
  11. 11. External input : input comes from outside JCCS i.e. referral Step: an action that must be performed i.e. “Call staff member” Decision: actor answers a question to determine where to go next in the process. i.e. “Is today Thursday?” Self- Defined Process : process exist for the actions but listing the steps individually is not necessary. Terminator : end of actionable actions Connectors : on-page /off page
  12. 12. Retrieve mail from box Sort mail Stop. Incoming mail Input comes in the office Actor does this All mail sorted Perform this process 1 1 Answer yes / no Ends the process Look for this shape and # on the page no yes
  13. 13. <ul><li>What is a guiding or governing principle. </li></ul><ul><li>What are the 2 minimum parts of a policy? </li></ul><ul><li>What are the optional parts of a policy? </li></ul><ul><li>Why do we use process maps? </li></ul><ul><li>What is this shape, ? </li></ul>
  14. 14. <ul><li>“ MEETING THE STANDARDS” </li></ul>Jireh Counseling & Consulting Services, Inc.
  15. 15. <ul><li>“ It is the policy of JCCS to provide services that fully comply with all federal, state, and local regulations and applicable laws, and to adhere to explicit ethical standards throughout all facets of the organization’s operations. JCCS will ensure these conditions of operation are met through an organized and ongoing comprehensive corporate compliance program.” </li></ul>
  16. 16. <ul><li>Maintain and enhance the quality of services. </li></ul><ul><li>Comply with all applicable laws. </li></ul><ul><li>Revise and develop p&p to enhance compliance </li></ul><ul><li>Enhance comm. w/governmental entities to ensure compliance. </li></ul><ul><li>Empowerment of everyone to prevent, detect, respond to, report, and resolve conduct that violates applicable laws, regulations, ethical standards & codes of conduct </li></ul><ul><li>Ensure that all questions and concerns about compliance issues are appropriately addressed </li></ul>
  17. 17. <ul><li>Is appointed by the CEO (currently is the OM) </li></ul><ul><li>provide leadership and oversight of the Corporate Compliance Program </li></ul><ul><li>The duties include, but not be limited to: </li></ul><ul><ul><li>id and assess compliance systems and issues. </li></ul></ul><ul><ul><li>Plan and provide guidelines for development of service specific compliance procedures. </li></ul></ul><ul><ul><li>educational training and programming </li></ul></ul><ul><ul><li>Disseminate compliance information </li></ul></ul><ul><ul><li>prevent and reduce errors, and to id wrongdoing. </li></ul></ul><ul><ul><li>investigate reports of potential violations </li></ul></ul><ul><ul><li>implement remedial/corrective/disciplinary actions </li></ul></ul><ul><ul><li>Annual report to CEO of all investigations/incidents </li></ul></ul>
  18. 18. <ul><li>All new staff will review the CCP </li></ul><ul><li>Code of Conduct will be reviewed during annual contract review & evaluations </li></ul><ul><li>Staff will be informed of compliance issues at regularly scheduled staff meetings </li></ul><ul><li>Staff will participate in ongoing compliance trainings </li></ul><ul><li>Regular publication of reporting mechanisms </li></ul><ul><li>Staff exit interviews will include compliance-related questions </li></ul>
  19. 19. <ul><li>All programs shall implement internal controls, including monitoring activities to ensure compliance with the organization’s program </li></ul><ul><li>Internal self-audits will include fiscal services, marketing, contractual services, health and safety practices, use of agency resources, confidentiality, dual relationships, and medical necessity. </li></ul><ul><li>Ongoing monitoring and auditing activities will be reported to the CCO </li></ul>
  20. 20. <ul><li>All info will be held in strict confidence </li></ul><ul><li>Accused is not part of the investigation team </li></ul><ul><li>May require legal counsel </li></ul><ul><ul><li>provide final approval of violations by the CEO </li></ul></ul><ul><ul><li>ensure confidentiality and attorney-client privilege </li></ul></ul><ul><ul><li>focus on critical issues which should be investigated,& </li></ul></ul><ul><ul><li>help design a strategy for effectively using the findings of the investigation. </li></ul></ul><ul><ul><li>advise the CEO with regard to the need to self-report the violation to the appropriate government regulatory agency, and will assist in the process should it be necessary </li></ul></ul>
  21. 21. <ul><li>May involve interviews with witnesses and clients, as well as other relevant information </li></ul><ul><li>Focus is on respecting the client’s rights </li></ul><ul><ul><li>If the suspected violation is a consumer right’s violation, then the investigation, notification, and appeal procedure will follow the consumers right’s policy and procedures. </li></ul></ul><ul><ul><li>If it is determined that the client’s rights have been violated, the appropriate advocacy representative or entity will be contacted to begin their own investigation </li></ul></ul>
  22. 22. <ul><li>The CCO will conduct interview(s) </li></ul><ul><li>CCO determine if we need Legal counsel, & makes recommendations to the CEO </li></ul><ul><li>The staff member is notified that there is a complaint and, may be instructed to discontinue direct services </li></ul><ul><ul><ul><li>His/her supervisor will provide the client with a clinician that can provide services during the investigation </li></ul></ul></ul>
  23. 23. <ul><li>CCO files a report to the CEO including </li></ul><ul><ul><li>a summary of all allegations, </li></ul></ul><ul><ul><li>results of the investigation, and </li></ul></ul><ul><ul><li>recommendations for corrective actions </li></ul></ul><ul><li>The CCO, the CEO, and the supervisor of the staff member(s) involved will </li></ul><ul><ul><li>review the recommendations and </li></ul></ul><ul><ul><li>develop a corrective plan of action </li></ul></ul>
  24. 24. <ul><li>Must be written w/14 days of complaint </li></ul><ul><ul><li>The nature of the complaint, including time, date, persons involved, services involved. </li></ul></ul><ul><ul><li>The person whom the complaint is lodged against. </li></ul></ul><ul><ul><li>Results of persons interviewed and investigation of circumstances surrounding the incident. </li></ul></ul><ul><ul><li>A recommendation based on the gathered information. </li></ul></ul><ul><ul><ul><li>Founded: violation did occur </li></ul></ul></ul><ul><ul><ul><li>Unfounded: violation did not occur </li></ul></ul></ul><ul><ul><ul><li>Undetermined: unable to prove if it did/didn’t </li></ul></ul></ul>
  25. 25. <ul><li>Unfounded </li></ul><ul><ul><li>the paperwork of the complaint and the investigation will be destroyed. </li></ul></ul><ul><li>undetermined, </li></ul><ul><ul><li>the supervisor will adjust the supervision to ensure that the suspected behavior is not occurring </li></ul></ul><ul><ul><ul><li>The employee will be informed of the details and will be actively involved with the supervisor in this process </li></ul></ul></ul><ul><li>Founded </li></ul><ul><ul><li>reported to the executive management as a critical incident </li></ul></ul><ul><ul><li>Reviewed to assist in quality improvement, risk management, and corrective measures. </li></ul></ul>
  26. 26. <ul><li>CCO </li></ul><ul><ul><li>monitors and evaluates the corrective plan </li></ul></ul><ul><ul><li>reevaluates the actions/corrections on a monthly basis </li></ul></ul><ul><ul><li>provide updates to the CEO until the situation has been resolved </li></ul></ul><ul><ul><li>Adds the incident, investigation, and outcome to the annual corporate compliance report </li></ul></ul><ul><li>CEO </li></ul><ul><ul><li>utilize all information to recommend revision and development of policy, procedures, and guidelines </li></ul></ul>
  27. 28. <ul><li>“ ETHICAL BEHAVIOR STANDARDS FOR JCCS STAFF” </li></ul>Jireh Counseling & Consulting Services, Inc.
  28. 29. <ul><li>Staff reviews code of conduct at hiring </li></ul><ul><ul><li>Standards of JCCS are part of the contract </li></ul></ul><ul><li>Signs an acknowledgment </li></ul><ul><li>The Code of Conduct and Standard are reviewed annually </li></ul><ul><ul><li>Updates, changes, additions and deletions </li></ul></ul><ul><li>Staff receives an Annual training </li></ul><ul><li>Signs an acknowledgement </li></ul><ul><li>Should be shared with clients and consumers and posted throughout JCCS </li></ul>
  29. 30. <ul><li>Respect the rights, privacy and confidentiality of the consumer </li></ul><ul><li>Be honest and not misleading </li></ul><ul><ul><li>w/the consumer, w/team leader, w/management </li></ul></ul><ul><ul><li>Accurately represent JCCS at all times </li></ul></ul><ul><ul><li>Keep honest records, make honest reports </li></ul></ul><ul><ul><li>Honest billing </li></ul></ul><ul><li>Talk to colleagues </li></ul><ul><ul><li>Adhere to the codes of conducts and the standard for your discipline </li></ul></ul><ul><li>Disclose all relationships </li></ul><ul><li>Only have professional relationships with the consumer </li></ul>
  30. 31. <ul><li>Avoid conflicts of interest </li></ul><ul><ul><li>No compete rules </li></ul></ul><ul><ul><li>Consumer choice if you vacate JCCS </li></ul></ul><ul><li>Don’t accept or give gifts or favors </li></ul><ul><ul><li>From consumers or referral source </li></ul></ul><ul><ul><li>Illegal from/to medicaid/medicare </li></ul></ul><ul><li>Don’t discuss pricing with competitors </li></ul><ul><li>Provide quality care </li></ul><ul><ul><li>Only what is necessary </li></ul></ul><ul><ul><li>Inform the consumer of their options </li></ul></ul><ul><ul><li>Get the their consent </li></ul></ul>
  31. 32. <ul><li>All records belong to JCCS </li></ul><ul><li>Do not destroy/ remove records </li></ul><ul><li>Do no sign/initial for other people </li></ul><ul><li>Comply & cooperate with all governmental entities </li></ul><ul><li>If you are contacted </li></ul><ul><ul><li>Notify the CEO immediately </li></ul></ul><ul><ul><li>Get and id and business card (if in person) or </li></ul></ul><ul><ul><li>name, office, address, phone number, and identification number and then contact the person’s office to confirm his/her identity. </li></ul></ul>
  32. 34. <ul><li>JCCS will comply with its Corporate Compliance program </li></ul><ul><li>Billing- </li></ul><ul><ul><li>We only bill for what is necessary </li></ul></ul><ul><ul><li>We only bill for what we are entitled </li></ul></ul><ul><ul><li>Billing is consistent </li></ul></ul><ul><ul><li>All billing includes supportive clinical documentation </li></ul></ul><ul><li>Marketing material will be </li></ul><ul><ul><li>honest & factual </li></ul></ul><ul><ul><li>Clear in language </li></ul></ul><ul><ul><li>Not include rewards or gifts for consumers </li></ul></ul>
  33. 36. <ul><li>Any staff member who believes/suspects that a violation has occurred is OBLIGATED to report it </li></ul><ul><li>If the violation involves the safety of a consumer, client or staff it must be reported IMMEDIATELY </li></ul><ul><li>Once the report is made the reporting staff member is no longer obligated to be involved and is free from reprisal </li></ul><ul><li>Each suspected violation must be reported separately </li></ul>
  34. 37. <ul><li>Consumers or vendors who suspect a violation can report that violation to any staff member </li></ul><ul><li>Staff will report violations to… </li></ul><ul><ul><li>Supervisor through the Corporate Compliance Program </li></ul></ul><ul><ul><li>Corporate Compliance Officer </li></ul></ul><ul><li>Supervisor/Managers must report violations to the Corporate Compliance Officer </li></ul>
  35. 38. OBLIGATION To report IMMEDIATELY Report Freedom from reprisal Report Violations separately
  36. 39. <ul><li>Code of Conduct investigations will follow the guidelines outlined in the JCCS Corporate Compliance Policy and Procedure </li></ul><ul><li>The following violations of the Code of Conduct will result in termination of contract: </li></ul><ul><ul><li>theft of funds, and/or </li></ul></ul><ul><ul><li>physical, emotional, or sexual abuse of a client or employee. </li></ul></ul>
  37. 40. <ul><li>CCO will begin investigations immediately </li></ul><ul><li>the following issues will be considered and action taken depending on the situation: </li></ul><ul><ul><li>Is any client in any harm or potential harm because of this behavior? </li></ul></ul><ul><ul><li>Does the complaint require immediate action to remove the employee from contact with a client? </li></ul></ul><ul><ul><li>Does the complaint put JCCS or its employee in a potentially liable situation that needs legal consultation? </li></ul></ul>
  38. 42. <ul><li>Mr. Kellum receives a birthday gift from the caregiver of a consumer? </li></ul><ul><li>Ms. Clark tells a potential vendor she will have a personal lunch with him? </li></ul><ul><li>Mrs. Caldwell adds an extra unit to her billing. </li></ul><ul><li>Mr. Day is long-time friends with a DFCS worker in a county we are trying to move into? </li></ul><ul><li>Ms. Witcher has stock in a small start-up company that creates charts? </li></ul>
  39. 43. <ul><li>A CSR tells you a FIS is flirting with her? </li></ul><ul><li>The team leader signs the treatment plan for another team member? </li></ul><ul><li>A CSR tells you he/she paid a CSI to write an article for his/her small business? </li></ul><ul><li>You over hear Ops Manager offer to give a favorable contract review in exchange for some personal time from a staff member? </li></ul><ul><li>You hear the Program manager verbally abuse a CSR? </li></ul>