The Office of Healthcare Compliance office works to ensure compliance with federal and state laws and regulations as well as University policies. Healthcare compliance at UConn Health encompasses patient care, billing and reimbursement practices and employee and student education.
As healthcare becomes increasingly complex, practitioners must understand and adhere to applicable laws to avoid consequences such as negative publicity, lawsuits, fines, loss of funding, or exclusion from participation in federal healthcare programs.
Q: What is EMTALA?
The Emergency Medical Treatment and Labor Act. It's a federal law, enacted in 1986 that requires hospital emergency departments to do a medical screening examination on every patient who seeks emergency care and to stabilize or transfer those with medical emergencies, regardless of health insurance status or ability to pay.
Q: What is Targeted, Probe & Educate?
TPE is a prepay chart review conducted by the government to evaluate whether health care providers are compliant in providing services with federal regulations and Medicare coverage guidelines. If selected for review, typically 20-40 claims are reviewed for supporting documentation that meets Medicare rules and regulations.
Q: What is the False Claims Act?
The FCA prohibits knowingly submitting false or fraudulent claims for payment, or engaging in misconduct involving federal government money or property. The government imposes civil liability on persons who knowingly submit false or fraudulent claims.