Fraud, Waste, and Abuse Training for Community Rehabilitation Programs

Fraud, Waste, and Abuse Training for Community Rehabilitation Programs

Definition of a Community Rehabilitation Program (CRP) A CRP is a program which directly provides or facilitates the provision of vocational rehabilitation services to individuals with disabilities, DOR consumers, to enable them to maximize opportunities for employment, including career advancement. 2

Fraud, Waste, and Abuse Prevention It is DOR’s responsibility to maintain appropriate oversight of services provided to DOR consumers. The CRP and DOR are responsible for preventing and detecting fraud, waste, and abuse (FWA). It is the CRPs responsibility to provide services to a consumer in alignment with the Authorization for Vocational Rehabilitation Services (form DR 297B) and the CRP Guide to Certification and Vendorization. The CRP also agrees to consumer privacy protection. 3

Consumer Privacy Protection The employees, contractors, and individuals who perform services for or on behalf of DOR are required to have practices in place to: Protect the personal information of consumers including SS#’s, birthdates, medical information, and driver’s license numbers. Report security breaches including to managers/supervisors, their information security officer, and DOR. 4

What is FRAUD? Fraud is any illegal act characterized by deceit, concealment, or violation of trust. Fraud is perpetrated by parties and organizations to obtain money, property, or services; to avoid payment or loss of services; or to secure personal or business advantage. Examples: Duplicate billing of services provided in a previous month Falsifying service hours claimed on the invoice 5

What is WASTE? Waste involves the taxpayers not receiving reasonable value for money in connection with any government funded activities. Waste relates to mismanagement, inappropriate actions, and inadequate oversight. Examples: Recommending or invoicing for unnecessary services Charging excessively for services 6

What is ABUSE? Abuse involves behavior that is deficient or improper when compared with behavior that a prudent person would consider reasonable and necessary business practice given the facts and circumstances. Abuse may include misuse of authority or position for personal gain. Examples: Providing or recommending unnecessary services or products Providing substandard services 7

How can CRPs prevent FWA? Never deliver services to a consumer before receiving an authorization Stay within scope of the service authorization Maintain documents that adequately support the services provided Comply with the policies and procedures in the CRP Guide to Certification & Vendorization 8

More Ways CRPs can prevent FWA Ensure progress reports include sufficient detail of services provided and consumer progress Provide necessary and quality services Ensure invoices are accurate and complete Only bill for actual services provided Ask DOR for clarity on questions related to billing and authorizations to avoid invoicing errors 9

DOR’s Responsibilities DOR staff will monitor CRP services including: Reviewing the quality of services Tracking billing Obtaining consumer feedback regarding service satisfaction Ensuring CRP is adhering to written record retention policy 10

Consequences Consider the potential penalties of FWA: Disputed invoices Requested reimbursement of overpayments Suspension of services Termination of the CRP Certification Fines Prosecution 11

Conclusion The next slide is your training certificate. Please print and fill out the certificate and retain it for three (3) years. Certifications must be made available upon DOR request. For further questions on fraud, waste, and abuse, contact: DOR Audit Services Phone: (916) 558-5835 Email: [email protected] 12

Department of Rehabilitation Certificate of Completion is hereby granted to: {type or print name} of {type or print Community Rehabilitation Program name} to certify that he/she has completed to satisfaction Fraud, Waste, and Abuse Training for Community Rehabilitation Providers Date: 3/16/23 {sign name} Note: This certificate is only valid for one year and must be renewed annually.