Health and Human Resource Center, Inc. DBA Aetna Resources for Living Corporate Compliance/Anti-Fraud Helpline

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Health and Human Resource Center, Inc. DBA Aetna Resources for Living Corporate Compliance/Anti-Fraud Helpline

A Corporate Compliance Helpline has been established to provide employees, providers and clients with a venue to raise issues and concerns regarding fraud, waste and/or abuse. Health and Human Resource Center, Inc. DBA Aetna Resources for Living has established this Helpline, to ensure that employees, providers and clients can report possible wrongdoings or unethical conduct occurring within or to Health and Human Resource Center, Inc. DBA Aetna Resources for Living without fear of retaliation. The Helpline is available seven days a week, twenty-four hours a day excluding designated holidays. Helpline calls are handled by the Compliance Officer to ensure confidentiality. Calls will not be recorded or traced and the caller will not be required to furnish his or her name. Calls will be investigated and the Corporate Compliance Officer will ensure follow-up actions are taken. Retaliation against employees, providers and clients for calling the Helpline is strictly prohibited.

Remember, every call will be treated confidentially and callers may remain anonymous.

Helpline: (800) 342-8111
Contact: Director, Quality Improvement

Health and Human Resource Center, Inc. DBA Aetna Resources for Living CRITICAL COMPLIANCE INFORMATION

To provide employees, providers and clients with every avenue possible to raise their concerns and report possible wrongdoing, Health and Human Resource Center, Inc. DBA Aetna Resources for Living has established an ANONYMOUS Corporate Compliance/Anti-Fraud Helpline.

H

Calls are Handled professionally

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The Operating protocols are developed by the Compliance Officer

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Telephones are answered by the Compliance Officer

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Report potential violations of Laws and Regulations

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The Compliance Officer will initiate an Inquiry where appropriate

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The Non-Retaliation Policy protects employees from retaliation

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The Compliance Officer will Ensure Confidentiality

If you are concerned about an ethical or legal compliance issue at Health and Human Resource Center, Inc. DBA Aetna Resources for Living , please report it immediately by using one or more of the following options:

1. Speak with your Supervisor, Manager or Director

2. Consult with the Corporate Compliance Officer

3. Report anonymously by calling Health and Human Resource Center, Inc. DBA Aetna Resources for Living Compliance/Anti-Fraud Helpline (1-800-342-8111)

1-800-342-8111

Health and Human Resource Center, Inc. DBA Aetna Resources for Living CORPORATE
COMPLIANCE/ANTI-FRAUD HELPLINE
ALWAYS WORKING FOR YOU!!


FRAUD TIPS FOR PROVIDERS

The following TIPS are provided to assist you in preventing and deterring any allegations of inappropriate behavior and/or fraud.

  1. Medical records should be properly documented
  2. Diagnosis must fit the prescription (services administered)
  3. Certifications and Licenses must be current
  4. Clients should not be solicited for payment for EAP services
  5. Dates of Service and/or patient services should not be altered to maximize payment
  6. Services must be clinically appropriate
  7. Under-utilization patterns will be reviewed
  8. Only one insurer must be billed per visit, per patient
  9. Only services that are rendered can be billed
  10. Soliciting, offering, or receiving kickbacks or bribes is illegal