Anti-Kickback Law: Prohibits the solicitation, receiving, offering, or paying of any remuneration directly or indirectly in cash or in kind in exchange.
Attestation: The affirmation by signature, usually on a printed form, that the action outlined has been accomplished by the individual signing; e.g., the individual has read the code of conduct and agreed to adhere to its principles.
Attorney-Client Privilege: A legally accepted policy that communication between a client and attorney is confidential in the course of the professional relationship and that such communication cannot be disclosed without the consent of the client. Its purpose is to encourage full and frank communication between attorneys and their clients.
Audit, baseline: A systematic inspection of records, policies, and procedures with the goal to establish a set of benchmarks for comparison for future inspections.
Audit, concurrent: An ongoing inspection of records, policies, and procedures at a given point in time in which identified potential problems are investigated as they arise (e.g., pre-published financial statements).
Audit, retrospective: A comprehensive inspection of records, policies, and procedures done usually in anticipation of launching a compliance program. All potential problems are identified and then investigated (e.g., published financial statements, historical audit).
Benchmarking: The measurement of performance against “best practice” standards.
Best Practices: Generally recognized superior performance by organizations in operational and/or financial processes.
Caremark International Derivative Litigation: The 1996 U.S. civil settlement of Caremark International, Inc. in which an imposed corporate integrity agreement precluded Caremark from providing health care in certain forms for a period of five years. Also suggests that the failure of a corporate director to attempt in good faith to institute a compliance program in certain situations may be a breach of a director’s fiduciary obligation.
Chain of Command: The hierarchy of reporting structure within an organization, which assumes all issues will be presented first to one’s immediate supervisor.
Civil Monetary Penalties Law (CMPL): Regulations which apply to any claim for an item or service that was not provided as claimed or that was knowingly submitted as false and which provides guidelines for the levying of fines for such offences.
Compliance: Also: Corporate Compliance. Adherence to the laws and regulations passed by official regulating bodies as well as general principles of ethical conduct. In the United States, such regulating bodies include the U.S. Congress; federal executive departments and federal agencies and commissions; and corresponding state-level entities.
Corporate Integrity Agreement (CIA): Also: Consent Decrees. A negotiated settlement between a organization and the government in which the provider accepts no liability but must agree to implement a strict plan of government-supervised corrective action.
Culpability Score: Part of the U.S. Sentencing Commission guidelines for the Sentencing of Organizations, a system that adds points for aggravating factors and subtracts points for mitigating factors in the determination of fines imposed for fraud or abuse.
Equal Employment Opportunity Commission (EEOC): U.S. agency created in 1964 to end discrimination based on race, religion, sex, or national origin in employment. The commission reviews and investigates charges of discrimination and, if found to be true, attempts remedy through conciliation or legal means.
False Claims Act (FCA): Originally adopted by the U.S. Congress in 1863 during the Civil War to discourage suppliers from overcharging the federal government, legislation that prohibits anyone from knowingly submitting or causing to be submitted a false or fraudulent claim.
Federal Sentencing Guidelines: Guidelines developed by the U.S. Sentencing Commission, an independent agency in the judicial branch of government established by the 1984 Sentencing Reform Act, to govern the sentencing of individual defendants (1987) and organizations (1991).
Foreign Corrupt Practices Act (FCPA): Law adopted by the U.S. Congress in 1977 that prohibits the bribery of foreign officials to obtain or retain business. The law also requires public corporations to maintain accurate books and records and establish an adequate system of internal accounting controls.
General Services Administration (GSA): The federal agency that manages the federal government’s property and records, including the construction and operation of buildings and procurement and distribution of supplies, among other functions.
Hotline; Helpline: A common reporting system, administered in house or by outside consultants, giving anonymous telephone access to employees seeking to report possible instances of wrongdoing.
Inspector General (IG): An officer of a federal agency whose primary function is to conduct and supervise audits and investigations relating to operations and procedures over which the agency has jurisdiction.
OIG: Office of the Inspector General; See also Inspector General.
OIG Compliance Program Guidances: Guidelines issued by the various Inspector General offices for the suggested development of compliance programs. Most notably, the Department of Health and Human Services OIG issues ongoing compliance guidance to assist health care organizations in achieving compliance with the multitude of health-care regulations established by Congress and the Centers for Medicare and Medicaid Services.
Qui Tam: Authorized by the False Claims Act, qui tam is an abbreviated term for “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” or “he who brings the action for the king as well as for himself.” A qui tam suit is one filed by an employee of an organization, a whistleblower, with the federal government accusing an organization of fraud and abuse.
Society of Corporate Compliance and Ethics (SCCE): The professional association dedicated to helping compliance professionals through education, networking opportunities, and other information resources. Its mission is “to champion ethical practice and compliance standards in all organizations and to provide the necessary resources for compliance professionals and others who share these principles.”
Self-reporting: Having identified actual wrongdoing, the organization informs the government. Although not protected from civil or criminal action under the False Claims Act, providers disclosing fraud are advised in the government self-disclosure protocol that timely self-reporting of wrongdoing may offer mitigating factors in potential penalties and/or fines.
Voluntary Disclosure: See Self-Reporting.