1/1/2010
Government Resources:
1. Office of the Inspector General, Fraud Prevention and Detection Compliance Guidance: http://www.oig.hhs.gov/fraud/complianceguidance.html
2. Compliance Guidance for Medicare+Choice Organizations:
http://oig.hhs.gov/authorities/docs/cpgm_c.pdf
3. Compliance Guidance for Pharmaceutical Manufacturers:
http://oig.hhs.gov/authorities/docs/03/050503FRCPGPharmac.pdf
4. Compliance Guidance for Hospitals:
http://oig.hhs.gov/authorities/docs/cpghosp.pdf
5. Effective Compliance and Ethics Program- Federal Sentencing Guidelines:
http://www.ussc.gov/2004guid/8b2_1.htm
6. Office of Inspector General’s (OIG) database of excluded individuals/entities:
http://exclusions.oig.hhs.gov/search.html
7. General Services Administration (GSA) database of excluded individuals/ entities: http://epls.arnet.gov/
8. Fraud Alerts, Bulletins and Other Guidance from the OIG: http://oig.hhs.gov/fraud/fraudalerts.html
9. Title I of the Medicare Modernization Act (MMA): http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/pdf/05-1321.pdf
10. Title II of the Medicare Modernization Act (MMA): http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/pdf/05-1322.pdf
11. False Claims Act:
http://www.usdoj.gov/usao/vaw/civil_div/title31_3729.html
12. Health Insurance Portability and Accountability Act (HIPAA):
http://aspe.hhs.gov/admnsimp/pl104191.htm
13. Anti-Kickback Statute (see section 1128B(b)):
http://www.ssa.gov/OP_Home/ssact/title11/1128B.htm#f
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14. Department of Health and Human Services (DHHS), Office of Civil Rights – HIPAA website:
http://www.hhs.gov/ocr/hipaa/
15. Medicare Part D Reporting Requirements:
http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/PartDReportingRequirements_01.25.06.pdf
16. Medicare Part B versus Part D Coverage Issues (Draft for Discussion Purposes Only):
http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/Downloads/PartBandPartDdoc_07.27.05.pdf
17. Part D Plan Marketing Guidelines:
http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/MarketingGuidelines_11.01.05.pdf
18. TRICARE Fraud & Abuse website:
http://www.tricare.osd.mil/fraud/
19. Freedom of Information Act (FOIA):
http://www.usdoj.gov/04foia/foiastat.htm
Other Resources:
1. Code of Ethics for Pharmacists:
http://www.aphanet.org/pharmcare/ethics.html
2. The Code of Ethics of the American Pharmaceutical Association: http://www.aphanet.org/AM/Template.cfm?Section=Search&template=/CM/HTMLDisplay.cfm&ContentID=2809
3. Medicare Prescription Drug Benefit Model Guidelines: Drug Categories and Classes in Part D (Submitted by: United States Pharmacopeial Convention, Inc.): http://www.usp.org/
4. Health Care Administrators Association (HCAA):
http://www.hcaa.org/
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