Compliance at DPH

• Find out about OCPA's Compliance Program's activities and services.
• Understand what fraud, waste, and abuse is.
• Understand your responsibilities under the Code of Conduct and ethics rules.  
• Report a compliance concern.
• Find links to DPH Compliance Policies.
• Find out how to get guidance and see frequently asked questions.  

The OCPA Compliance Programs operates in all DPH services areas, including:  Zuckerberg San Francisco General Hospital, Laguna Honda Hospital and Rehabilitation Center, Ambulatory Care, Population Health, and Behavioral Health Services.  OCPA focuses its compliance activities on:

• Educating DPH's workforce on preventing and detecting fraud, waste, and abuse; and on their ethical responsibilities under the Code of Conduct.  
• Providing guidance on regulations related to payment for services.
• Conducting risk assessments and engaging in annual monitoring plans.

Payment for services that DPH provides must be legitimate and comply with all regulations related to claims.  OCPA works with service areas to audit and monitor claims to ensure that DPH only submits claims for services that it is entitled to.

• “Fraud” is an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to themselves or some other person. 
• “Waste” is the intentional or unintentional over-utilization of services, careless or thoughtless expenditure, consumption, mismanagement, squandering of government resources; or engaging in practices that result in unnecessary costs. 
• “Abuse” is any practice that is inconsistent with accepted medical or business practice that results in an unnecessary cost to the Medicare or Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.

The DPH Code of Conduct is the foundation of the department’s compliance program. The purpose of the Code of Conduct is to provide direction to all DPH employees, contractors and other agents who do business with or on behalf of DPH.  

• All employees are expected to be familiar with the federal, state, and local laws, rules and regulations, or policies that apply to their duties.  
• Supervisors and Managers are responsible for overseeing the quality of their employees’ work.  
• All employees must avoid policy violations and activities that may be construed as deceitful, false, or fraudulent.  
• It is the responsibility of each employee to seek assistance for clarification or application of a particular rule, law, or regulation.

You can find more detailed information on the Code of Conduct, Conflicts of Interest, and Gift Rules on our dedicated Gifts, Conflicts, and Outside Activities and Employment page.  

DPH Compliance Policies

Compliance issues can be complex.  OCPA is here to provide advice to support DPH operational decisions.  You can request advice directly from your division's Compliance Officer.  Visit the Our Team page to find your Compliance Officer.

You can also make requests to compliance.privacy@sfdph.org.  

Answers to commonly asked questions can be found at Compliance FAQs.