US · guidance
CMS SOM App. U, Tag R178
(3) Application of all safeguards to protect against the possibility of fraud and abuse
(42 CFR part 455).
Interpretive Guidelines: §403.738(a)(3)
The RNHCI governing body and administration is responsible for ensuring that the
organization complies not only with all federal, state and local laws, but also ensures
patients and staff are protected from the possibility of fraud and abuse. In accordance
with the requirements at 42 CFR 455, an organization is responsible for having
mechanisms and criteria for identifying suspected fraud within the facility. The
organization is responsible for having policies for reporting suspected fraud and abuse to
the appropriate legal authorities and for referring suspected fraud cases to law
enforcement officials.
Survey Procedures:
• Determine whether the facility is in compliance with Federal, State and local
laws.
• Verify the RNHCI has a process for detecting fraud and abuse and for reporting
fraud and abuse to the appropriate legal authority.
History
Rev. 239; Issued: 04-24-26; Effective: 04-24-26; Implementation: 04-24-26
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
4fb8decf683cc1b64ff148160fad18ede5112eae094d421723eabe4be764002e
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