Hospice

Reporting Suspected Fraud or Abuse

It is the responsibility of all HWR employees, volunteers, vendors and agents to fulfill all their legal, professional and ethical obligations and to adhere to all laws and regulations in providing hospice care and services to the community. Any HWR employee, volunteer, vendor, agent, patient, family member or caregiver who believes that an act has taken place that would place HWR at risk of fraud or abuse should report such an incident.

Such matters can be reported directly to the Chief Compliance Officer, by completing this online form, in writing, via voice mail, by E-mail or to the Compliance Hotline voice mailbox (216-383-6688). Information for contacting the Chief Compliance Officer follows:

John E. Harvan, Jr.
Chief Compliance Officer
Hospice of the Western Reserve, Inc.
300 E. 185th Street
Cleveland, Ohio 44119
Telephone - (216) 383-3755
E-mail - jharvan@hospicewr.org

Complaints, questions or comments regarding all other matters should be reported on the Contact Us form.

What type of incident are you reporting? Please select one:
Fraud Abuse Violation of Law Other/Unknown

Please identify any persons involved in the incident:

Staff Member(s)	Please type staff member name(s) if known...
Visitor(s)	Please type visitor name(s) if known...
Patient(s)	Please type patient number(s) or name(s) if known...
Vendor or Supplier	Please type vendor name(s) if known...

Please describe below the incident in as much detail as possible including names, dates, location, etc.?

HWR shall strive to maintain the confidentiality of the person making the report. However, there may be a time when the person’s identity may become known or may have to be revealed on a need to know basis in certain instances. Please provide the following contact information:

First Name:

Last Name:

Telephone:

Additional Comments related to contact information:

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