AURORA HEALTH CARE, INC.



COMPLIANCE EXIT INTERVIEW

Name:

Date:

Phone #:

Fax #:

Interviewer:

Aurora Health Care is committed to integrity, ethical behavior, and adherence to a code of values. Our Code of Ethical Conduct guides us to conduct all of our activities consistent with federal and state laws and requirements, as well as with private health care requirements. Your participation in this Compliance Exit Interview will help us learn and better understand any areas where we can improve these efforts.

What is your current job title?

How long have you been with Aurora?

What are your major job duties?

What was the last day you worked?

1. What is/was your primary reason for leaving?

2. Tell me about any compliance issues you or someone else has reported that you feel have not been appropriately or adequately addressed? When did you/someone else report these?

3. Of those reported compliance issues that you feel have not been addressed, who’s attention did you bring them to? When?

4. Tell me about any compliance issues that you have not reported?

5. Please explain any instances where you felt that you were asked to engage in conduct that you believed to be either unethical or illegal?

6. Describe for me any instances where you have witnessed any conduct by an Aurora employee, contractor, or agent that you would characterize as either unethical or illegal?

7. Share with me any non-compliance issues that you feel have not been addressed appropriately or adequately that potentially could turn into compliance issues?

8. What other Compliance related concerns would you like to share with me?

REMINDER: Inform the interviewee that you are available via phone (provide your number) anytime should he or she think of additional concerns, and provide the hotline number:

(888)847-6331.

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