Compliance 360

All staff members are expected to report issues and concerns they have via the appropriate web form as soon as practical. Submitting a report should take only a few minutes and is critical to making the MFA the best it can be. Please select the appropriate web form below to report any incident or concern you have. If you are prompted to login, please use your MFA network username and password.


Please use this reporting form for:

  • Patient care complications, errors, or quality of care concerns
  • Medication errors
  • Falls
  • Malfunctioning or damaged equipment
  • Property damage
  • Security issues: Theft, threats, or acts of violence
  • Regulatory inquiries/complaints: Board of Medicine, Department of Health, private insurers
  • Threats of legal action, subpoenas or demands for money
  • Please DO NOT inform patients, families, and visitors that an event report was filed.
  • Document the event report in the medical record.
  • Copy, print out or take screen shots or picture of the event report.
  • Document discussions with Risk Management.

Report an issue involving Risk Management


Please use this reporting form for:

  • Violations of a patient’s HIPAA rights
  • Privacy Incidents involving misdirected, lost or stolen patient information
  • Reporting patient information in the wrong chart; patient charges billed to wrong patient
  • Unauthorized access to an individual’s health information
  • Impermissible disclosures to an individual’s health information

Report an issue involving Patient Privacy



Please use this reporting form for:

  • Reporting occurrences of missing or unbilled physicians’ charges/documentation in our systems
  • Documentation of pending appeals of charges that have been denied by payers
  • Documenting coverage changes to our enrolled insurance plans (government or private) that will impact our reimbursement
  • Documenting changes to Medicare and Medicaid regulations that impact our revenue cycle operations
  • Recording updates or changes to ICD-10, AMA CPT or HCPCS Level II code datasets that require revision in our systems

Report an issue involving Revenue Cycle


Please use this reporting form for:

  • Reporting and recording any patient complaints or concerns. If a patient’s complaint or concern cannot be resolved at the department level, the Patient Experience team will review and triage the issue.
  • Patient compliments or suggestions
  • IKudos or feedback to fellow employees

Report an issue involving Patient Experience



Please use this reporting form for:

  • Incidents involving a stolen or lost device which sends or stores MFA data or information
  • A potential virus or malware attack on your computer
  • Unauthorized access of another individual using credentials that are not their own
  • Suspicion of a data breach

Report an issue involving Information Systems & Technology


Please use this reporting form for:

  • Reporting exposure to patients with a communicable or contagious disease, i.e., varicella, meningitis, pertussis
  • Workplace injury and events in which employees need to complete a report to notify occupational health regarding a workplace illness/injury or near miss event.

Report an issue involving Health Employee Injury



Please use this reporting form for informing Human Resources of incidents such as:

  • Complaints
  • Concerns
  • Concerns
  • Experiences or problems that affect you, or your interaction with your colleagues and manager

Please DO NOT use this form to ask questions regarding your Benefits (i.e. health, dental, PTO, ELB, FMLA). Please email:

Report an issue involving Human Resources


Please use this reporting form for:

  • Concern that a particular transaction may be inappropriate given what you know about federal or other regulations
  • Concern about conduct that you believe may violate the MFA’s Code of Conduct or Policies
  • A situation that feels ethically wrong and makes you uncomfortable

 If you’re unsure which department your incident should be filed under, please use the Corporate Compliance form.

Report an issue involving Compliance