All of the AMISTAD HOMECARE, INC. (the agency) business affairs must be conducted in accordance with federal, state, and local laws, professional standards, applicable federally funded health care program regulations and policies, and with honesty, fairness, and integrity. Employees should perform their duties in good faith, in a manner that he or she reasonably believes to be in the best interest of the agency and its patients and with the same care that a reasonably prudent person in the same position would use under similar circumstances. To further these overall goals, a number of policies or standards of conduct have been adopted by the agency.
A. EMPLOYEE HANDBOOK
The employee handbook sets out several types of conduct, which are unacceptable. These are:
1 Intentionally or knowingly making false or erroneous entries on reports, patient charts, or other agency records. 2 Dishonesty. 3 Unauthorized alteration or destruction of agency records including patients’ charts. 4 Coding or billing which violates Medicaid rules or regulations or other federal rules or regulations. 5 Behavior detrimental to the operation.
Other unacceptable conduct may be found in the handbook.
B. CONFLICT OF INTEREST
In order to perform their duties with honesty and fairness and in the best interest of the agency, employees must avoid conflicts of interest in their employment. Conflicts of interest may arise from having a position or interest in or furnishing managerial or consultative services to any concern or business from which the agency obtains goods or services or with which it competes or does business, from soliciting or accepting gifts, excessive entertainment, or gratuities from any person or entity that does or is seeking to do business with the agency and from using agency property for personal or private purposes. Conflicts also may arise in other ways. If an employee has any doubt or any question about any of his or her proposed activities, guidance or advice should be obtained from the Director of Human Resources or the Personnel Operations Manager in the Department of Human Resources.
C. CONFIDENTIALITY OF INFORMATION
A patient’s health care record is the property of the agency and shall be maintained to serve the patient, necessary health care providers, the institution, and third-party payers such as Medicaid in accordance with legal, accrediting and regulatory agency requirements. The information contained in the health care record belongs to the patient and the patient is entitled to the protection of that information. All patient care information is regarded as confidential and available only to authorized users such as treating or consulting physicians and employees who may be providing patient care and to third party payers in order to facilitate reimbursement. The operations, activities, business affairs, and finances of the agency should also be kept confidential and discussed or made available only to authorized users.
D. WORKPLACE ADMINISTRATIVE SEARCHES
To assist in providing a reliable, efficient, and productive workforce for the proper care of patients, to assist in providing employees with a safe working environment, to assist in the effective operation of the Compliance Program, and to supplement the Drug and Alcohol Policy, supervisors may conduct unannounced administrative searches of agency premises, offices, work areas, property and equipment and the contents of such property and equipment. No employee should have any expectation of privacy on the agency property or in their offices or work areas including lockers, desks, cabinets, drawers, shelves or trash cans or in folders, envelopes, or packages located on the agency premises. Personal possessions or materials should not be brought to work if they are of a sensitive or confidential nature. The agency policy on Workplace Administrative Searches is Policy see attached. A copy may be obtained from the Department of Human Resources. Other policies permit monitoring of and access to computers by supervisors. The use of computers, e-mail, and access to the Internet must be reasonable and responsible.
E. FRAUD AND ABUSE
Employees shall refrain from conduct, which may violate fraud and abuse laws. These laws prohibit (1) direct, indirect or disguised payments in exchange for the referral or patients; (2) the submission of false, fraudulent, or misleading claims to any government entity or a third-party payer, including claims for services not rendered, claims which characterize the service differently than the service actually rendered or claims which do not otherwise comply with the applicable program or contractual requirements; and (3) making false representations to any person or entity in order to gain or retain participation in a program or to obtain payment or excessive payment for any service.
F. BUSINESS ETHICS
Employees must accurately and honestly represent the agency and should not engage in any activity or scheme intended to defraud anyone of money, property, or honest services.
G. FINANCIAL REPORTING
All financial reports, accounting records, research reports, expense accounts, timesheets, and other documents must accurately and clearly represent the relevant facts or the true nature of a transaction. Improper or fraudulent accounting, documentation, or financial reporting is not only contrary to agency policy, but it may also be in violation of applicable laws. Sufficient and competent evidential matter or documentation shall support all cost reports.
H. PROTECTION OF ASSETS
The agency will make available to employees assets and equipment necessary to conduct agency business including such items as computer hardware and software, billing and medical records, both hardcopy and in electronic format, fax machines, office supplies. Employees should strive to use agency assets in a prudent and effective manner. The agency property should not be used for personal reasons or be removed from the agency without approval from a departmental manager.
I. ANTI-COMPETITIVE CONDUCT
The agency will not engage in anticompetitive conduct that could produce an unreasonable restraint of trade of a substantial lessening of competition. Evaluation of anti-competitive conduct requires legal guidance. Communication by employees with competitors about matters that could be perceived to have the effect of lessening competition or could be considered as collusion or an attempt to fix prices should take place only after consultation with legal counsel.
J. CREDIT BALANCES
The agency will comply with Federal and state laws and regulations governing credit balance reporting and refund all overpayments in a timely manner.
K. FINANCIAL INDUCEMENTS
No employee shall offer any financial inducement, gift, payoff, kickback, or bribe intended to induce, influence, or reward favorable decisions of any government personnel or representative, any customer, contractor, or vendor in a commercial transaction or any person in a position to benefit the agency or the employee in any way. Employees are strictly prohibited from engaging in any corrupt business practice either directly or indirectly. No employee shall make or offer to make any payment or provide any other thing of value to another person with the understanding or intention that such payment or another thing of value is being used for an unlawful or improper purpose. Appropriate commissions, rebates, discounts, and allowances are customary and acceptable business inducements provided that they are approved by Administration and that they do not constitute illegal or unethical payments. Any such payments must be reasonable in value, competitively justified, properly documented, and made to the business entity to which the original agreement or invoice was made or issued. Such payments should not be made to individual employees or agents of business entities.
L. ADDITIONAL STANDARDS
The agency has adopted a number of other agency-wide policies and procedures. Employees may obtain copies in the Compliance office. Additional standards and policies may be applicable only to particular departments and copies may be obtained from supervisors or directors in those departments. It is particularly important that coding, billing, and submission of claims to Medicaid and other third-party payers, be appropriate, accurate, and in compliance with applicable laws and regulations. Standards relating to billing will be found in a later section of this Program. These Standards of Conduct apply to all employees, including supervisors, managers, directors, and administrators. They also apply to temporary and contract employees and where practical to independent contractors doing business with the agency and to physicians on the Medical Staff. These Standards are not intended to cover every situation that may be encountered and employees should comply with all applicable laws and regulations whether or not specifically addressed in the Standards.
Questions about the existence, interpretation, or application of any law, regulation, policy, or standard should be directed, without hesitation, to an employee’s supervisor, manager, or director or to the Compliance Officer mentioned in a later section of this Program. Because laws, regulations, and policies are constantly evolving, this Compliance Program will be revised and updated as needed. Revisions will be communicated timely to agency employees. Failure to comply with the Standards of Conduct or to conduct business in an honest, ethical, reliable manner can result in civil fines or criminal penalties against the agency and its employees or disciplinary action by the agency, including termination. Supervisors are responsible for ensuring that their employees receive a copy of this Program and participate in mandatory training related to the Program.
M. FALSE CLAIMS ACT
The Federal False Claims Act is a law that prohibits a person or entity, such as the agency from “knowingly” presenting or causing to be presented a false or fraudulent claim for payment or approval to the Federal Government and from “knowingly” making, using or causing to be made a false record or statement to get a false or fraudulent claim paid or approved by the Federal Government. These prohibitions extend to claims submitted to federal health care programs, such as Medicare and Medicaid. The terms “knowing” and “knowingly” are having knowledge of the information, acts in deliberate ignorance of the truth or falsity of the information, and acts in reckless disregard of the truth or falsity of the information.
A person or entity found guilty of violation can be obligated to civil penalty up to $11,000 plus three times the amount of actual damages. A person or entity can also find themselves excluded from the Medicare and Medicaid programs if found in violation.
Note: A private person who brings civil actions for violations to the False Claims Act is entitled to receive percentages of monies obtained through settlements and is protected by the Non-Retaliation and Non-Retribution for Reporting Policy of the Compliance Program. False Claims Act makes it unlawful to knowingly make a false statement or representation (or deliberate concealment of any material fact or other fraudulent scheme or device) to attempt to obtain Medicaid payments for services or supplies furnished under the Medical Assistance Program. A violation of this Act can result in civil damages three times the overstated amount or $5,000, whichever is greater. The Agency or individual may also be required to pay a civil monetary penalty to the Medicaid program if it was known that the services or supplies were not medically necessary, not provided as claimed, if the person requesting such were excluded from the program or the services or supplies for which payment was received were not provided.
The State program may impose the threat of criminal prosecution who had the intent to defraud the State program a Class A misdemeanor punished in accordance with the penalties fixed by such law.
N. NON-RETALIATION AND NON-RETRIBUTION FOR REPORTING
The agency understands that employees may not report concerns if they feel that they will be subject to retaliation or retribution or harassment for reporting the concern. To reassure employees who wish to report concerns through the Compliance Line, or directly to the Compliance Department, a non-retaliation/non-retribution policy has been established. Supervisors, managers, or employees are not permitted to engage in retaliation, retribution, or any form of harassment directed against an employee who reports a compliance concern.
Anyone who is involved in any act of retaliation or retribution against an employee that has reported suspected misconduct in good faith will be subject to disciplinary action. Employees have the responsibility to report, in good faith, concerns about actual or potential wrongdoing.
The agency is committed to a policy that encourages timely disclosure of such concerns and prohibits any action directed against an employee, manager, or staff member for making a good faith report of concern.
Any manager, supervisor, or employee who engages in retribution, retaliation, or harassment against a reporting employee is subject to discipline up to and including dismissal on the first offense.
All instances of retaliation, retribution, or harassment against reporting employees will be brought to the attention of the Compliance Officer who will, in conjunction with Legal and Human Resources, investigate and determine the appropriate discipline, if any. If an employee reports a concern regarding his or her own inappropriate or inadequate actions, reporting those concerns does not exempt him or her from the consequences of those actions.
Prompt and forthright disclosure of an error by an employee, even if the error constitutes inappropriate or inadequate performance, will be considered a positive constructive action by the employee.
Compliance with and the promotion of the Standards of Conduct will be a factor in evaluating the performance of agency employees. Following the Standards of Conduct is not hard to do. Employees should not be apprehensive or frightened.
Employees may stop by in person and speak to Ramona Diego, the Compliance Officer, or call 877-713-7878.
Conflict of Interest Policy
All members of the Board of Directors, Governing Body/Management Team, office staff, and nurses will sign a Conflict of Interest Statement. These statements will be kept in a file in the President’s office. All board members and management personnel will disclose any existing or potential conflicts of interest.
To ensure no conflict of interest. The Agency defines “conflict of interest” as those activities or actions which:
• Conflict with the mission, philosophy of objection of the Agency.
• Violate local, state, or federal regulations.
• Place the Agency, personnel, clients, or their families at risk ethically, financially or legally.
• To protect the Agency’s assets, both material, concepts, and publications, as well as to include:
- Confidentiality of patient diagnosis. - Financial matters - Staff salaries - Nursing or executive plans that can go to unauthorized agencies - Anything given to staff (e.g. forms, systems, equipment) that go to unauthorized people.
1. A signed statement from Governing Body/Management members to assure compliance with the privacy of company policies.
2. The Board of Directors will review relationships with other agencies, organizations, educational organizations, health care providers, and payers, in order to ensure that those relationships comply with local, state, and federal regulations, as well as promote the Agency’s mission and philosophy.
3. The Board Members and staff upon hire will sign the Conflict of Interest form attached, during orientation. Forms are filed in the administrative office.
4. The Agency has coordinated its Conflict of Interest Statement with company attorney and financial officers for legality and appropriateness.
5. Conflict of Interest includes:
• Double billing • Patient’s referral to the agency you also work for • Kickbacks