DOMINICAN SISTERS FAMILY HEALTH SERVICE INTRODUCTION Founded in N.Y.C. in 1879, Dominican Sisters Family Health Service, Inc. (DSFHS) has a long history as a religious sponsored Visiting Nurse Service. In 1966, DSFHS became an accredited home health agency under the Social Security Act and participated in the Medicare and Medicaid Programs. Reimbursement is also received from other Third Party Payors. The Board of Directors of DSFHS sets the direction and policies of the Agency. In its fiduciary responsibilities the Board of Directors exercises stewardship in providing care at reasonable costs to patients while promoting the health of people in communities served by the DSFHS. The Board has determined that the DSFHS will be in compliance with all applicable federal, state, and local laws, regulations, and private accreditation body standards. Each employee of DSFHS is expected to adhere to this high standard whenever he or she acts on behalf of DSFHS, whether dealing with other employees, with patients and their families, with vendors, with government representatives or with the general public. Violations of legal or ethical requirements jeopardize the welfare of DSFHS, its employees and patients and the communities it serves. COMPLIANCE POLICY The Compliance Policy evidences the policy of the DSFHS regarding compliance with all applicable federal, state and local laws, including, but not limited to, the Federal False Claims Act, all applicable regulations governing participation in the Medicare and Medicaid Program, the requirements necessary to maintain DSFHS’s exemption from federal, state and local taxes, the Stark Bill, the Medicare and Medicaid Anti-kickback laws, the state licensure regulations, and the federal, state, and local civil rights law. A. General Principles 1. It is the policy of DSFHS to comply with all applicable federal, state, and local laws and regulations, both civil and criminal. 2. No employee has any authority to act contrary to the provision of the law or to authorize, direct, or condone violations offered by any other employee. 3. Any employee or agent of DSFHS who has knowledge of facts concerning the Agency’s activities that he or she believes might violate the law has an obligation, promptly after learning such facts, to report the matter to his or her immediate superior or to the institution’s compliance monitor. DSFHS - Corporate Compliance Policy 4. The DSFHS will take steps to communicate effectively its standards and procedures to all employees and agents by requiring participation in inservice programs and by disseminating publications that explain in a practical manner what is required. 5. The DSFHS will take steps to achieve compliance with its standards by utilizing monitoring and auditing systems reasonably designed to detect inappropriate conduct by its employees and agents and by having in place and publicizing a reporting system where-by employees and other agents can report inappropriate conduct by others within the organization without fear of retribution. 6. This Compliance Policy will be consistently enforced through mechanisms, which may include, discipline of individuals responsible for the failure to detect an offense and those individuals who commit or conduct an offense. The form of discipline will be appropriate and case-specific. 7. In the event an offense is identified, the DSFHS will take all reasonable steps to respond appropriately to the offense and to prevent further similar offenses--including any necessary modifications to its program to prevent and detect violations of law. B. Commitments The DSFHS is a non-profit organization that is organized for the delivery of home care services and the promotion of the health of the individuals who reside in the DSFHS service areas. In order to further its purposes, the DSFHS, its Board, officers, employees, and agents hereby express the following commitments: 1. To the community: the DSFHS is committed to the promotion of health and to using the Agency’s best efforts to satisfy the home care needs of the community while operating in a fiscally responsible manner. 2. To DSFHS employees: the Agency will implement and maintain employment practices and programs that comply with all applicable federal, state and local laws. 3. To DSFHS patients: the Agency is committed to providing quality care, that is responsive to patient needs and complies with government laws and resources that govern the operation of a non-profit, home care agency. The Agency is also committed to maintaining accreditation by the Joint Commission on Accreditation of Healthcare Organizations and/or other such accreditation bodies as the Agency may determine. 4. To third-party payors, both private and public: the DSFHS is committed to submitting bills for services in an timely and accurate fashion and reporting all reimbursable costs to the Medicare and Medicaid program and to other third parties in an appropriate manner. 2 DSFHS - Corporate Compliance Policy 5. To the DSFHS vendors: the Agency stresses a sense of responsibility that enables it to be a good customer. When the Agency determines that is in its best interest to utilize a competitive bidding process, DSFHS is committed to a fair and equitable bidding process. 6. To all who do business with DSFHS, the Agency shall conduct its business in a manner that is consistent with the Agency’s philosophy and mission and all other applicable laws and regulations. C. Federal and State Tax-Exempt Status 1. DSFHS is a not-for-profit, religious sponsored organization that is exempt from federal taxation pursuant to Section 501(c)(3) of the Internal Revenue Code. That tax- exempt status could be jeopardized if any of the tax-exempt benefits enjoyed by the Agency inure to the benefit of certain private individuals. All employees, consultants, and agents who contract with DSFHS must do so in a manner that is consistent with the Agency’s policies. 2. Political contributions and activities might also jeopardize DSFHS’s federal tax- exempt status. No funds or assets, including the work time of any employee, will be contributed, loaned, or made available directly or indirectly to any political party or to the campaign of any candidate for federal, state, or local office. Any involvement and participation in a political campaign by employees must be on an individual basis, on their own time, and at their own expense. Further, when an employee speaks on public issues, it must be made clear that comments or statements made are those of the individual and not of the Agency. 3. The DSFHS is also exempt from certain state and local taxes, including but not limited to state income tax, state sales tax, and local real estate taxes. All employees must make a good faith effort not to jeopardize the Agency’s exemption from state and local taxation. D. Compliance Monitor. 1. The President/CEO designates the Performance Improvement Coordinator as its Corporate Compliance Monitor. Each employee has a duty to report any suspected violations of any of these Standards to the Compliance Monitor. When the Compliance Monitor is made aware of a potential violation of these Standards, the Compliance Monitor will contact the Agency’s President. When necessary, the Compliance Monitor, in consultation with the Executive Committee, is authorized to secure the opinions of outside legal counsel, consultants, and other experts in compliance issues. Any investigation of a suspected violation of these standards shall be done by the Compliance Monitor in consultation with the Executive Committee and outside legal counsel, when indicated. 3 DSFHS - Corporate Compliance Policy 2. The Compliance Monitor shall also review and, determine if reasonable to do so, disseminate to appropriate parties the monthly program exclusion listing by the Inspector General’s Office and the Department of Health and Human Services that are published in the Federal Register from time to time. The Compliance Monitor will also regularly review and disseminate new statutes, regulations, pronouncements, or directives of the federal or state government, the government’s fiscal intermediary, any third-party payors, or any association or trade publication that might affect these Standards. 3. The Compliance Monitor shall also monitor DSFHS’s continued compliance with the terms and conditions set forth in any settlement agreement that might be executed by the Agency with the federal, state or local government. E. Duty to report violations of these standards It is the duty of each employee to report promptly any suspected violation of these Standards to the Compliance Monitor. The Compliance Monitor’s telephone number is 914-941-1710 extension 138. The Compliance Hot Line Number is 914-941-1710 extension 333. Alternately, suspected violations of these Standards may be reported to the President/Chief Executive Officer (CEO). F. Conclusion. If any employee has a question concerning a particular provision contained herein, or concerning any practice not addressed in this document, he or she should confer with the Compliance Monitor or the President/CEO. 8/02 9/07 ADDENDUM A Applicable Laws 4 ADDENDUM A Applicable Laws The following is a summary of some of the specific laws prohibiting false/fraudulent claims for payment to public health care programs (including Medicare and Medicaid) that apply to DSFHS. While not exhaustive, these are the laws primarily used by the government to prosecute and prevent fraud, waste and abuse in its taxpayer financed health programs. The Federal Civil False Claims Act (31 U.S.C. § 3729 et seq.) The False Claims Act (“FCA”) was originally enacted during the Civil War to address the problem of fraud among defense contractors. The current version of the FCA (c. 1982-1986) was designed to enhance the government’s ability to detect and recover losses due to fraud. The FCA prohibits the: Knowing submission (actual knowledge or deliberate ignorance) of a false or fraudulent claim for payment and/or knowingly making a false record or statement to secure government payment and/or conspiring with others to get such a claim allowed or paid. Employees who report potential violations of the FCA may not be discharged, demoted, harassed or discriminated against as a consequence of reporting. This aspect of the FCA is known as “whistleblower” protection. Civil and Administrative Penalties under the FAC include but are not limited to: A fine of $5,500 to $11,000 per claim. Up to 3 times the amount of actual damages (losses) sustained. Payment of all costs incurred by the government to recover losses. Exclusion from participating in Federal Health insurance programs. Remedies may be sought under the Program Fraud Civil Remedies Act 31U.S. § 3810. Private individuals, called qui tam relators, may bring lawsuits for violations of the FCA and may be awarded a portion (15.25%) of the proceeds if the government takes the case. If the government does not take the case, a qui tam relator can still bring a lawsuit on his/her own, and if successful, may be awarded 25-30% of the proceeds. But, if unsuccessful, and if the lawsuit is frivolous, then a qui tam relator may be responsible for the defense costs of the provider. New York State False Claims Law & Whistleblower Protections New York’s False Claims Act is very similar to the Federal law, including provisions for qui tam suits and whistleblower protection. In addition to Federal and State False Claims law, New York State makes it a crime to knowingly and willfully submit false information or conceal a material fact for the purpose of obtaining greater compensation than is otherwise permitted under a public or private health plan (including HMO’s). “Health Care Fraud” may be a Class A misdemeanor, or Class E-A felony, depending on the amount of payment wrongfully sought or received. NYS Penal Law Article 177 and NY Social Service Law § 366-b(2). Also, NY Social Service Law §145-b provides for civil penalties for fraudulent claims which include fines of 3 times the amount of falsely overstated charges and civil monetary payments of $2,000 for each item or service paid as restitution to the Medical Assistance Program ($7,500 for repeat offenders). NYS Labor Law §740 prohibits employers from taking retaliatory action against an employee who discloses (or threatens to disclose) a violation of law. An employer who is discharged, demoted, disciplined or otherwise discriminated against can bring a lawsuit against his/her employers but will only receive NYS “whistleblower” protection if he/she brought the issue to the attention of his/her employer and afforded the employer a reasonable opportunity to correct the problem.
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