VISITING PHYSICIANS ASSOCIATION COMPLIANCE PLAN by saj38576

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									    VISITING
  PHYSICIANS
  ASSOCIATION
COMPLIANCE PLAN




                  January 2008
         A Message From The VPA Medical Director
         And The Chief Executive Officer of USMM

Visiting Physicians Association (VPA), along with U.S. Medical Management (USMM),
VPA’s management company (hereinafter jointly referred to as “VPA”) are committed to
conducting business with integrity and in accordance with federal, state and local laws.
We are proud of our honest reputation, due largely to employees like yourself. To further
this tradition, we have enhanced and revised the VPA Corporate Compliance Program to
more fully set forth our standards and rules for ethical business practices for all
employees, management and business partners.

This document provides general guidelines to help you understand how VPA wishes to
conduct business and, as such, governs the conduct of all VPA employees and
management. We want to ensure that everyone understands VPA’s Compliance Program
and that all questionable, unethical or illegal conduct is reported, fully reviewed, and
subjected to the appropriate action. While this document may be a valuable guide, it may
not provide answers to all issues. You should all be familiar with the policies and
procedures relevant to your specific duties and responsibilities and seek clarification or
advice, as needed, from your manager, supervisor, or VPA’s Compliance Officer. Your
dedication to these standards will allow us to continue to provide compassionate, cost-
effective care to those in need. Thanks for helping us maintain our fine tradition of
integrity.

                                         Sincerely,



                                         Erlinda del Pilar, M.D., Medical Director, VPA
                                         Mark Mitchell, CEO, USMM
                          TABLE OF CONTENTS

  I. INTRODUCTION

  II. STATEMENT OF POLICY

        A. BENEFITS OF A COMPLIANCE PLAN
        B. THE DIFFERENCE BETWEEN “FRAUDULENT” AND "ERRONEOUS"
           CLAIMS TO FEDERAL HEALTH PROGRAMS

  III. CODE OF CONDUCT

      ALL EMPLOYEES ARE REQUIRED TO HAVE A SIGNED COMPLIANCE
      PLAN AFFIRMATION STATEMENT IN THEIR EMPLOYEE FILE (H.R.)


  IV. THE SEVEN BASIC COMPLIANCE PROGRAM ELEMENTS

     STEP ONE:   AUDITING AND MONITORING

     STEP TWO: WRITTEN POLICIES
        A. EMPLOYEE/MANAGER/SUPERVISOR RESPONSABILITIES
        B. MANAGER’S ADDITIONAL RESPONSIBILITIES
        C. NEW EMPLOYEE POLICY
        D. VENDORS

     STEP THREE: DESIGNATION OF A COMPLIANCE OFFICER AND COMMITTEE
        A. COMPLIANCE OFFICER’S RESPONSIBILITIES
        B. COMPLIANCE COMMITTEE’S RESPONSIBILITIES
        C. PROCEDURES FOR MAINTENANCE OF THE PROGRAM

     STEP FOUR: CONDUCTING EFFECTIVE TRAINING AND EDUCATION

     STEP FIVE: RESPONDING TO IDENTIFIED OFFENSES AND DEVELOPING
                CORRECTIVE ACTION INITIATIVES

     STEP SIX:   DEVELOPING OPEN AND EFFECTIVE LINES
                 OF COMMUNICATION

     STEP SEVEN: ENFORCING STANDARDS THROUGH WELL-PUBLICIZED
                DISCIPLINARY GUIDELINES

V. RETENTION OF RECORDS

VI. CONCLUSION


                                  i
APPENDIX A:     COMPLIANCE PLAN AFFIRMATION STATEMENT

   ALL EMPLOYEES ARE REQUIRED TO HAVE A SIGNED COMPLIANCE
   PLAN AFFIRMATION STATEMENT IN THEIR EMPLOYEE FILE (H.R.)


APPENDIX B:     COMPLIANCE TRAINING AND EDUCATION ATTENDANCE
                STATEMENT

APPENDIX C:     EXIT INTERVIEW QUESTIONS

APPENDIX D:     RIGHTS AND OBLIGATIONS OF EMPLOYEES IF CONTACTED BY A
                GOVERNMENT ATTORNEY OR AGENT

APPENDIX E:     ADDITIONAL RISK AREAS

  I. Reasonable and Necessary Services
        A. Local Medical Review Policy (LMRP) and Local Carrier Decisions (LCDs)
        B. Advanced Beneficiary Notices
        C. Physician Liability for Certifications in the Provision of Medical Equipment and
           Supplies
        D. Billing for Non-covered Services as if Covered

  II. Physician Billing Practices
         A. Professional Courtesy

  III. Other Risk Areas
          A. Rental of Space or Provision of Equipment in VPA Offices by Persons or Entities
              to Which Physicians Refer

APPENDIX F:     CRIMINAL STATUTES

  I. Health Care Fraud (18 U.S.C. 1347)

  II. Theft or Embezzlement in Connection with Health Care (18 U.S.C. 669)

  III. False Statements Relating to Health Care Matters (18 U.S.C. 1035)

  IV. Obstruction of Criminal Investigations of Health Care Offenses (18 U.S.C. 1518)

  V. Mail and Wire Fraud (18 U.S.C. 1341, 1343)

  VI. Criminal Penalties for Acts Involving Federal Health Care Programs
      (42 U.S.C. 1320a-7b)


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APPENDIX G:      CIVIL AND ADMINISTRATIVE STATUTES

  I. The False Claims Act (31 U.S.C. 3729-3733)

  II. Civil Monetary Penalties Law (42 U.S.C. 1320a-7a)

  III. Exclusion of Certain Individuals and Entities from Participation in Medicare and State
       Health Care Programs (42 U.S.C. 1320a-7)

APPENDIX H:      CARRIER CONTACT INFORMATION

APPENDIX I:      INTERNET RESOURCES




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                    VISITING PHYSICIANS ASSOCIATION
                           COMPLIANCE PLAN

I. INTRODUCTION

  This voluntarily implemented Compliance Plan (“the Plan”) is intended to ensure that
  Visiting Physicians Association (VPA) develops and implements internal controls and
  procedures that promote adherence to all applicable federal, state, and local laws, rules and
  policies relating to payment for healthcare services, including but not limited to billing,
  coding, claims submission, and improper conduct. Other purposes of the Plan are to:

  •   further VPA’s mission to provide compassionate and high quality medical care to it’s
      patients;

  •   further accentuate the organizational commitment to accurate submission of all claims to
      third parties;

  •   promote the prevention, detection and resolution of conduct which is not in conformance
      with applicable federal or state laws, rules and regulations; and

  •   minimize, through early detection and reporting, any potential loss to the government
      from erroneous claims, as well as reduce VPA’s potential exposure to damages and
      penalties that might result from questionable activities.

  The Plan, having been approved by VPA management, constitutes official organizational
  policy. VPA physicians, employees and other affiliated healthcare providers who fail to
  comply with the elements of this Plan may face disciplinary actions including reprimand,
  suspension without pay, termination, or civil and/or criminal charges.

  VPA has always strived to maintain a good faith effort to comply with applicable regulations
  and laws. In today’s dynamic healthcare environment, VPA is determined to organize,
  centralize and formalize procedures and implement required enhancements, as directed by
  the U.S. Department of Health and Human Services and the Office of Inspector General, to
  it’s existing corporate and operational policies and procedures.

  VPA is committed to pro-active management of its billing processes in order to ensure full
  compliance with Medicare and other governmental regulations. The VPA policies and
  procedures referenced in this document are meant to encompass all employees, physicians
  and vendors of VPA. It is the intention of VPA to enforce all policies and procedures, most
  importantly those designed to detect and prevent issues of non-compliance.




                                              1
II. STATEMENT OF POLICY

   It is the intent of VPA to uphold the business integrity and ethical conduct of a participant in
   governmentally-funded healthcare programs and other contractual arrangements. Delivery of
   care must be in compliance with all laws and regulations applicable to such programs as well
   as all Federal, State and local laws and regulations which govern its operations. It is the
   responsibility of every VPA manager and employee, including physicians and ancillary
   providers operating at VPA locations, to proactively identify issues relating to potential
   waste, fraud and abuse and to comply with the policies and procedures designed to minimize
   such exposure. Compliance in this area is challenging because the regulatory requirements
   governing reimbursement are complex and ever changing. To underscore and enhance its
   continued pledge of compliance and to better assist all employees, including physicians and
   allied health professionals, in this area, VPA is fully committed to this comprehensive
   Compliance Program. VPA has adopted the various directives set forth in the Office of
   Inspector General's Compliance Program Guidance for our sector of the healthcare industry
   to prevent and detect potential violations of law. The adoption and implementation of this
   voluntary Compliance Program will significantly advance the prevention of potential fraud,
   abuse and waste while, at the same time, ensuring the adherence to all governing State,
   Federal and local laws and regulations. This will serve to further the fundamental mission of
   the entire VPA organization.

   VPA’s Compliance Officer should be contacted when questions concerning compliance arise
   or to report potential violations. At any time, communication to the Compliance Officer may
   occur either by utilizing VPA’s 24 hour toll-free ComlianceLine (800-609-9783), by
   memorandum or in person. To the extent possible, all communication to the Compliance
   Officer will be treated confidentially.

A. Benefits of a Compliance Program

   The benefits of an effective and comprehensive compliance program include:

      •   effective internal procedures to ensure compliance with regulations, payment policies
          and coding rules;
      •   improved medical record documentation;
      •   improved education for all physicians and employees;
      •   reduction in the denial of claims;
      •   streamlined practice operations through improved communication and comprehensive
          policies; and
      •   the avoidance of potential liability arising from noncompliance




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An effective compliance program is essential for all healthcare providers. With adherence to this
program, VPA should clearly find it easier to comply with its affirmative duty to ensure the
accuracy of claims submitted for reimbursement.

B. The Difference Between “Fraudulent” and "Erroneous" Claims To Federal Health
   Programs

   The government realizes that physicians and other providers misunderstand the critical
   differences between “fraudulent” (intentionally or recklessly false) health care claims on the
   one hand and innocent "erroneous" claims on the other. Some medical providers feel that
   Federal law enforcement agencies have maligned medical professionals and are focused on
   innocent billing errors. These individuals are under the impression that innocent billing
   errors can subject them to civil penalties, or even jail. These feelings and impressions
   are mistaken and need to be corrected.

   To these concerns, the government has set forth the following points:

    First, the government does not disparage physicians, other medical professionals or medical
   enterprises. In their view, the great majority of medical professionals are working ethically to
   render high quality medical care to Medicare beneficiaries and to submit proper claims to
   Medicare.

   Second, under the law, physicians are not subject to civil or criminal penalties for innocent
   errors, or even negligence. The Government's primary enforcement tool, the civil False
   Claims Act, covers only offenses that are committed with actual knowledge of the falsity of
   the claim, reckless disregard, or deliberate ignorance of the falsity of the claim. The False
   Claims Act simply does not govern mistakes, errors, or negligence. The other major civil
   remedy available to the Federal Government, the Civil Monetary Penalties Law, has exactly
   the same standard of proof. The government has stated that it is very mindful of the
   difference between innocent errors ("erroneous claims") on one hand, and reckless or
   intentional conduct ("fraudulent claims") on the other. For criminal penalties, the standard of
   higher criminal intent to defraud must be proved beyond a reasonable doubt. The Attorney
   General of the United States has stated, "it is not the [Justice Department's] policy to punish
   honest billing mistakes . . . [or] mere negligence. . . . These are not cases where we are
   seeking to punish someone for honest billing mistakes."

   Third, even ethical physicians (and their staffs) make billing mistakes and errors through
   inadvertence or negligence. When billing errors, honest mistakes, or negligence result in
   erroneous claims, the government expects the physician practice to return the funds
   erroneously claimed, but without penalties. In other words, erroneous claims result only in
   the return of funds claimed in error.




                                                3
  Fourth, innocent billing errors are a significant drain on the various government-funded
  programs and all parties (physicians, providers, carriers, fiscal intermediaries, Government
  agencies, and beneficiaries) need to work cooperatively to reduce the overall error rate. But
  again, it is emphasized by the government that civil or criminal penalty action will not be
  initiated with respect to billing errors due to inadvertence or negligence, or for billings based
  on a negligent medical judgment.

  Finally, it is reasonable for physicians (and other providers) to ask: what duty do they owe
  the Federal health care programs? The answer is that all health care providers have a duty to
  reasonably ensure that the claims submitted to Medicare and other Federal health care
  programs are true and accurate. The government continues to engage the provider
  community in an extensive, good faith effort to work cooperatively on voluntary compliance
  to minimize errors and to prevent potential penalties for improper billings before they occur.
  To that end, the government has directed the implementation of compliance programs for the
  majority of health care providers. As such, VPA has pro-actively re-designed, enhanced and
  implemented this voluntary compliance program for the ongoing benefit of all those we
  strive to serve on a daily basis.

III. CODE OF CONDUCT

  Scope of Code

  This Code governs the conduct of employees at all VPA locations. The code is also
  applicable to vendors and other outside parties who interact with our organization.

  References herein to "VPA policy" denote policies common to all VPA locations and
  operations whether set forth in separate operational manuals or other reference materials
  available at our various locations.

  Basic Principles

  VPA is committed to integrity, ethical behavior, and the highest professional conduct from
  our physicians, managers, employees and others who act on our behalf. The Code of
  Conduct reaffirms our commitment to always doing what is professionally and ethically
  right, and is intended to guide us in upholding this commitment. Each physician, manager
  and employee is expected to know, understand and abide by the guidelines outlined in the
  Code of Conduct. This will ensure that we continue to provide the highest level of
  compassionate, quality health care while complying with all applicable laws, rules, and
  regulations.

  These guidelines are designed to assist each of us in making the right choices when
  confronted with difficult situations. The Code requires every member of the VPA
  organization to act with a level of integrity that is higher than what the government requires.
  We clearly understand that the responsibility for ethical behavior rests with each of us
  through the judgments we make and our own responsibilities.
                                                 4
VPA also expects each physician, manager and employee to recognize and avoid activities
and relationships that involve, or might appear to involve, conflicts of interest or behavior
that may cause embarrassment to the organization or compromise its integrity.

The following principles should help all VPA constituents to recognize questionable
situations:

   •   VPA, its staff and vendors understand and abide by the letter of the law and its spirit
       as well. Through full disclosure of even the smallest facts related to questionable
       activity, we are demonstrating our commitment to integrity.

   •   VPA and its staff will act with the highest level of ethics in our business activity. Our
       actions will demonstrate our standing as strong ethical contributors within the
       community.

   •   VPA will deal fairly and honestly with those who are affected by our actions and treat
       them as we would expect them to treat us if the situation were reversed.

   •   VPA will promote relationships based on mutual trust and respect. We will create an
       environment where we can challenge questionable activity without fear of retribution.

   •   Each of us will abide by VPA's Conflict of Interest Policy. We will disclose and
       remove any potential conflict of interest that would affect our responsibility to act
       ethically within our organization.

It is the policy of VPA to prevent unethical or unlawful behavior, to stop such behavior as
soon as reasonably possible after its discovery, and to discipline people who violate the
standards contained within the Code. This includes people who recklessly fail to detect any
such activity. No Code of Conduct can cover all circumstances or anticipate every situation.
Consequently, employees encountering situations not specifically mentioned in the Code
should apply the overall philosophy and concepts of the Code to the particular situation,
along with the highest ethical standards repeatedly discussed herein.

We expect outside colleagues, including physicians, vendors, consultants and others whose
actions are directly connected to VPA, to adhere to the same standards in their dealings with
us and with others on our behalf.




                                             5
   Individuals with questions about any part of the Code or Compliance Program should seek
   advice from his/her supervisor, the Compliance Officer, or call the VPA Compliance Hotline
   @ 1-800-609-9783.

Conducting Business

   VPA's activities involve thousands of business transactions each day. Obviously, we must
   have strict rules to guard against fraud or dishonesty and guidelines for addressing possible
   problems that may arise.

   If you witness or suspect any questionable behavior from any physician, employee or agent
   of VPA, or any person with whom VPA deals, especially in regards to the guidelines
   contained within this Compliance Program, you should report this behavior immediately so
   that it can be investigated. VPA has established a compliance hotline (1-800-609-9783)
   which is operated by a private outside vendor. Employees may report concerns anonymously
   via the hotline, and hotline operators will document and forward any such reports, to VPA's
   Compliance Officer for investigation. If evidence of a violation of the Code is established,
   any involved employee or agent is subject to disciplinary action, including termination. Any
   such evidence will be reviewed by the Compliance Officer, Senior Management, and if
   appropriate, legal counsel.

Proper Use of Assets

   VPA’s business records must always be prepared accurately and reliably. It is a given
   physician’s or manager’s responsibility to control internal accounting methods to ensure the
   accuracy of all records related to their areas of oversight and pertinent VPA’s assets.
   Physicians and managers are expected to follow established principles of accounting to
   assure an accurate record of all transactions.

Trade Practices/Antitrust

   Antitrust laws are designed to preserve and foster fair and honest competition within the free
   enterprise system. To accomplish this goal, the language of these laws is deliberately broad,
   prohibiting such activities as “unfair methods of competition” and agreements “in restraint of
   trade.” Such language gives enforcement agencies the right to examine many different
   business activities to judge their effect on competition.

   VPA fully complies with all antitrust laws. No employee, under any circumstances, has the
   authority to approve a violation of these laws. Anyone who violates the law or knowingly
   permits another employee to do so will face disciplinary action or dismissal.




                                               6
    Employees must never discuss the make-up of patients, geographic areas, or services; the
    circumstances under which business will be conducted with suppliers, insurance companies,
    patients or customers (including boycotts); or specific marketing efforts with any
    competitors. This includes all forms of communication. Further, employees should avoid
    discussions regarding the future business plans of VPA or any competitors. Finally,
    employees should never discuss prices, reimbursement, or salary levels with any competitor.

Compliance With Anti-Kickback and Corrupt Influence Statutes

    Both federal and state laws specifically prohibit any form of kickback, bribe or rebate made
    directly or indirectly, overtly or covertly, in cash or in kind to induce the purchase,
    recommendation to purchase, or referral of any kind of healthcare goods, services or items
    paid for by the Medicare or Medicaid programs. In other words, “kickback” means the
    exchange of remuneration, or anything of value. VPA must never offer or receive any
    improper remuneration. Through our business relationships, we must never be involved with
    a “kickback” for the referral of patients or patient care, or decisions regarding the use of
    particular products or the referral or recommendation of patients to other providers of goods
    and services paid for by Medicare or Medicaid.

                           VPA prefers a “Zero Tolerance” Policy to vendor
                             gifts, food of any amount or dollar value. (1)


Billing for VPA Services

    VPA and its staff provide a wide range of services. In most cases, VPA billing statements
    are provided to the patient or a third-party insurer responsible for payment. Statements must
    always reflect the services actually provided including the precise charges for those services.
    This includes any information related to the patients or their insurance coverage.

    We honestly believe that no physician, employee or other person acting on behalf of VPA
    would intentionally falsify a claim. Such conduct is a crime, is never in our best interest and
    would tarnish our name. Such actions would result in immediate and severe sanctions. An
    incorrect bill could, in certain circumstances, be deemed to be a “false claim”.

    We require all employees involved in any aspect of billing to know, understand and abide by
    Medicare, Medicaid or other third-party insurer billing rules. Each employee must use his or
    her best efforts to prevent and report errors, as well as billing situations which seem
    suspicious.




(1) Please see October 27, 2007 Policy Directive

                                                   7
Gifts and Entertainment

   Giving or receiving gifts or entertainment can be interpreted by some to be an attempt to
   create an unwanted influence from the giver on our organization. Any gift to a VPA
   employee must be documented. If a personal gift seems like it was offered in an attempt to
   improperly influence an employee or agent of our organization, it must be refused.

   If a gift is one of nominal value, and offered or received without any attempt to influence
   business activity or transactions between our employees and vendors, it may be appropriate.
   But remember, any gift may raise the issue of a "kickback”, and gifts of money are never
   allowed. An employee’s better judgment should tell them when a gift is improper. Those
   gifts should be refused to prevent embarrassment and avoid what may be an unintentional
   violation of the law. If you are unclear in certain situations where a gift is offered, please
   feel free to contact your supervisor, the VPA Compliance Officer or the VPA Compliance
   Hotline at 1-800-609-9783.


                        VPA prefers a “Zero Tolerance” Policy to vendor
                          gifts, food of any amount or dollar value. (1)


Labor and Employee Relations Matters

   VPA faces a number of labor issues every day. It is our policy to comply fully with all
   applicable wage and hour laws and other statutes regulating the employer-employee
   relationship and the workplace environment. If you have any questions about the myriad of
   laws governing labor and employee relation matters, please contact the Human Resources
   Department.

Environmental Health and Safety

   VPA takes its responsibility to the environment very seriously. We understand our financial
   and legal responsibility in the proper handling and disposal of hazardous materials and
   infectious wastes that are generated by our daily operation. It is essential that everyone at
   VPA who deals with hazardous materials and infectious waste comply with environmental
   laws and regulations and understand and follow the environmental safety procedures
   explained in our programs and existing manuals.

Occupational Health and Safety

   VPA believes that every employee should work in a safe environment. The state and federal
   government has instituted laws regarding occupational safety and job related hazards. Strict
   attention should be given to those laws so that we may safely continue to provide the highest
   level of service to the communities we serve.
                                               8
Medicare and Medicaid Requirements

    VPA is a participant in the Medicare and Medicaid programs, both of which are governed by
    complicated laws and regulations. These laws are strict and much more extensive than those
    of non-government commercial contracts. For example, the Medicare and Medicaid
    payment guidelines identify not only under which scenarios, but also how much, they will
    reimburse VPA for goods and services rendered to patients covered under those programs.
    These guidelines are often times different than directives received from other third-party
    payers. Violations of these laws and regulations can result in criminal sanctions being
    imposed, not only on the employees actively involved, but also on the organization for
    whom they work. If VPA were found to be involved, it could be banned from further
    participation in the Medicare and Medicaid programs. It is essential, therefore, that there be
    strict compliance with all Medicare and Medicaid laws and regulations.

Employee Loyalty and Conflicts of Interest

    VPA expects its employees to serve the organization with undivided loyalty. VPA's interests
    must be placed ahead of any other business and commercial interest that you may have as an
    individual. Avoid situations in which a conflict of interest, or the appearance of a conflict,
    could arise.

Safeguarding the Privacy of Our Patients

    Our business requires us to gather a great deal of protected health information (known as
    PHI) about our patients. Therefore, we must always protect our patients’ right to privacy,
    prevent the misuse of information identifiable to them, and limit access to that information.
    Any employee who discloses information in violation of the privacy rights of our patients or
    others may be subject to immediate termination, in addition to possible civil or criminal
    punishment.

Confidentiality of VPA Information

    One of VPA’s most valuable assets is our body of confidential information. Computers
    make this information readily accessible to employees on all levels. Failure to protect this
    information can lead to the loss of highly confidential protected health information and other
    confidential data that may place all of us at great legal or other risk. Employees, either
    during their employment, or after, must never use any confidential information, whether
    patient-related or otherwise, obtained during their employment for any reason in any
    circumstance without the written consent of VPA. Every VPA employee acknowledges that
    the mere identity of a VPA patient is deemed confidential information.




                                                9
Information Owned by Others

   Other organizations and individuals have confidential information that they strive to protect,
   but sometimes disclose for a particular business purpose. If you have access to another
   party's confidential information, you can prevent accusations that you misused their
   information by following certain guidelines. Never use, copy, or distribute their information
   unless you are doing so in accordance with the terms of their agreement with our
   organization.

   This is especially true in acquiring software from others. Software is protected by copyright
   laws and may also be protected by patent, trade secret laws or as confidential information.
   Such software includes computer programs, databases and related documentation owned by
   the party you are dealing with or by a third party. The terms and conditions of software
   license agreements, such as provisions not to copy or distribute programs, must be strictly
   followed. Never, under any circumstances, bring in or install personal copies of software
   from your home or personal computer for use on any computer equipment owned or
   operated by VPA.

Record Retention/Destruction

   VPA is required by law to keep certain types of medical and business records for a specific
   period of time. Failure to keep these documents for their minimum time period could
   subject VPA to penalties and fines, cause the loss of rights, obstruct justice, place the
   organization in contempt of court, or put us at a serious disadvantage if the issue were to go
   to court. These records include hard copies, computer records, electronic systems,
   microfiche and microfilm.

   In direct relation to this, all records must be fully and accurately completed. We make many
   decisions about patient treatment based on these records. We also use them to calculate how
   much a patient will be billed. Without accurate information, we cannot fulfill our
   obligations to the patients, medical and nursing staff, and our vendors. It is every
   employee’s job to take great care in both documenting records correctly and dealing with
   records in an appropriate manner.

Government Inquiries

   VPA has established guidelines on how and when to respond to government inquiries. If we
   provide government officials with inaccurate or incomplete information, we may make a
   simple legitimate inquiry much more complicated. Any information that an employee
   discloses without authorization jeopardizes the rights of our patients and puts our
   organization at risk. Therefore, we must follow procedures when responding to all
   government investigations.


                                              10
   Employees of VPA who are approached by any federal or state law enforcement agency, or
   other officials seeking any information about our organization or any of its agents or
   employees, should call the Compliance Officer or senior management before providing any
   information. In addition, please: (1) obtain the name and affiliation of the person asking for
   the information before supplying it, (2) maintain a written record of each and every
   document they are given access to; and (3) keep a detailed record of all telephone contacts
   made, including names, information requested, and responses given to questions.

Commitment To Fairness

   VPA recognizes that its greatest strength lies in the talents and abilities of its employees.
   Although the tasks of our employees may be different, we have established the following
   guidelines to ensure that each employee is treated with fairness and equality:

       •   VPA provides equal opportunity for employment and advancement on the basis of
           ability and aptitude without regard to race, color, creed, age, sex or sexual
           orientation, handicaps or national origin, except where age, sex or physical status is a
           bona fide occupational qualification.

       •   VPA protects the health and safety of our employees in their work environment.

       •   VPA will compensate employees according to their performance, and provide
           equitable benefits within the framework of prevailing practices.

   VPA is committed to a work environment in which all individuals are treated with respect
   and dignity. Each employee has a right to work without fear of sexual harassment.
   Discrimination or harassment, whether based on race, color, religion, gender, national
   origin, age, disability or sexual orientation, in or out of the workplace, is unacceptable and
   will not be tolerated.

   Our employee handbook has been designed to educate every employee about matters of
   discrimination. Each employee is expected to know, understand and follow discrimination
   guidelines without exception.

Questions Regarding the Code

   The Compliance Officer is responsible for the implementation and ongoing operation of
   VPA's Corporate Compliance Program as well as making sure each employee abides by the
   Code of Conduct. Employees with questions about the Compliance Program or Code of
   Conduct should contact the Compliance Officer in person, in writing or by calling the
   compliance hotline at 1-800-609-9783.



                                               11
Reporting of Violations

    VPA expects all employees to report suspect or questionable conduct to the Compliance
    Officer or the person designated by the Compliance Officer to handle such matters. Reports
    can be made anonymously if desired. Failure to report misconduct can be seen as
    misconduct itself. So we must strongly encourage the immediate reporting of any action
    that is questionable. Failure to do so may result in disciplinary action against those who fail
    to report. Any manager or supervisor who receives a report of a potential Code violation
    must likewise immediately contact the Compliance Officer. There will be no retribution for
    those who report misconduct in good faith and the identity of the employee making the
    report will be kept confidential if at all possible.

Investigation of Violations

    All reported violations of the Compliance Program and Code of Conduct will be
    investigated by the Compliance Officer in a timely manner. To protect our interests and
    fulfill our legal obligations where applicable, these matters will be addressed confidentially.
    Furthermore, employees are required to cooperate in the investigation of alleged violations
    and may be disciplined for not cooperating in any such investigation.

Discipline for Violations

    Disciplinary action may be taken for:

       •   Involvement in any activity, that in any way violates the Compliance Program or
           Code of Conduct.

       •   Failure to report any violation of the Compliance Program, Code of Conduct or to
           cooperate in an investigation.

       •   Physicians, supervisors or managers who fail to detect, or purposefully overlook,
           misconduct from employees for whom they are responsible.

       •   Retaliation against anyone who reports possible or actual violations of the
           Compliance Program or Code of Conduct.

    Disciplinary action may include dismissal. Other options are detailed in the VPA Employee
    handbook but all concerned individuals should know that principles of fairness will apply.




                                               12
Individual Judgment

   VPA staff are often faced with making critical judgments based on activities in the
   workplace. The following questions are intended to help employees evaluate situations and
   respond in a manner that would be appropriate:

       •   Is my action consistent with VPA’s established policies and procedures?

       •   Could my action give the appearance of misconduct?

       •   Will the action bring discredit to any employee or to VPA if publicized?

       •   Can I defend my action to my supervisor, to other employees and to the general
           public?

       •   Does my action meet my own personal standards of integrity?

       •   Does my action conform to the spirit of the Compliance Program and Code of
           Conduct?

IV. THE SEVEN BASIC COMPLIANCE PROGRAM ELEMENTS

   The federal government has set forth seven basic elements necessary for an “effective”
   compliance program. Regulations state:

    An effective program to prevent and detect violations of law means a program that has been
   reasonably designed, implemented, and enforced so that it generally will be effective in
   preventing and detecting criminal conduct. Failure to prevent or detect the instant offense, by
   itself, does not mean that the program was not effective. The hallmark of an effective
   program to prevent and detect violations of law is that the organization exercised due
   diligence in seeking to prevent and detect criminal conduct by its employees and other
   agents. Due diligence requires, at a minimum, that the organization must have taken the
   following types of steps:

      1.      Auditing & Monitoring

              The organization must have taken reasonable steps to achieve compliance by
              conducting internal auditing and monitoring through the performance of periodic
              audits.




                                               13
       2.     Organizational Standards & Procedures

              The organization must have established compliance standards through the
              development of operational policies and procedures available to all relevant
              personnel.

       3.     Designation of a Compliance Officer and Compliance Committee

              Specific individual(s) within the organization must have been assigned
              responsibility to oversee compliance with the specific organizational standards
              and procedures.

       4.     Training

              The organization must have taken steps to communicate effectively, via
              comprehensive training, its standards, procedures, policies and practice ethics to
              all employees and other agents.

       5.     Response & Correction

              After an offense has been detected, the organization must have taken all
              reasonable steps to respond appropriately to the offense and to prevent further
              similar offenses-including any necessary modifications to its compliance program
              to prevent and detect violations of law.

       6.     Open Lines of Communication

              The organization must have developed accessible lines of communication, such as
              a hotline, discussions at staff meetings regarding fraudulent or erroneous conduct
              issues and community bulletin boards, to keep physicians and employees updated
              regarding compliance activities.

       7.     Enforcement & Discipline

              The standards must have been consistently enforced through appropriate
              disciplinary mechanisms, including, as appropriate, discipline of individuals
              responsible for the failure to detect an offense. Adequate discipline of individuals
              responsible for an offense is a necessary component of enforcement; however, the
              form of discipline that will be appropriate will be case specific.

In light of the foregoing directives, VPA has implemented the following areas to ensure optimum
compliance throughout the organization:


                                               14
STEP ONE: AUDITING AND MONITORING

An ongoing evaluation process is important to a successful compliance program. This ongoing
evaluation will include not only whether the organization’s standards and procedures are in fact
current and accurate, but also whether or not the compliance program is effective, i.e., whether
individuals are properly carrying out their responsibilities and claims are submitted
appropriately.

Auditing and monitoring procedures will enable VPA to continually assess the Compliance
Program’s effectiveness while ensuring compliance with applicable laws, regulations, policies
and procedures. An integral part of VPA’s Compliance Program will be the ongoing auditing
and monitoring of billing and coding practices, processes and adherence to the Compliance
Program. The ongoing evaluation process is critical to the success of VPA’s Compliance
Program. Compliance reports will be given to the Compliance Committee and VPA’s senior
management, either orally or in writing, by the Compliance Officer on a periodic basis.

Although many monitoring techniques are available to VPA, the most effective tool to promote
and ensure compliance will be the performance of periodic compliance audits by internal or
external auditors who have expertise in federal and state healthcare statutes, regulations and
requirements. The audits may occasionally focus on VPA’s programs or divisions that have
relationships with third-party contractors, specifically those with substantive exposure to
governmental enforcement actions.

Monitoring techniques may include sampling protocols that will permit the Compliance Officer
to identify and review variations from an established baseline. If an inquiry determines that a
deviation occurred for legitimate, explainable reasons, the Compliance Officer, manager or
supervisor may want to either limit corrective action or take no action at all. If a determination is
made that the deviation was caused by improper procedures, misunderstanding of rules and/or
systemic problems, VPA will take prompt steps to correct not only the potential problem, but
initiate possible amendments to the organization’s Compliance Program. Any potential
overpayments discovered as a result of deviations will be promptly refunded to the affected
payor in a manner determined to be appropriate upon consultation with management and legal
counsel.

VPA will also undertake periodic reviews of whether the elements of VPA’s Compliance
Program have been satisfied. Areas analyzed may include appropriate dissemination of the Code
of Conduct and Compliance Program, training, ongoing educational programs and disciplinary
actions, among others. This process will verify actual conformance by all departments with the
Compliance Program. When monitoring discloses program deficiencies, appropriate
modifications will be implemented by the authorized VPA individuals.

As part of the review process at VPA, the Compliance Officer, or designated reviewer(s), might
utilize the following techniques:


                                             15
   •   testing billing staff on their knowledge of reimbursement coverage criteria and
       official coding guidelines (e.g., present hypothetical scenarios of situations
       experienced in daily practice and assess responses);
   •   on-site visits to all facilities and locations;
   •   ongoing risk analysis and vulnerability assessments of VPA’s operations;
   •   assessment of existing relationships with physicians, and other potential referral
       sources;
   •   unannounced audits, mock surveys, and investigations;
   •   examination of VPA’s hotline logs;
   •   checking personnel records to determine whether any individuals who have been
       reprimanded for compliance issues in the past are among those currently engaged in
       improper conduct;
   •   interviews with personnel involved in management, operations, sales and marketing,
       claim development and submission, and other related activities;
   •   questionnaires developed to solicit impressions of VPA’s employees;
   •   interviews with physicians or other authorized persons who order services provided
       by VPA;
   •   interviews with independent contractors who provide services to VPA;
   •   reviews of medical necessity documentation (e.g., physicians orders, CMNs), and
       other documents that support claims for reimbursement;
   •   validation of qualifications of physicians or other authorized persons who order
       services provided by VPA;
   •   evaluation of written policies and procedures; and
   •   utilization/trend analyses that uncover deviations, positive or negative, for specific
       codes or types of items over a given period.
The reviewer(s) will:
  •    possess the qualifications and experience necessary to adequately identify potential
       issues with the subject matter to be reviewed;
  •    be objective and independent of line management;
  •    have access to existing audit and health care resources, relevant personnel, and all
       relevant areas of operation;



                                          16
       •   present written evaluative reports on compliance activities to the owner(s), president,
           governing body, and members of the compliance committee on a regular basis, but
           not less than annually; and
       •   specifically identify areas where corrective actions are needed.

With the above-described reports, VPA management will take whatever steps are necessary to
correct past problems, if any, and prevent them from recurring. In certain instances, subsequent
reviews and/or studies may be undertaken to ensure that the recommended corrective action has
been successfully implemented. VPA will document its efforts to comply with applicable
statutes, regulations and federal healthcare program requirements. By way of example, where
VPA in its efforts to comply with a particular statute, regulation or program requirement,
requests advice from a government agency (including a Medicaid representative or Medicare
Carrier) charged with administering a federally-funded healthcare program, VPA will document
and retain, through appropriate personnel, a record of the request and any written or oral
response. This step is extremely important if and when VPA intends to rely on a given response
to guide its future decisions, actions or claim reimbursement requests or appeals. Maintaining a
log of oral inquiries between VPA and third parties represents an additional basis for establishing
documentation on which VPA might rely to demonstrate continual attempts at compliance.
Furthermore, VPA will maintain these records to illustrate reasonable reliance and due diligence
in developing the appropriate procedures to implement specific advice.

VPA is committed to assuring the Medicare and Medicaid programs, as well as other third party
insurers, guarantors and its patient population, that all billings accurately reflect the services and
supplies that were actually rendered and documented and that all applicable codings and other
designations impacting payment levels are appropriately determined and assigned.

VPA expects all departments and individuals to comply with the applicable billing and coding
policies set forth in the various policy and procedure manuals throughout the VPA organization.
Interpretations different from, or actions inconsistent with, VPA policies and procedures are
prohibited. Due to the dynamic changes, intricacies and possible misinterpretation of billing
standards, all billing personnel must actively participate in the Compliance Program to enable
consistency with policies and legal requirements regarding billing.

The overall objective of VPA’s Compliance Program is to identify potential areas of
noncompliance with the requirements of Medicare, Medicaid, third party insurers and other
guarantors, and with other governing laws and regulations. As previously mentioned, ongoing
auditing and monitoring undertaken through the use of detailed claims data will be used to
determine the propriety of billing submissions. When deciding on the specific areas for review,
input from VPA departments, the Compliance Officer, the Compliance Committee, legal
counsel, retained consultants, industry publications, Medicaid notices, Carrier/Fiscal
Intermediary notices and government publications (i.e., HHS/OIG Workplan, which is available
on the Internet at http://www.dhhs.gov/progorg/oig) will be referenced on the VPA website and
utilized.


                                             17
In addition to maintaining policies and procedures reflective of potential exposure areas, and in
order to ensure that VPA’s auditing and monitoring activities encompass those topics of special
concern to the OIG, the following risk areas may be analyzed:

Specific Risk Areas

VPA is committed to conducting its business in a lawful and ethical manner. VPA’s physicians
and employees are required to comply with all applicable laws, regulations, and policies
affecting the operations of the practice (some of which are discussed in Appendix E - Additional
Risk Areas), including but no limited to rules relating to:

a.     Coding and Billing

The identification of risk areas associated with coding and billing is a major part of VPA’s
compliance program.

The following risk areas associated with billing have been among the most frequent subjects of
investigations and audits by the government:

       •       billing for items or services not rendered or not provided as claimed;
       •       double billing;
       •       billing for non-covered services as if covered;
       •       knowing misuse of provider identification numbers, which results in improper
               billing;
       •       billing for unbundled services;
       •       failure to properly use coding modifiers;
       •       upcoding the level of service provided.

b.     Reasonable and Necessary Services

VPA’s compliance program will attempt to ensure that only claims for services that the physician
practice finds to be reasonable and necessary in the particular case are submitted. The
government recognizes that physicians should be able to order any tests, including screening
tests, they believe are appropriate for the treatment of their patients. However, the practice
should be aware that Medicare will only pay for services that meet the Medicare definition of
reasonable and necessary.

Medicare (and many insurance plans) may deny payment for a service that the physician believes
is clinically appropriate, but which is not reasonable and necessary. Thus, when a physician
provides services to a patient, he or she should only bill those services believed to be reasonable
and necessary for the diagnosis and treatment of a patient. Upon request, the physician practice
should be able to provide documentation, such as a patient's medical records and physician's
orders, to support the appropriateness of a service that the physician has provided.



                                            18
c.     Documentation

Timely, accurate and complete documentation is critical to nearly every aspect of a physician
practice. Therefore, one of the most important physician practice compliance issues is the
appropriate documentation of diagnosis and treatment. Physician documentation is necessary to
determine the appropriate medical treatment for the patient and is the basis for coding and billing
determinations. Most importantly, failure to document properly has the potential to compromise
good patient care. Thorough and accurate documentation helps to ensure accurate recording and
timely transmission of information.

       i.       Medical Record Documentation

       In addition to facilitating high quality patient care, a properly documented medical record
       verifies and documents precisely what services were actually provided. The medical
       record may be used to validate: (a.) the site of the service; (b.) the appropriateness of the
       services provided; and (c.) the accuracy of the billing. Accurate medical record
       documentation should comply, at a minimum, with the following principles:

       •     The medical record should be complete and legible;

       •     The documentation of each patient encounter should include the reason for the
             encounter; any relevant history; physical examination findings; prior diagnostic test
             results; assessment, clinical impression, or diagnosis; plan of care; and date and
             legible identity of the observer;

       •     If not documented, the rationale for ordering diagnostic and other ancillary services
             should be easily inferred by an independent reviewer or third party. Past and present
             diagnoses should be accessible to the treating and/or consulting physician; and

       •     Appropriate health risk factors should be identified. The patient's progress, his or her
             response to, and any changes in, treatment, and any revision in diagnosis should be
             documented.

       The CPT and ICD-9-CM codes reported on the health insurance claims form should be
       supported by documentation in the medical record and the medical chart should contain
       all required information. Additionally, CMS and the local carriers should be able to
       determine who provided the services. These issues can be the root of investigations of
       inappropriate or erroneous conduct, and have been identified by CMS and OIG as a
       leading cause of inappropriate payments.

       ii.      CMS 1500 Form

       Another documentation area that VPA will monitor closely is the proper completion of
       the CMS 1500 form. The following practices will help ensure that the form has been
       properly completed:

                                              19
       •   link the diagnosis code with the steps taken to perform an examination and the record
           of personal history obtained;
       •   link a single most appropriate diagnosis with the corresponding procedure code;
       •   use modifiers appropriately; and
       •   provide Medicare with all information about a patient's other insurance coverage.

d.     Kickbacks, Inducements and Self-Referrals

VPA’s compliance program will ensure compliance with the anti-kickback statute, and the
physician self-referral law. Remuneration for referrals is illegal because it can distort medical
decision-making, cause overutilization of services or supplies, increase costs to Federal health
care programs, and result in unfair competition by shutting out competitors who are unwilling to
pay it. Remuneration for referrals can also affect the quality of patient care by encouraging
physicians to order services or supplies based on profit rather than the patients' best medical
interests. In particular, arrangements with hospitals, external hospice agencies, nursing facilities,
external home health agencies, durable medical equipment suppliers and vendors are areas of
potential concern. In general, the anti-kickback statute prohibits the knowing and willfull giving
or receiving of anything of value to induce referrals of Federal health care program business.
Whenever a physician practice intends to enter into a business arrangement that involves its
making referrals, the arrangement should be reviewed by internal counsel and our Chief
Compliance Officer who are familiar with the anti-kickback statute and physician self-referral
statute.

VPA will implement measures to avoid offering inappropriate inducements to patients. Examples
of such inducements include routinely waiving coinsurance or deductible amounts without a
good faith determination that the patient is in financial need or failing to make reasonable efforts
to collect the cost-sharing amount.

Possible risk areas that will be reviewed pursuant to VPA’s Compliance Program include:

       •       financial arrangements with outside entities to whom the practice may refer
               Federal health care program business;
       •       joint ventures with entities supplying goods or services to the physician practice
               or its patients;
       •       consulting contracts or physician medical directorships; and
       •       soliciting, accepting or offering any gift or gratuity of more than nominal value to
               or from those who may benefit from a physician practice's referral of Federal
               health care program business.




                                             20
In order to keep current with this area of the law, VPA will attempt to obtain copies, available on
the U.S. Department of Health and Human Services, Office of Inspector General (OIG) website,
of all relevant OIG Special Fraud Alerts and Advisory Opinions that address the application of
the anti-kickback and physician self-referral laws to ensure that practice policies reflect current
positions and opinions.

Remember to always use good judgment and common sense. If anything within the Compliance
Program or Code of Conduct goes against your own good judgment, you are encouraged to
discuss it with your supervisor, the Compliance Officer or via a call to the Compliance Hotline.

STEP TWO: WRITTEN POLICIES AND PROCEDURES

VPA, as part of its commitment to compliance, will implement policies and procedures that take
into consideration relevant statutes, rules, regulations and program directives. In contrast to the
VPA Code of Conduct, which is designed to be a collection of fundamental standards, the
policies and procedures, which exist in various policy and procedure manuals throughout the
VPA organization, articulate specific procedures that VPA employees and agents must follow.
Additional duties have been placed on the following VPA members with reference to the Code
of Conduct and Operational Policies and Procedures.

    A. EMPLOYEE/MANAGER/SUPERVISOR RESPONSIBILITIES

    All business decisions and behavior while employed by VPA shall be governed by VPA’s
    operational policies and procedures and the Code of Conduct. It is the responsibility of all
    VPA staff to be familiar with relevant policies and procedures and the Code of Conduct and
    to be sensitive to any situations that would violate the Code or cause the appearance of a
    violation. Claims of ignorance, good intentions or bad advice will not be tolerated or
    accepted as excuses for noncompliance. Failure to comply with the Code of Conduct can
    take the form of (1) the commission of an act that violates the Code, or (2) the failure to act
    to remedy a violation.

    Failure to comply with the Code of Conduct, either through commission or omission, may
    result in discipline up to and including termination of employment, as set forth in the
    disciplinary policy of VPA.

    If an employee has any questions, comments or concerns regarding any activity that
    potentially violates the Code of Conduct, such concerns should be discussed with the
    employee’s supervisor, the Compliance Officer or, if anonymity is desired, the employee
    should contact VPA’s Compliance Hotline at 1-800-609-9783.




                                            21
B. MANAGER'S ADDITIONAL RESPONSIBILITIES

Managers of VPA must make sure that the employees they supervise understand and comply
with the high standards of ethical conduct set forth in the Compliance Program and Code of
Conduct. All new employees must be introduced to the VPA Corporate Compliance
Program. Managers are responsible for ensuring that personnel attend programs in order to
familiarize themselves with matters relating to the Code of Conduct and the VPA
Compliance Program. VPA’s Compliance Program requires the promotion of, and
adherence to, the elements of the Compliance Program as a factor in evaluating the
performance of managers and supervisors. Managers and supervisors, in addition to other
employees, must be periodically trained in new compliance policies and procedures.
Furthermore, all managers and supervisors involved in the coding, and claims process
should:

   •   discuss with all supervised employees the compliance policies and legal
       requirements applicable to their function;

   •   inform all supervised personnel that strict compliance with these policies, procedures
       and requirements is a condition of employment; and

   •   disclose to all supervised personnel that VPA will take disciplinary action, up to and
       including termination of employment, for violations of these policies and
       requirements.

It is the policy of VPA that managers and supervisors will be sanctioned for failure to
adequately instruct their subordinates with respect to governing legal requirements and the
VPA Compliance Program. Furthermore, managers and supervisors will be sanctioned for
failing to detect noncompliance with applicable policies and legal requirements where
reasonable diligence, on the part of the manager or supervisor, would have led to the
discovery of potential problems or violations and given VPA management the opportunity to
correct them at an earlier time.

C. NEW EMPLOYEE POLICY

A reasonable and prudent background investigation, including reference checks, will be
performed as part of the employment process for all new VPA employees who, in relation to
the position they have applied for, may have discretionary authority to make decisions that
may involve compliance with the law or compliance oversight.            VPA’s employment
application will specifically require applicants to disclose any criminal conviction, as
defined by 42 U.S.C. § 1320a-7(i), or exclusion action. VPA’s policies and Compliance
Program prohibit the employment of individuals who have been recently convicted of a
criminal offense related to healthcare or who are listed as debarred, excluded or otherwise
ineligible for participation in governmental healthcare programs.


                                      22
    It is the responsibility of the Compliance Officer and his/her designee(s) to ensure that
    employment applications are reviewed and that the OIG's List of Excluded
    Individuals/Entities (available on the Internet at http://www.dhhs.gov/progorg/oig) is
    checked. The Compliance Officer, or his/her designee(s), will also request, when
    applicable, periodic reports from the Healthcare Fraud and Abuse Data Collection Bank
    when that information becomes available.

    Furthermore, pending the resolution of any proposed debarment or exclusion of an
    individual from a governmental healthcare program, VPA will remove said individual from
    direct responsibility for, or involvement in, any governmental healthcare program. With
    regard to current employees or independent contractors, if the resolution of the matter results
    in debarment or exclusion, VPA will immediately terminate the employment arrangement
    with the individual or contractor.

    Pending the resolution of criminal charges against an employee, VPA will make an
    assessment, on a case-by-case basis, of whether such employee poses a risk to the health and
    safety of patients, and whether such employee poses a risk of non-compliance with
    governing laws. Depending on the conclusion of such an assessment, the employee may be
    removed from responsibility for, or involvement in, any activity involving the provision of
    healthcare services or relating to governmental healthcare programs, and may be subject to
    other discipline. In making this assessment, VPA will consult with legal counsel as
    appropriate. If the resolution of the criminal charges results in a conviction of the employee,
    a similar assessment will be made.

    D. VENDORS AND REFERRAL ENTITIES

    A background check of all new and existing vendors and referral entities will take place and
    will include, at a minimum, screening the Government Services Administration (“GSA”) list
    of debarred or excluded vendors entitled, “List of Parties Excluded from Federal
    Procurement and Non-Procurement Programs. Such a screening will continue on an annual
    basis for all current vendors.

STEP THREE:        DESIGNATION OF THE COMPLIANCE OFFICER AND
                   COMPLIANCE COMMITTEE

Although it is the responsibility of all VPA employees and agents to comply with VPA’s
Compliance Program and applicable directives, the Compliance Committee and Compliance
Officer have primary responsibility for the day-to-day administration of the program. However,
it is the Compliance Officer's ultimate responsibility to administer the program and render final
decisions and directives in accordance with the program. Following is a succinct description of
the duties and responsibilities of the VPA Compliance Officer and Compliance Committee.




                                            23
A. COMPLIANCE OFFICER’S RESPONSIBILITIES

The Compliance Officer has ultimate responsibility for the administration and
management of VPA’s Corporate Compliance Program. In this capacity, the Compliance
Officer must ensure that he/she is accessible to all employees of VPA and maintains
frequent and direct communication with VPA’s senior management and Board.

The Compliance Officer's primary responsibilities include:

•   Overseeing and monitoring the implementation of the Compliance Program;

•   Reviewing and revising, as appropriate, the Code of Conduct and other policies
    contained in or referenced in this Compliance Program;

•   Developing, approving and/or monitoring the educational and training materials and
    programs related to the Compliance Program, and ensuring that all employees have
    attended the required training sessions;

•   Working with the Compliance Committee to coordinate the internal monitoring and
    auditing processes to ensure accurate code selection and bill submission on an
    ongoing basis, and to otherwise ensure compliance via the use of current QA
    protocols in order to ensure compliance with all governing laws and regulations;

•   Redirecting the internal monitoring and auditing processes in response to regulatory
    changes, newly identified investigatory targets and perceived weaknesses or
    exposures in VPA’s practices;

•   Ensuring that independent contractors, vendors, and other relevant third parties are
    aware of the relevant requirements of the Compliance Program;

•   Coordinating personnel issues with VPA’s Human Resources staff and ensuring that
    Cumulative Sanction Report and other appropriate sources are utilized in screening
    employees and vendors;

•   Direct the investigation and resolution, with the advice of legal counsel if deemed
    necessary, of reported or suspected concerns related to compliance, including the
    design and coordination of internal investigations (in response to reports of problems
    or suspected violations) and the determination of any appropriate corrective and/or
    disciplinary actions;

•   Periodically revising the Compliance Program in light of changes in VPA’s
    operations or operating practices, and changes in prevailing laws, rules and
    regulations;

•   Developing policies and programs that encourage employees to report suspected
                                   24
    waste, abuse, fraud and other improprieties and noncompliance without fear of
    retaliation;

•   Overseeing the review of employment contracts, leases and other agreements, with
    the assistance of legal counsel if deemed necessary, to ensure that they are in
    compliance with applicable laws and regulations;

•   Overseeing the appropriate operation of the hotline by a competent third party,
    monitoring the calls received by the hotline vendor, and ensuring that all calls are
    appropriately reported, investigated, and resolved on a timely basis;

•   Ensuring that the disciplinary measures stipulated within the Compliance Program
    are appropriately enforced in all instances of non-compliance or non-compliant
    behavior;

•   Responding to all internal and external inquiries regarding compliance; and

•   Preparing periodic reports that summarize the various activities undertaken in
    conjunction with the Compliance Program, the results of the ongoing monitoring and
    auditing processes, the content of and attendance at required compliance training
    programs, and the status and resolution of calls to the outsourced hotline.

The Compliance Officer must interact closely with numerous locations and departments
within VPA to ensure an overall understanding of and adherence to the VPA compliance
initiative, as well as to oversee and evaluate the applicable auditing, monitoring and
training activities related thereto. Additionally, the Compliance Officer must work
closely with certain department heads to review the results of periodic billing and other
audits and to assess any revisions to existing practices necessitated by the results of these
audits.

The Compliance Officer must have the authority to review all documents and other
information that are relevant to compliance activities, including, but not limited to,
patient records, billing files, and contractual arrangements with employees, independent
contractors, suppliers, agents, etc. Access to these records will enable the Compliance
Officer to better assess the organization’s level of compliance, identify any potential
weaknesses or exposures with regard to compliance, and readily investigate any reported
instances of suspected noncompliance.

It should be clearly understood that the Compliance Officer is not responsible for the
organization’s actual compliance with applicable laws, rules and regulations or for
transacting business in conformity thereto. Rather, the Compliance Officer is
responsible for ensuring that the organization has in place, at all times, an effective
Compliance Program, and that the applicable policies, procedures and practices are
sufficient for purposes of communicating, monitoring and enforcing VPA’s ongoing
commitment to compliance.

                                    25
B. COMPLIANCE COMMITTEE RESPONSIBILITIES

  The Compliance Committee is primarily responsible for advising and assisting the
  Compliance Officer in the fulfillment of his/her responsibilities and in facilitating the
  implementation and ongoing operation of the organization’s Corporate Compliance
  Program. The Committee will be comprised of individuals who have an expressed
  interest in the success of the compliance initiative and whose backgrounds, experiences
  and areas of expertise are relevant to our Compliance Program. In addition to being
  representative of the affected functional disciplines within the organization, the
  Committee’s membership should include a representation from all pertinent
  departments.

  The specific responsibilities of the Compliance Officer that might be shared with the
  Compliance Committee include:

  •   Overseeing and monitoring the implementation of the Compliance Program;

  •   Reviewing and revising, as appropriate, the Code of Conduct and other policies
      contained in or referenced in this Compliance Program;

  •   Developing, approving and/or monitoring the educational and training materials and
      programs related to the Compliance Program, and ensuring that all employees have
      attended the required training sessions;

  •   Coordinating the internal monitoring and auditing processes to ensure accurate chart
      code selection and bill submission on an ongoing basis and to otherwise ensure
      compliance with all governing laws and regulations;

  •   Redirecting the internal monitoring and auditing processes in response to regulatory
      changes, newly identified investigatory targets and perceived weaknesses or
      exposures in the organization’s practices;

  •   Periodically revising the Compliance Program in light of changes in VPA’s
      operations or operating practices, and changes in prevailing laws, rules and
      regulations; and

  •   Developing policies and programs that encourage employees to report suspected
      waste, abuse, fraud and other potential improprieties and/or noncompliance with law
      without fear of retaliation.

  As is the case with the Compliance Officer, the Compliance Committee is not
  responsible for the organization’s actual compliance with applicable laws, rules, and
  regulations, but merely strives to ensure that a continually effective Compliance
  Program exists and that the requisite policies, procedures and practices are most
                                     26
   appropriate for VPA and are properly communicated, monitored and enforced on an
   ongoing basis.

C. PROCEDURES FOR MAINTENANCE OF PROGRAM

Listed below are the procedures to be followed in connection with the implementation, and
ongoing maintenance of, the Compliance Program:

   •   A copy of the Compliance Program will be disseminated to all affected employees,
       contractors and vendors. Each employee, contractor and vendor must read,
       understand, conform to, and certify in writing to their receipt of the program.
       Employee certifications will be maintained in a manner as directed by the
       Compliance Officer.

   •   Employees will be informed of and educated with respect to their responsibility to
       comply with the principles of the Compliance Program on an annual basis. New
       employees will be educated about these principles through the
       employment/orientation process.

   •   Training sessions will be established to inform and educate affected employees of
       applicable laws, regulations, and standards of business conduct that employees are
       expected to follow. Employees will also be advised of the consequences, both to the
       employee and VPA, should violations of such requirements occur.

   •   Failure to comply with any provision of VPA’s Code of Conduct and Compliance
       Program will result in disciplinary action, up to and including termination.

   •   VPA’s Code of Conduct will be incorporated, by reference, into the Employee
       Handbook.

   An open line of communication between VPA’s Compliance Officer and all VPA
   personnel and agents is imperative to the successful implementation and maintenance of
   our Compliance Program. Furthermore, free flowing communication will reduce the
   potential for fraud, abuse and waste. All information will be kept confidential, and
   employees will not be subject to retaliation, as described herein.




                                     27
STEP FOUR: COMPLIANCE TRAINING AND EDUCATION

 VPA has developed a training program to ensure that all VPA staff are familiar with the
 Corporate Compliance Program and understand all of its policies and procedures, including
 the Code of Conduct.

 As part of their initial orientation, all new employees will receive training that discusses the
 goals and objectives of the Corporate Compliance Program. At the conclusion of the
 orientation session, new employees will be asked to sign an Acknowledgment stating that
 they are familiar with the Corporate Compliance Program and that they will abide by the
 Code of Conduct.

 After the initial orientation, all employees will receive additional training with respect to the
 Corporate Compliance Program and Code of Conduct. In these sessions, employees will be
 reeducated with respect to the Corporate Compliance Program and the Code of Conduct. The
 annual training session will focus on any changes made to the Corporate Compliance
 Program, the Code of Conduct, or other changes in federal laws and regulations affecting
 VPA and recent government enforcement actions. This training session will be conducted at
 the direction of the Compliance Officer. Employees will sign an attendance sheet
 immediately after each training session.

 In addition to specific training in the risk areas identified above, primary training to
 appropriate corporate officers, managers and other claim development and billing staff may
 include such topics as:

 •   specific Government and private payor reimbursement principles;
 •   improper alterations to documentation (e.g., patient records, CMNs);
 •   compliance with the Federal, State, and private payor supplier standards; and
 •   duty to report misconduct.

 At the direction of the Compliance Officer, other training sessions may be held as the need
 arises to address changes in the Corporate Compliance Program, in Federal, State and local
 laws and regulations or any issues of interest. Additional training sessions may be conducted
 for specific employees who have responsibilities with compliance issues such as employees
 responsible for billing government programs. In addition, the Compliance Officer may direct
 specific employees to attend continuing education classes.

 The Compliance Officer shall be responsible for monitoring, developing and conducting the
 training and orientation sessions. The Compliance Officer shall maintain a written record of
 all such training sessions. Additional training sessions may be conducted as the need arises.
 The Compliance Officer, or his designee, will also take attendance at all training sessions
 with a sign-in sheet and will maintain a record of course attendance at any training session
 which is performed as part of the Corporate Compliance Program. The Compliance Officer
                                          28
  shall maintain a file of all attendance forms for all employees and shall place a copy of each
  attendance sheet in the employee's file. Participation in and attendance at training sessions is
  mandatory and attendance of training sessions will be one criteria for which employees will
  be evaluated during their reviews.

  Employees shall be informed during the training session that strict compliance with the
  Corporate Compliance Program and the Code of Conduct is a condition of employment and
  that compliance with the Corporate Compliance Program and the Code of Conduct is one
  criterion upon which employees will be evaluated. Managers and supervisors are required to
  instruct subordinates in Corporate Compliance Program requirements and compliance with
  such requirements. Supervisors and managers who fail to provide such instruction or fail to
  detect non-compliance with applicable policies and legal requirements, where reasonable
  diligence on the part of the manager or supervisor would have led to the discovery of any
  problems or violations and given VPA an opportunity to correct them earlier, will be
  sanctioned.

   Training and educational programs for affected employees will include, without limitation,
   sessions highlighting VPA’s Compliance Program, summaries of fraud and abuse laws,
   coding requirements, claim development and submission processes, and marketing practices
   that reflect current legal and program standards. VPA will take steps to communicate
   effectively its standards and procedures to all affected employees, physicians, independent
   contractors and other significant agents by requiring participation in training programs and
   by disseminating publications that explain, in a practical manner, specific requirements.
   These publications might include HHS/OIG produced documents such as the OIG's
   Management Advisory Report, Special Fraud Alerts, Audit and Inspection Reports,
   Advisory Opinions, and the annual OIG Work Plan (available on the Internet), which will be
   used as the basis for topical training and educational courses for affected and appropriate
   VPA employees.

STEP FIVE:        RESPONDING TO IDENTIFIED OFFENSES AND DEVELOPING
                  CORRECTIVE ACTION INITIATIVES

    Violations of VPA’s Compliance Program, failure to comply with applicable federal or
    state law, and other types of misconduct threaten VPA’s status as a reliable, honest and
    trustworthy provider capable of participating in federal healthcare programs. Detected but
    uncorrected misconduct can seriously endanger the mission, reputation, and legal status of
    VPA. Consequently, upon reports or reasonable indications of suspected noncompliance,
    the Compliance Officer and other designated management officials will initiate prompt
    steps to investigate the conduct in question. A determination as to whether a material
    violation of applicable law or the requirements of VPA’s Compliance Program occurred so
    that the appropriate measures, if necessary, can be commenced to correct the problem.
    Such steps may include an immediate referral to criminal and/or civil law enforcement
    authorities, a corrective action plan, a report to the government, and/or the refunding of any
    overpayments, if applicable.


                                          29
   Please note that instances of noncompliance will be determined on a case-by-case basis and
   that the existence, or amount, of a monetary loss to a healthcare program is not solely
   determinative of whether or not the conduct should be investigated and reported to
   governmental authorities. There may be instances where there is no loss at all, but
   corrective action and possible reporting are still necessary to protect the integrity of the
   specific program and its beneficiaries. The advice of VPA’s legal counsel should be sought
   to plan the appropriate course of action.

   If an alleged violation is discovered and an investigation is initiated, the Compliance
   Officer may remove the subjects of the investigation from their current work activity in
   order to protect the integrity of the investigation. This will be done with the advice of
   competent legal counsel. If a violation is ongoing, immediate steps will be taken to halt the
   behavior in question.

   If an offense has occurred despite the existence of VPA’s Compliance Program, the
   Compliance Program will be promptly and appropriately modified through the Compliance
   Committee, Compliance Officer and others expressly authorized to implement
   amendments.

   If the Compliance Officer, Compliance Committee or management personnel discover
   sufficient credible evidence of material misconduct, as determined by legal counsel, and
   after reasonable inquiry there is reason to believe that the misconduct may violate criminal,
   civil or administrative law, then VPA will report the existence of such misconduct to the
   appropriate governmental authority within a reasonable amount of time.

   Again, VPA will ensure that the decision to report credible evidence of a violation will be
   determined by the appropriate officials in order to demonstrate VPA’s good faith and
   willingness to work with governmental authorities to correct and remedy a potential
   problem. All VPA employees and affiliates should be aware that the reporting of credible
   evidence of misconduct to the government is considered a mitigating factor by the
   government in determining sanctions (e.g., penalties, fines, assessments, and exclusion) if
   VPA or a VPA employee or affiliate becomes the target of an investigation. When a report
   of misconduct to the government is made, the Compliance Officer and Compliance
   Committee, with the advice of legal counsel, will do so in accordance with VPA
   procedures that are consistent with VPA’s interests and legal obligations.

STEP SIX: EFFECTIVE LINES OF COMMUNICATION

  Employees, contractors and vendors are required to report any non-compliance, potential
  non-compliance or suspected non-compliance on the part of any VPA employee, physician,
  contractor or vendor, regardless of whether or not it occurs at VPA, in accordance with the
  process set forth herein. VPA takes all reports of non-compliance seriously. The purpose of
  disclosure is to provide a mechanism whereby employees, physicians, contractors and
  vendors of VPA are able to report matters that may be unprofessional, unethical, illegal or
  potentially non-compliant without the fear of retribution. Employees may be subject to
  discipline for failing to report any perceived or suspected non-compliance. Reports may be
                                           30
made in the following manner:

       1.     In person, through a supervisor or the Compliance Officer; or

       2.     Orally, and anonymously if so desired, through VPA’s toll-free hotline at
              1-800-609-9783.

VPA’s toll-free hotline and in-person reporting processes are the responsibility of, and are
monitored by, the Compliance Officer. All reports will be assigned an identification code at
the time of the call or date of contact that can be used when referring any new/additional
information on the same matter. The caller is encouraged to provide as much information as
possible to assist with the issue at hand. Please note that employees will be subject to
disciplinary action, including potential termination of employment, if VPA reasonably
concludes that the report of wrongdoing was knowingly fabricated, distorted, exaggerated or
minimized to either injure someone else or to protect others.

It is the responsibility of the Compliance Officer to ensure that each report of potential
violations, in whatever format, is documented pursuant to VPA policy, investigated and
brought to a satisfactory conclusion. The Compliance Officer will report, as required, on
call activity and the status of ongoing investigations, if any, to the Compliance Committee,
the President, legal counsel and governing Board on a periodic basis.

It is the policy of VPA that no employee shall be disciplined on the basis that he or she
reported what was reasonably believed to be an act of wrongdoing or a violation of VPA’s
Compliance Program or Code of Conduct.

However, an employee whose report of potential misconduct contains admissions of
personal wrongdoing will not be guaranteed protection from potential disciplinary action.
The fact of an admission, however, as opposed to deliberate non-reporting, will be taken into
consideration in connection with making a disciplinary decision, and depending on all of the
relevant circumstances, may result in a lesser disciplinary action than would result in the
event of non-reporting.

An individual reporting known or suspected improper conduct is not required to identify
himself/herself. Anonymous reports will be investigated and acted upon in the same manner
as reports where the reporter reveals his/her identity. No effort will be made to determine
the identity of an individual making an anonymous report unless the individual admits to
engaging in improper conduct. This type of disclosure format should also be used by
employees who are uncertain whether an action violates VPA’s Code of Conduct or
Compliance Program and would like to communicate with VPA on a confidential basis.

The Compliance Officer will be required, in compiling disclosure reports, to ensure that an
objective and informed version of the facts has been uncovered during the investigation. The
resulting report may contain:


                                       31
                 --The circumstances that led to the investigation;

                 --The investigative steps that were taken;

                 --The facts disclosed during the investigation;

                 --The applicable laws or regulations at issue;

                 --The internal policies, procedures, or practices that led to the violation; and

                 --Recommended remedial actions.

  All disclosed reports of substantial violations may be referred to VPA’s legal counsel via the
  Compliance Officer for advice and input where necessary.

STEP SEVEN: DISCIPLINARY GUIDELINES FOR FAILURE TO COMPLY WITH
    VPA’S CODE OF CONDUCT, COMPLIANCE PROGRAM, POLICIES AND
    PROCEDURES, OR FEDERAL, STATE AND LOCAL LAWS

  Common sense, integrity and appropriate personal behavior is expected of each VPA
  officer, manager, employee, and contractor. Intentional or reckless non-compliance will
  subject violators to significant sanctions. Such sanctions will range from oral warnings to
  suspension, privilege revocation (subject to applicable peer review procedures), or
  termination or financial penalties, as appropriate. Disciplinary action will be taken where
  the failure by an officer, manager, employee, or contractor to detect a violation is
  attributable to his or her negligence or reckless or intentional misconduct. Disciplinary
  action will be taken on a fair and equitable basis. Violations will be handled through VPA’s
  normal disciplinary procedures which are set forth in the Employee handbook.

  In determining what disciplinary action may be taken against an employee, VPA will take
  into account an employee's own admission of wrongdoing, provided, however, that the
  employee's conduct was not previously known to VPA or its discovery was not imminent,
  and that the admission was complete and truthful. In addition to disciplining employees
  who violate VPA’s Code of Conduct and/or Compliance Program, VPA will also discipline
  employees who ignore conduct that is potentially violative.

  Managers and supervisors should be aware that they have a responsibility to discipline
  employees in an appropriate and consistent manner. The consequences of noncompliance
  will be consistently and uniformly applied and enforced so that VPA’s disciplinary policy
  has the required deterrent effect. All levels of employees will be subject to the same
  disciplinary action for the commission of similar offenses. VPA’s commitment to
  compliance applies to all personnel levels within VPA. Corporate officers, managers,
  supervisors and other healthcare professionals should know that they will be held
  accountable for failing to comply with, or for the foreseeable failure of their subordinates to
  adhere to, the applicable standards, laws and procedures.

                                          32
  If an employee has committed a violation of VPA’s Code of Conduct or Compliance
  Program that would otherwise require termination, he or she may nevertheless be subject to
  other discipline. Whether the employee is terminated will be influenced by: (a) whether he
  or she promptly reported his/her own violation, (b) whether the report constitutes VPA’s
  first awareness of the violation and the employee's involvement, and (c) whether the
  employee cooperates fully in investigating and/or correcting the activity or violation
  involved.

  Determining whether VPA will eventually impose discipline less stringent than termination
  will be left to the sole discretion of VPA in accordance with applicable established Human
  Resources policies.

  The employment relationship between VPA and its employees is “at-will”. Each employee
  is free to resign at-will any time, with or without cause, subject to certain notice
  requirements. VPA my terminate the employment relationship at-will at any time with or
  without notice or cause, so long as there is no violation of applicable federal or state law.
  Please consult your Employee Handbook or Human Resource Department for additional
  details.

V. RETENTION OF RECORDS

  All records necessary to protect the integrity of VPA’s Compliance Program (e.g.,
  documentation illustrating that employees were adequately trained; reports from VPA’s
  hotline including the nature and results of investigations and modifications to the program;
  self-disclosures; documentation regarding requests and responses from government agencies
  about proper procedures and regulations that are to be used at the facility; and the results of
  VPA’s auditing and monitoring efforts) will be maintained by the Compliance Officer or
  designated employee in accordance with VPA policy. In light of VPA’s desire to document
  its compliance efforts, and continued desire to adhere to state and federal mandates,
  employees should consult the various records retention policies at VPA before any records or
  files are destroyed.

  Disposal or destruction of VPA’s records and files is not discretionary with any employee,
  including the originator of such records. Legal and regulatory practice require the retention
  of certain records for various periods of time, particularly in the tax, personnel, health and
  safety environment, contract and corporate structure area. In addition, when litigation or a
  government investigation or audit is pending or imminent, relevant records must not be
  destroyed until the matter is closed. In this regard, employees and supervisors are directed to
  VPA’s policies and procedures relating to record retention.

  Additionally, VPA has developed a records system that ensures complete and accurate
  medical documentation. All employees should follow these policies to ensure accurate and
  timely documentation of all medical and nursing services provided to patients. VPA is
  committed to designing and maintaining a records system that protects the privacy of its
  patients and staff.

                                          33
VI. CONCLUSION

  VPA expects that its Compliance Program will ensure that all of its employees and affiliates
  will be better able to fulfill their commitment to ethical behavior, as well as meet the
  dynamic changes and challenges being imposed upon VPA by Congress, the Office of
  Inspector General, and private insurers. Ultimately, it is VPA’s desire that this voluntarily
  created Compliance Program will enable it to meet its goals, continually improve the quality
  of patient care, and substantially reduce potential fraud, waste, abuse and other
  noncompliance. In closing, through the appropriate implementation and continued
  maintenance of this Compliance Program, VPA will be able to further the fundamental
  mission of VPA.




                                         34
                                                                                APPENDIX A

                                 COMPLIANCE PLAN
                              AFFIRMATION STATEMENT

I have been provided a copy of the Visiting Physicians Association Compliance Plan
(hereinafter, “the Plan”). Following ample opportunity to read the Plan, I fully understand the
information and policies contained therein, including but not limited to VPA’s Code of Conduct.
I have been given the opportunity to address any questions and/or concerns regarding the Plan,
including the Code of Conduct. I also understand that should I have any questions and/or
concerns regarding the Plan, including the Code of Conduct, in the future that I am free to
contact my supervisor or Chief Compliance Officer for assistance. I understand that full
compliance with the Plan, including the Code of Conduct is a condition of my employment. I
further understand that any failure to comply may result in disciplinary action, up to and
including termination. I understand that I am required to report any suspected violation of the
Plan, including the Code of Conduct, through the voluntary reporting mechanisms in existence at
VPA. Failure to do so may also result in disciplinary action, up to and including termination. I
further understand that at all times relevant hereto I remain an “at-will” employee.


Employee Name:________________________________________________________________

Title/Department:_______________________________________________________________

Location/Facility: _______________________________________________________________


Signature:_______________________________________             Date____________________




Please return this form to the Human Resources Department/Corporate Compliance Office.

ADMINISTRATIVE USE ONLY:

Processed on _______________ by_________________________________________________
                                                                                   APPENDIX B


       COMPLIANCE TRAINING AND EDUCATION ATTENDANCE STATEMENT

I.      Course Title: __________________________________________________

        Date Attended/Completed: _______________________________________

        Employee Name: _______________________________________________

        Location/Facility: _______________________________________________

II.∗    Since the time of your last training/educational seminar/session, have you become aware
        of, or have you observed any, conduct or activity that could be considered questionable,
        unethical or illegal at VPA?

        ____________      No

        ____________      Yes, if so, explain: _____________________________________

        _______________________________________________________________________

        _______________________________________________________________________

*       If you are desirous of remaining anonymous, you need not fill out Section II of this form.
        If you would have answered yes, you must use VPA’s ComplianceLine at 1-800-609-
        9783, and you need not supply your identity.



        I HEREBY AFFIRM that I have attended, through completion, the above-listed
        training/education.

        Signature:_______________________________________ Date________________


****************************************************************


        ADMINISTRATIVE USE ONLY

        Processed on _______________________________ by ________________________
                                                                                  APPENDIX C


                              EXIT INTERVIEW QUESTIONS

VPA will, in its sole discretion, determine those individuals who will receive an exit interview.
Any employee may request an exit interview. The following questions should be included in the
Exit Interview, but are in no way meant to be exhaustive. Any affirmative answers should be
followed up with detailed questions designed to identify: (1) participants in the conduct, (2)
witnesses to the conduct or others with knowledge of the conduct, (3) the date and place of the
conduct, (4) location of any documents or physical evidence, and (5) any other information
necessary for VPA to either verify or disprove the allegations. In other words, any affirmative
answer will result in a request for additional details.

1.     Have you ever engaged in conduct as a VPA employee which you believe was either
       unethical or illegal?

2.     Have you ever been asked to engage in conduct you believe was either unethical or
       illegal?
       If so, by whom?

3.     Have you ever witnessed conduct by any VPA employee you believe was unethical or
       illegal?

4.     Have you heard substantive rumors or reports (i.e., those you felt had some believability)
       of unethical or illegal conduct by other VPA employees?

5.     Have you ever removed VPA documents (including documents created by you) without
       returning them to VPA?

6.     Do you now have copies of any VPA documents anywhere off premises? Have you ever
       given VPA documents to any non-VPA employee?

7.     Do you know of any VPA employee who has handled company documents in the manner
       described in questions #5 and #6?

8.     Has any government investigator, agent or attorney interviewed you or asked to interview
       you about possible unethical or illegal conduct related to VPA?

9.     While an employee of VPA, did you or any family member own, operate, invest in, assist
       or otherwise have an interest in any VPA or enterprise which competes with VPA?
                                                                                           APPENDIX D

                     RIGHTS AND OBLIGATIONS OF VPA PERSONNEL
                 IF CONTACTED BY A GOVERNMENT ATTORNEY OR AGENT

Government attorneys, agents, and investigators frequently conduct investigations and inquiries in order
to monitor compliance with government regulations and laws. As a result, employees of VPA may be
contacted by a government attorney or agent in the course of an investigation. Employees may be
contacted either at work or away from work during off hours. As an employee, you have certain rights
and obligations of which you should be aware in the event you are contacted by an agent or attorney
during the course of an investigation. Please be aware of the following:

•While you are free to talk with government investigators, you are under no obligation to do so.

•You have a right to decline to be interviewed by a government attorney or investigator.

•Absent formal process, government agents or investigators cannot compel you to be interviewed or
make a statement.

•You also have a right to choose to speak with a government investigator or agent. If you choose to be
interviewed or make a statement, VPA expects you to respond to questions truthfully.

•Regardless of whether you refuse to be interviewed or agree to be interviewed, VPA requests that you
inform your supervisor of the date of the contact and the name of the investigator.

•If contacted by a government attorney or agent, you have the right to meet with an attorney. You also
have the right to have an attorney present during an interview.

•VPA will provide an attorney to meet with any employee who is contacted during the course of an
investigation. If an attorney is requested, the attorney will be able to inform you of the nature of the
investigation and your rights in connection with the investigation. Notwithstanding, VPA is under no
obligation to provide an attorney to an employee who is being investigated for their own individual
wrong doings.
                                                                                          APPENDIX E

                                    ADDITIONAL RISK AREAS


I.     Reasonable and Necessary Services

A.     Local Medical Review Policy (LMRP) and Local Carrier Decisions (LCDs)

An area of concern for physicians relating to determinations of reasonable and necessary services is the
variation in local medical review policies (LMRPs) and Local Carrier Decisions (LCDs) among carriers.
Physicians are supposed to bill the Federal health care programs only for items and services that are
reasonable and necessary. However, in order to determine whether an item or service is reasonable and
necessary under Medicare guidelines, the physician must apply the appropriate LMRP or LCD.

With the exception of claims that are properly coded and submitted to Medicare solely for the purpose
of obtaining a written denial, physician practices are to bill the Federal health programs only for items
and services that are covered. In order to determine if an item or service is covered for Medicare, a
physician practice must be knowledgeable of the LMRPs applicable to its practice’s jurisdiction. The
practice may contact its carrier to request a copy of the pertinent LMRPs, and once the practice receives
the copies, they can be incorporated into the practice’s written standards and procedures manual. When
the LMRP indicates that an item or service may not be covered by Medicare, the physician practice is
responsible to convey this information to the patient so that the patient can make an informed decision
concerning the health care services he/she may want to receive. Physician practices convey this
information through Advance Beneficiary Notices (ABNs).

B.     Advance Beneficiary Notices

Physicians are required to provide ABNs before they provide services that they know or believe
Medicare does not consider reasonable and necessary. (The one exception to this requirement is for
services that are performed pursuant to EMTALA requirements as described in section II.A). A properly
executed ABN acknowledges that coverage is uncertain or yet to be determined, and stipulates that the
patient promises to pay the bill if Medicare does not. Patients who are not notified before they receive
such services are not responsible for payment. The ABN must be sufficient to put the patient on notice
of the reasons why the physician believes that the payment may be denied. The objective is to give the
patient sufficient information to allow an informed choice as to whether to pay for the service.

Accordingly, each ABN should:

        1. be in writing;
        2. identify the specific service that may be denied (procedure name and CPT/HCPC code is
           recommended);
       3. state the specific reason why the physician believes that service may be denied; and
                                                                                           APPENDIX E

                                     ADDITIONAL RISK AREAS

The Medicare Carrier’s Manual provides that an ABN will not be acceptable if: (1) the patient is asked
to sign a blank ABN form; or (2) the ABN is used routinely without regard to a particularized need. The
routine use of ABNs is generally prohibited because the ABN must state the specific reason the
physician anticipates that the specific service will not be covered.

A common risk area associated with ABNs is in regard to diagnostic tests or services. There are three
steps that a physician practice can take to help ensure it is in compliance with the regulations concerning
ABNs for diagnostic tests or services:

       1.      determine which tests are not covered under national coverage rules;
       2.      determine which tests are not covered under local coverage rules such as LMRPs (contact
               the practice’s carrier to see if a listing has been assembled); and
       3.      determine which tests are only covered for certain diagnoses.

The OIG is aware that the use of ABNs is an area where physician practices experience numerous
difficulties. Practices can help to reduce problems in this area by educating their physicians and office
staff on the correct use of ABNs, obtaining guidance from the carrier regarding their interpretation of
whether an ABN is necessary where the service is not covered, developing a standard form for all
diagnostic tests (most carriers have a developed model), and developing a process for handling patients
who refuse to sign ABNs.

C.     Physician Liability for Certifications in the Provision of Medical Equipment and Supplies

In January 1999, the OIG issued a Special Fraud Alert on this topic, which is available on the OIG web
site at www.hhs.gov/oig/frdalrt/index.htm. The following is a summary of the Special Fraud Alert.

The OIG issued the Special Fraud Alert to reiterate to physicians the legal and programmatic
significance of physician certifications made in connection with the ordering of certain items and
services for Medicare patients. In light of information obtained through OIG provider audits, the OIG
deemed it necessary to remind physicians that they may be subject to criminal, civil and administrative
penalties for signing a certification when they know that the information is false or for signing a
certification with reckless disregard as to the truth of the information.

Medicare has conditioned payment for many items and services on a certification signed by a physician
attesting that the physician has reviewed the patient’s condition and has determined that an item or
service is reasonable and necessary. Because Medicare primarily relies on the professional judgment of
the treating physician to determine the reasonable and necessary nature of a given service or supply, it is
important that physicians provide complete and accurate information on any certifications they sign.
Physician certification is obtained through a variety of forms, including prescriptions, orders, and
Certificates of Medical Necessity (CMNs). Two areas where physician certification as to whether an
                                                                                             APPENDIX E

                                     ADDITIONAL RISK AREAS

item or service is reasonable and necessary is essential and which are vulnerable to abuse are: (1) home
health services; and (2) durable medical equipment.


By signing a CMN, the physician represents that:

       1.      he or she is the patient’s treating physician and that the information regarding the
               physician’s address and unique physician identification number (UPIN) is correct;
       2.      the entire CMN, including the sections filled out by the supplier, was completed prior to
               the physician’s signature; and
       3.      the information in section B relating to whether the item or service is reasonable and
               necessary is true, accurate, and complete to the best of the physician’s knowledge.

Activities such as signing blank CMNs, signing a CMN without seeing the patient to verify the item or
service is reasonable and necessary, and signing a CMN for a service that the physician knows is not
reasonable and necessary are activities that can lead to criminal, civil and administrative penalties.

Ultimately, it is advised that physicians carefully review any form of certification (order, prescription or
CMN) before signing it to verify that the information contained in the certification is both complete and
accurate.

D.     Billing for Non-covered Services as if Covered

In some instances, we are aware that physician practices submit claims for services in order to receive a
denial from the carrier, thereby enabling the patient to submit the denied claim for payment to a
secondary payer.

A common question relating to this risk area is: If the medical services provided are not covered under
Medicare, but the secondary or supplemental insurer requires a Medicare rejection in order to cover the
services, then would the original submission of the claim to Medicare be considered fraudulent? Under
the applicable regulations, the OIG would not consider such submissions to be fraudulent. For example,
the denial may be necessary to establish patient liability protections as stated in section 1879 of the
Social Security Act (the Act) (codified at 42 U.S.C. 1395pp). As stated, Medicare denials may also be
required so that the patient can seek payment from a secondary insurer. In instances where a claim is
being submitted to Medicare for this purpose, the physician should indicate on the claim submission that
the claim is being submitted for the purpose of receiving a denial, in order to bill a secondary insurance
carrier. This step should assist carriers and prevent inadvertent payments to which the physician is not
entitled.
                                                                                           APPENDIX E

                                        ADDITIONAL RISK AREAS

In some instances, however, the carrier pays the claim even though the service is non-covered, and even
though the physician did not intend for payment to be made. When this occurs, the physician has a
responsibility to refund the amount paid and indicate that the service is not covered.


II.       Physician Billing Practices


A.        Professional Courtesy

The term “professional courtesy” is used to describe a number of analytically different practices. The
traditional definition is the practice by a physician of waiving all or a part of the fee for services
provided to the physician’s office staff, other physicians, and/or their families. In recent times,
“professional courtesy” has also come to mean the waiver of coinsurance obligations or other out-of-
pocket expenses for physicians or their families (i.e., “insurance only” billing), and similar payment
arrangements by hospitals or other institutions for services provided to their medical staffs or
employees.

In general, whether a professional courtesy arrangement runs afoul of the fraud and abuse laws is
determined by two factors: (i) how the recipients of the professional courtesy are selected; and (ii) how
the professional courtesy is extended. If recipients are selected in a manner that directly or indirectly
takes into account their ability to affect past or future referrals, the anti-kickback statute -- which
prohibits giving anything of value to generate Federal health care program business -- may be
implicated. If the professional courtesy is extended through a waiver of copayment obligations (i.e.,
“insurance only” billing), other statutes may be implicated, including the prohibition of inducements to
beneficiaries, section 1128A(a)(5) of the Act (codified at 42 U.S.C. 1320a-7a(a)(5)). Claims submitted
as a result of either practice may also implicate the civil False Claims Act.

The following are general observations about professional courtesy arrangements for physician practices
to consider:

      •   A physician’s regular and consistent practice of extending professional courtesy by waiving the
          entire fee for services rendered to a group of persons (including employees, physicians, and/or
          their family members) may not implicate any of the OIG’s fraud and abuse authorities so long as
          membership in the group receiving the courtesy is determined in a manner that does not take into
          account directly or indirectly any group member’s ability to refer to, or otherwise generate
          Federal health care program business for, the physician.
      •   A physician’s regular and consistent practice of extending professional courtesy by waiving
          otherwise applicable copayments for services rendered to a group of persons (including
          employees, physicians, and/or their family members), would not implicate the anti-kickback
          statute so long as membership in the group is determined in a manner that does not take into
          account directly or indirectly any group member’s ability to refer to, or otherwise generate
                                                                                               APPENDIX E

                                        ADDITIONAL RISK AREAS

           Federal health care program business for, the physician.
       •   Any waiver of copayment practice, including that described in the preceding bullet, does
           implicate section 1128A(a)(5) of the Act if the patient for whom the copayment is waived is a
           Federal health care program beneficiary who is not financially needy.

The legality of particular professional courtesy arrangements will turn on the specific facts presented,
and, with respect to the anti-kickback statute, on the specific intent of the parties. A physician practice
may wish to consult with an attorney if it is uncertain about its professional courtesy arrangements.



III.       Other Risk Areas


A.         Rental of Space or Provision of Equipment in VPA Offices by Persons or Entities to which
           Physicians Refer

In February 2000, the OIG issued a Special Fraud Alert on this topic, which is available on the OIG web
site at www.hhs.gov/oig/frdalrt/index.htm. The following is a summary of the Special Fraud Alert.

Among various relationships between physicians and labs, hospitals, home health agencies, etc., the OIG
has identified potentially illegal practices involving the rental of space in a physician’s office by
suppliers that provide items or services to patients who are referred or sent to the supplier by the
physician-landlord. An example of a suspect arrangement is the rental of physician office space by a
durable medical equipment (DME) supplier in a position to benefit from referrals of the physician’s
patients. The OIG is concerned that in such arrangements the rental payments may be disguised
kickbacks to the physician-landlord to induce referrals.

Space Rental Safe Harbor to the Anti-Kickback Statute

To avoid potentially violating the anti-kickback statute, the OIG recommends that rental agreements
comply with all of the following criteria for the space rental safe harbor:

       •   The agreement is set out in writing and signed by the parties.
       •   The agreement covers all of the space rented by the parties for the term of the agreement and
           specifies the space covered by the agreement.
       •   If the agreement is intended to provide the lessee with access to the space for periodic intervals of
           time rather than on a full-time basis for the term of the rental agreement, the rental agreement
           specifies exactly the schedule of such intervals, the precise length of each interval, and the exact
           rent for each interval.
       •   The term of the rental agreement is for not less than one year.
                                                                                    APPENDIX E

                                ADDITIONAL RISK AREAS

•   The aggregate rental charge is set in advance, is consistent with fair market value, and is not
    determined in a manner that takes into account the volume or value of any referrals or business
    otherwise generated between the parties for which payment may be made in whole or in part
    under Medicare or a State health care program.
•   The aggregate space rented does not exceed that which is reasonably necessary to accomplish the
    commercially reasonable business purpose of the rental.
                                                                                            APPENDIX F

                                        CRIMINAL STATUTES

This Appendix contains a description of criminal statutes related to fraud and abuse in the context of
health care. The Appendix is not intended to be a compilation of all Federal statutes related to health
care fraud and abuse. It is merely a summary of some of the more frequently cited Federal statutes.
I. Health Care Fraud (18 U.S.C. 1347)
Description of Unlawful Conduct
It is a crime to knowingly and willfully execute (or attempt to execute) a scheme to defraud any health
care benefit program, or to obtain money or property from a health care benefit program through false
representations. Note that this law applies not only to Federal health care programs, but to most other
types of health care benefit programs as well.
Penalty for Unlawful Conduct
The penalty may include the imposition of fines, imprisonment of up to 10 years, or both. If the
violation results in serious bodily injury, the prison term may be increased to a maximum of 20 years. If
the violation results in death, the prison term may be expanded to include any number of years, or life
imprisonment.
Examples
   Dr. X, a chiropractor, intentionally billed Medicare for physical therapy and chiropractic treatments
       that he never actually rendered for the purposes of fraudulently obtaining Medicare payments.
   Dr. X, a psychiatrist, billed Medicare, Medicaid, TRICARE, and private insurers for psychiatric
       services that were provided by his nurses rather than himself.
II. Theft or Embezzlement in Connection with Health Care (18 U.S.C. 669)
Description of Unlawful Conduct

It is a crime to knowingly and willfully embezzle, steal or intentionally misapply any of the assets of a
health care benefit program. Note that this law applies not only to Federal health care programs, but to
most other types of health care benefit programs as well.
Penalty for Unlawful Conduct
The penalty may include the imposition of a fine, imprisonment of up to 10 years, or both. If the value
of the asset is $100 or less, the penalty is a fine, imprisonment of up to a year, or both.
                                                                                            APPENDIX F

                                       CRIMINAL STATUTES

Example
An office manager for Dr. X knowingly embezzles money from the bank account for Dr. X's practice.
The bank account includes reimbursement received from the Medicare program; thus, intentional
embezzlement of funds from this account is a violation of the law.


III. False Statements Relating to Health Care Matters (18 U.S.C. 1035)
Description of Unlawful Conduct
It is a crime to knowingly and willfully falsify or conceal a material fact, or make any materially false
statement or use any materially false writing or document in connection with the delivery of or payment
for health care benefits, items or services. Note that this law applies not only to Federal health care
programs, but to most other types of health care benefit programs as well.
Penalty for Unlawful Conduct
The penalty may include the imposition of a fine, imprisonment of up to 5 years, or both.
Example
Dr. X certified on a claim form that he performed laser surgery on a Medicare beneficiary when he knew
that the surgery was not actually performed on the patient.
IV. Obstruction of Criminal Investigations of Health Care Offenses (18 U.S.C. 1518)
Description of Unlawful Conduct
It is a crime to willfully prevent, obstruct, mislead, delay or attempt to prevent, obstruct, mislead, or
delay the communication of records relating to a Federal health care offense to a criminal investigator.
Note that this law applies not only to Federal health care programs, but to most other types of health care
benefit programs as well.
Penalty for Unlawful Conduct
The penalty may include the imposition of a fine, imprisonment of up to 5 years, or both.
Examples
1.     Dr. X instructs his employees to tell OIG investigators that Dr. X personally performs all
       treatments when, in fact, medical technicians do the majority of the treatment and Dr. X is rarely
       present in the office.
2.     Dr. X was under investigation by the FBI for reported fraudulent billings. Dr. X altered patient
       records in an attempt to cover up the improprieties.
                                                                                            APPENDIX F

                                        CRIMINAL STATUTES

V. Mail and Wire Fraud (18 U.S.C. 1341, 1343)
Description of Unlawful Conduct
It is a crime to use the mail, private courier, or wire service to conduct a scheme to defraud another of
money or property. The term "wire services" includes the use of a telephone, fax machine or computer.
Each use of a mail or wire service to further fraudulent activities is considered a separate crime. For
instance, each fraudulent claim that is submitted electronically to a carrier would be considered a
separate violation of the law.
Penalty for Unlawful Conduct
The penalty may include the imposition of a fine, imprisonment of up to 5 years, or both.

Examples
1.       Dr. X knowingly and repeatedly submits electronic claims to the Medicare carrier for office
         visits that he did not actually provide to Medicare beneficiaries with the intent to obtain
         payments from Medicare for services he never performed.
2.       Dr. X, a neurologist, knowingly submitted claims for tests that were not reasonable and
         necessary and intentionally upcoded office visits and electromyograms to Medicare.
VI. Criminal Penalties for Acts Involving Federal Health Care Programs (42 U.S.C. 1320a-7b)
Description of Unlawful Conduct
False Statements and Representations
It is a crime to knowingly and willfully:
     •   make, or cause to be made, false statements or representations in applying for benefits or
         payments under all Federal health care programs;
     •   make, or cause to be made, any false statement or representation for use in determining rights to
         such benefit or payment;
     •   conceal any event affecting an individual's initial or continued right to receive a benefit or
         payment with the intent to fraudulently receive the benefit or payment either in an amount or
         quantity greater than that which is due or authorized;
     •   convert a benefit or payment to a use other than for the use and benefit of the person for whom it
         was intended;
                                                                                              APPENDIX F

                                        CRIMINAL STATUTES

   •   present, or cause to be presented, a claim for a physician's service when the service was not
       furnished by a licensed physician;
   •   for a fee, counsel an individual to dispose of assets in order to become eligible for medical
       assistance under a State health program, if disposing of the assets results in the imposition of an
       ineligibility period for the individual.
Anti-Kickback Statute
It is a crime to knowingly and willfully solicit, receive, offer, or pay remuneration of any kind (e.g.,
money, goods, services):
   •   for the referral of an individual to another for the purpose of supplying items or services that are
       covered by a Federal health care program; or

   •    for purchasing, leasing, ordering, or arranging for any good, facility, service, or item that is
       covered by a Federal health care program.
There are a number of limited exceptions to the law, also known as "safe harbors," which provide
immunity from criminal prosecution and which are described in greater detail in the statute and related
regulations (found at 42 CFR 1001.952 and www.hhs.gov/oig/ak). Current safe harbors include:
   •   investment interests;
   •   space rental;
   •   equipment rental;
   •   personal services and management contracts;
   •   sale of practice;
   •   referral services;
   •   warranties;
   •   discounts;
   •   employment relationships;
   •   waiver of Part A co-insurance and deductible amounts;
   •   group purchasing organizations;
   •   increased coverage or reduced cost sharing under a risk-basis or prepaid plan; and
                                                                                         APPENDIX F

                                      CRIMINAL STATUTES

   •   charge reduction agreements with health plans.
Penalty for Unlawful Conduct
The penalty may include the imposition of a fine of up to $25,000, imprisonment of up to 5 years, or
both. In addition, the provider can be excluded from participation in Federal health care programs. The
regulations defining the aggravating and mitigating circumstances that must be reviewed by the OIG in
making an exclusion determination are set forth in 42 CFR Part 1001.
Examples


   1. Dr. X accepted payments to sign Certificates of Medical Necessity for durable medical
      equipment for patients she never examined.


   2. Home Health Agency disguises referral fees as salaries by paying referring physician Dr. X for
      services Dr. X never rendered to Medicare beneficiaries or by paying Dr. X. a sum in excess of
      fair market value for the services he rendered to Medicare beneficiaries.
                                                                                             APPENDIX G

                            CIVIL AND ADMINISTRATIVE STATUTES

This Appendix contains a description of civil and administrative statutes related to fraud and abuse in
the context of health care. The Appendix is not intended to be a compilation of all Federal statutes
related to health care fraud and abuse. It is merely a summary of some of the more frequently cited
Federal statutes.
I. The False Claims Act (31 U.S.C. 3729-3733)
Description of Unlawful Conduct
This is the law most often used to bring a case against a health care provider for the submission of false
claims to a Federal health care program. The False Claims Act prohibits knowingly presenting (or
causing to be presented) to the Federal Government a false or fraudulent claim for payment or approval.
Additionally, it prohibits knowingly making or using (or causing to be made or used) a false record or
statement to get a false or fraudulent claim paid or approved by the Federal Government or it agents,
like a carrier, other claims processor, or state Medicaid program.
Definitions
False Claim - A false claim is a claim for payment for services or supplies that were not provided
specifically as presented or for which the provider is otherwise not entitled to payment. Examples of
false claims for services or supplies that were not provided specifically as presented include, but are not
limited to:
   •   a claim for a service or supply that was never provided.
   •   a claim indicating the service was provided for some diagnosis code other than the true diagnosis
       code in order to obtain reimbursement for the service (which would not be covered if the true
       diagnosis code were submitted).
   •   a claim indicating a higher level of service than was actually provided.
   •   a claim for a service that the provider knows is not reasonable and necessary.
   •   a claim for services provided by an unlicensed individual.
Knowingly - To "knowingly" present a false or fraudulent claim means that the provider: 1) has actual
knowledge that the information on the claim is false; 2) acts in deliberate ignorance of the truth or falsity
of the information on the claim; or 3) acts in reckless disregard of the truth or falsity of the information
on the claim. It is important to note the provider does not have to deliberately intend to defraud the
Federal Government in order to be found liable under this Act. The provider need only "knowingly"
present a false or fraudulent claim in the manner described above.
Deliberate Ignorance - To act in "deliberate ignorance" means that the provider has deliberately chosen
to ignore the truth or falsity of the information on a claim submitted for payment, even though the
                                                                                           APPENDIX G

                            CIVIL AND ADMINISTRATIVE STATUTES

provider knows, or has notice, that information may be false. An example of a provider who submits a
false claim with deliberate ignorance would be a physician who ignores provider update bulletins and
thus does not inform his/her staff of changes in the Medicare billing guidelines or update his/her billing
system in accordance with changes to Medicare billing practices. When claims for non-reimbursable
services are submitted as a result, the False Claims Act has been violated.
Reckless Disregard - To act in "reckless disregard" means that the provider pays no regard to whether
the information on a claim submitted for payment is true or false. An example of a provider who submits
a false claim with reckless disregard would be a physician who assigns the billing function to an
untrained office person without inquiring whether the employee has the requisite knowledge and
training to accurately file such claims.
Penalty for Unlawful Conduct
The penalty for violating the False Claims Act is a minimum of $5,500 up to a maximum of $11,000 for
each false claim submitted. In addition to the penalty, a provider could be found liable for up to three
times the amount unlawfully claimed.

Examples

   •    A physician submitted claims to Medicare and Medicaid representing that he had personally
       performed certain services when, in reality, the services were performed by a nonphysician and
       they were not reimbursable under the Federal health care programs.

   •    Dr. X intentionally upcoded office visits and angioplasty consultations that were submitted for
       payment to Medicare.

   •    Dr. X, a podiatrist, knowingly submitted claims to the Medicare and Medicaid programs for
       non-routine surgical procedures when he actually performed routine, non-covered services such
       as the cutting and trimming of toenails and the removal of corns and calluses.
II. Civil Monetary Penalties Law (42 U.S.C. 1320a-7a)
Description of Unlawful Conduct
The Civil Monetary Penalties Law (CMPL) is a comprehensive statute that covers an array of fraudulent
and abusive activities and is very similar to the False Claims Act. For instance, the CMPL prohibits a
health care provider from presenting, or causing to be presented, claims for services that the provider
"knows or should know" were:
   •   not provided as indicated by the coding on the claim;
   •   not medically necessary;
                                                                                           APPENDIX G

                             CIVIL AND ADMINISTRATIVE STATUTES

     •   furnished by a person who is not licensed as a physician (or who was not properly supervised by
         a licensed physician);
     •   furnished by a licensed physician who obtained his or her license through misrepresentation of a
         material fact (such as cheating on a licensing exam);
     •   furnished by a physician who was not certified in the medical specialty that he or she claimed to
         be certified in; or

     •    furnished by a physician who was excluded from participation in the Federal health care
         program to which the claim was submitted.
Additionally, the CMPL contains various other prohibitions, including:
     •   offering remuneration to a Medicare or Medicaid beneficiary that the person knows or should
         know is likely to influence the beneficiary to obtain items or services billed to Medicare or
         Medicaid from a particular provider; and
     •   employing or contracting with an individual or entity that the person knows or should know is
         excluded from participation in a Federal health care program.
The term "should know" means that a provider: 1) acted in deliberate ignorance of the truth or falsity of
the information; or 2) acted in reckless disregard of the truth or falsity of the information. The Federal
Government does not have to show that a provider specifically intended to defraud a Federal health care
program in order to prove a provider violated the statute.
Penalty for Unlawful Conduct
Violation of the CMPL may result in a penalty of up to $10,000 per item or service and up to three times
the amount unlawfully claimed. In addition, the provider may be excluded from participation in Federal
health care programs. The regulations defining the aggravating and mitigating circumstances that must
be reviewed by the OIG in making an exclusion determination are set forth in 42 CFR Part 1001.
Examples
1.       Dr. X paid Medicare and Medicaid beneficiaries $20 each time they visited him to receive
         services and have tests performed that were not preventive care services and tests.
2.       Dr. X hired Physician Assistant P to provide services to Medicare and Medicaid beneficiaries
         without conducting a background check on P. Had Dr. X performed a background check by
         reviewing the HHS-OIG List of Excluded Individuals/Entities, Dr. X. would have discovered
         that he should not hire P because P is excluded from participation in Federal health care
         programs for a period of five years.
                                                                                              APPENDIX G

                             CIVIL AND ADMINISTRATIVE STATUTES

3.       Dr. X and his oximetry company billed Medicare for pulse oximetry that they knew they did not
         perform and services that had been intentionally upcoded.


III. Exclusion of Certain Individuals and Entities From Participation in Medicare and other
Federal Health Care Programs (42 U.S.C. § 1320a-7)
Mandatory Exclusion
Individuals or entities convicted of the following conduct must be excluded from participation in
Medicare and Medicaid for a minimum of five years:
     •   a criminal offense related to the delivery of an item or service under Medicare or Medicaid;
     •   a conviction under Federal or State law of a criminal offense relating to the neglect or abuse of a
         patient;
     •   a conviction under Federal or State law of a felony relating to fraud, theft, embezzlement, breach
         of fiduciary responsibility or other financial misconduct against a health care program financed
         by any Federal, State, or local government agency; or
     •   a conviction under Federal or State law of a felony relating to unlawful manufacture,
         distribution, prescription, or dispensing of a controlled substance.
If there is one prior conviction, the exclusion will be for ten years. If there are two prior convictions, the
exclusion will be permanent.
Permissive Exclusion
Individuals or entities convicted of the following offenses, may be excluded from participation in
Federal health care programs for a minimum of 3 years:
     •   a criminal offense related to the delivery of an item or service under Medicare or Medicaid;
     •   a misdemeanor related to fraud, theft, embezzlement, breach of fiduciary responsibility or other
         financial misconduct against a health care program financed by any Federal, State, or local
         government agency;
     •   interference with, or obstruction of, any investigation into certain criminal offenses;
     •   a misdemeanor related to the unlawful manufacture, distribution, prescription or dispensing of a
         controlled substance;
     •   exclusion or suspension under a Federal or State health care program;
                                                                                               APPENDIX G

                              CIVIL AND ADMINISTRATIVE STATUTES

     •   submission of claims for excessive charges, unnecessary services or services that were of a
         quality that fails to meet professionally recognized standards of health care;
     •   violating the civil monetary penalties law or the statute entitled "Criminal Penalties for Acts
         Involving Federal Health Care Programs";
     •   ownership or control of an entity by a sanctioned individual or immediate family member
         (spouse, natural or adoptive parent, child, sibling, stepparent, stepchild, stepbrother or stepsister,
         in-laws, grandparent and grandchild);
     •   failure to disclose information required by law;
     •   failure to supply claims payment information; and
     •   defaulting on health education loan or scholarship obligations.
The above list is not all inclusive. Additional grounds for permissive exclusion are detailed in the
statute.
Examples
1.       Nurse R was excluded based on a conviction involving obtaining dangerous drugs by forgery.
         She also altered prescriptions that were given for her own health problems before she presented
         them to the pharmacist to be filled.
2.       Practice T was excluded due to its affiliation with its excluded owner. The practice owner,
         excluded from participation in the Federal health care programs for soliciting and receiving
         illegal kickbacks, was still participating in the day-to-day operations of the practice after his
         exclusion was effective.
                                                                                       APPENDIX H

                             CARRIER CONTACT INFORMATION



Medicare
A complete list of contact information (address, phone number, email address) for Medicare Part B
Carriers can be found on the CMS website at www.hcfa.gov/medicare/incardir.htm.
Medicaid
Contact information (address, phone number, email address) for each state Medicaid carrier can be
found on the CMS website at www.hcfa.gov/medicaid/mcontact.htm. In addition to a list of Medicaid
carriers, the website includes contact information for each State survey agency and the CMS Regional
Offices.
                                                                                        APPENDIX I

                                      INTERNET RESOURCES


Office of Inspector General - U.S. Department of Health and Human Services
(www.hhs.gov/oig)
This website includes a variety of information relating to Federal health care programs, including the
following:
Advisory Opinions
Anti-Kickback Information
Compliance Program Guidance
Corporate Integrity Agreements
Fraud Alerts
Links to web pages for the:
Office of Audit Services (OAS)
Office of Evaluation and Inspections (OEI)
Office of Investigations (OI)
OIG List of Excluded Individuals/Entities
OIG News
OIG Regulations
OIG Semi-Annual Report
OIG Workplan
Centers for Medicare / Medicaid Services (www.cms.gov)
This website includes information on a wide array of topics, including the following:
Medicare
National Correct Coding Initiative
Intermediary-Carrier Directory
Payment
Program Manuals
Program Transmittals & Memorandum
Provider Billing/CMS Forms
Statistics and Data


Medicaid
CMS Regional Offices
Letters to State Medicaid Directors
Medicaid Hotline Numbers
Policy & Program Information
                                                                         APPENDIX I

                                    INTERNET RESOURCES
State Medicaid Contacts
State Medicaid Manual
State Survey Agencies
Statistics and Data

                      CMS Medicare Training (www.medicaretraining.com)


This site provides computer-based training on the following topics:

CMS 1500 Form
Fraud & Abuse
ICD-9-CM Diagnosis Coding
Adult Immunization
Medicare Secondary Payer (MSP)
Women's Health
Front Office Management
Introduction to the World of Medicare
Home Health Agency
CMS 1
                                    COMPLIANCE PLAN
                                 AFFIRMATION STATEMENT

I have been provided a copy of the Visiting Physicians Association Compliance Plan (hereinafter,
“the Plan”). Following ample opportunity to read the Plan, I fully understand the information and
policies contained therein, including but not limited to VPA’s Code of Conduct. I have been given
the opportunity to address any questions and/or concerns regarding the Plan, including the Code of
Conduct. I also understand that should I have any questions and/or concerns regarding the Plan,
including the Code of Conduct, in the future that I am free to contact my supervisor or Chief
Compliance Officer for assistance. I understand that full compliance with the Plan, including the
Code of Conduct is a condition of my employment. I further understand that any failure to comply
may result in disciplinary action, up to and including termination. I understand that I am required to
report any suspected violation of the Plan, including the Code of Conduct, through the voluntary
reporting mechanisms in existence at VPA. Failure to do so may also result in disciplinary action, up
to and including termination. I further understand that at all times relevant hereto I remain an “at-
will” employee.


Employee Name:________________________________________________________________

Title/Department:_______________________________________________________________

Location/Facility: _______________________________________________________________


Signature:_______________________________________               Date____________________




Please return this form to the Human Resources Department/Corporate Compliance Office.

ADMINISTRATIVE USE ONLY:

Processed on _______________ by_________________________________________________

								
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