Adult Resources Center, Inc. has adopted this Compliance Plan in order to serve its Individuals as well as any and all third parties in accordance with the law as well as with the highest of ethical standards. The effectiveness of this Compliance Plan hinges on the active participation of all Board members, personnel, and independent contractors in preventing, detecting, and appropriately responding to fraud, abuse or other misconduct.
This Compliance Program is designed to promote Adult Resources Center, Inc.’s compliance with all applicable federal, State and local laws and regulations as well as government contracts and conditions of public support programs.
This plan is a long term commitment to conduct business in ways that promote “doing the right thing”. The plan will be continually monitored to make sure that the “right thing” is being done and responding to changes and problems that are identified along the way.
There are many benefits to Adult Resources Center, Inc.‘s Compliance Plan including but not limited to:
All Adult Resources Center, Inc. personnel and contractors have the obligation to assist in making the Compliance Plan successful. Personnel are expected to:
The Adult Resources Center, Inc. Compliance Program is based on compliance guidelines provided by the United States Department of Health and Human Services Office of the Inspector General and the requirements imposed on health care providers under Section 363-d of the New York Social Services Law.
The key elements of the Compliance Program, which are discussed in greater detail within the Compliance Plan are:
The following are the definitions for the terms as used in the Compliance Plan:
Actions that do not involve intentional misrepresentations of fact, but nevertheless are inconsistent with sound financial, business, or healthcare practices and create significant risk to the integrity of the organization such as 1) unnecessary cost to the programs,
2) reimbursement for services that are not medically necessary, or 3) reimbursement for services that fail to meet professionally recognized standards of care.
Any person or business that acts as a representative of or has the authority to act for or on behalf of Adult Resources Center, Inc..
The federal statute, as it relates to healthcare, which prohibits anyone from knowingly and willfully soliciting, receiving, offering, or paying any remuneration directly or indirectly, in cash or in kind, in exchange for services or purchases for which payment may be made by Medicare and/or Medicaid.
The process of utilizing a medical classification system to assign a numeric code to diagnostic and procedural data.
A group of people designated and chaired by the Compliance Officer to oversee and help administer this Compliance Plan.
The person within the organization who is assigned the responsibility of maintaining and overseeing an effective Compliance Plan.
This plan which establishes the standards of conduct for ARC designed to promote honest and ethical behavior, which also provides a structure for educating and communicating those standards to employees, management, and Board members with the overall objective to prevent, detect, and report significant noncompliance to the best of anyone’s abilities.
A federal law that imposes liability on any person who submits a claim to the federal government that he or she knows (or should know) is false. The False Claims Act also imposes liability on an individual who may knowingly submit a false record in order to obtain payment from the government. The third area of liability includes those instances in which someone may obtain money from the federal government to which he may not be entitled, and then uses false statements or records in order to retain the money. The Act provides that private parties may bring an action on behalf of the United States. These private parties are known as “qui tam relators.”
Medicare, Medicaid and any other programs funded by the federal government.
Intentional misrepresentation designed to induce reliance by another person to obtain unauthorized benefit.
Agencies involved in health care investigations include, but are not limited to, the United States Department of Health and Human Services’ Office of Inspector General, United States Department of Justice, Federal Bureau of Investigation, Centers for Medicaid and Medicare Services, New York State Department of Health, Office of the Medicaid Inspector General, New York State Medicaid Fraud Control Units, and New York State Office of Mental Retardation and Developmental Disabilities.
A federal law titled “Health Insurance Portability and Accountability Act”. Regulations issued under HIPAA protect the privacy of health information and identifying information for all Americans. HIPAA went into effect on April 14, 2003.
Any vendor, physician, dentist, therapist, psychologist, social worker, nursing staff member, dietician, volunteer, agent or other person who is empowered by contract or otherwise to provide health-related services on behalf of ARC.
To act “knowingly” is to act with actual knowledge, deliberate ignorance, or a reckless disregard for the truth or the falsity of information.
Any action, behavior or failure to act that is not in conformity with Adult Resources Center, Inc. standards, guidelines, or procedures or that is a violation of any federal, state or local law or regulation.
Exhibiting lack of due care or concern.
Closely tracts the federal False Claims Act. It imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from any state or local government, including healthcare programs such as Medicaid.
Failure or refusal to act in accordance with this Compliance Plan, or other standards or procedures, or with federal, state or local laws or regulations.
Any payor of healthcare services other than Medicare or Medicaid, including but not limited to private individuals and insurance plans.
Individuals who bring an action on behalf of the United States under the federal False Claims Act or on behalf of New York State under the New York State False Claims Act. Qui Tam Relators may share in a percentage of the proceeds from the False Claims Act action or settlement. These individuals are also known as “whistleblowers”.
Any action that constitutes any of the definitions of fraud or abuse or are a violation of a federal, state or local law or regulation.
Medicaid or any other program funded in whole or part by New York State.
Unnecessary expenditures or to use carelessly.
Same definition as above for Qui Tam Relator
Protection provided under the federal law and the State False Claims Act to whistleblowers or qui tam relators who are discharged, demoted, suspended, threatened, harassed, or in any manner discriminated against in the terms and conditions of their employment as a result of their furtherance of an action under the federal law or the State False Claims Act.
The following are descriptions of some of the major federal statutes specifically applicable to healthcare providers. This listing is not intended to identify all of the applicable laws. Employees, independent contractors, agents and vendors should promptly consult the Compliance Officer with specific questions.
The federal Anti-Kickback statute prohibits any person from knowingly and willfully soliciting, receiving, offering or paying anything of value to another person in return for the referral of a patient, or in return for the purchasing, leasing, ordering, or arranging for any item or service, reimbursed by a federal health care program such as Medicare or Medicaid (42 U.S.C. 1310a-7b). Penalties for violating the statute include imprisonment, criminal fines, exclusion from government health care programs and civil monetary penalties. A similar New York state law prohibits the exchange of remuneration for referrals for items or services covered by the state’s Medicaid program (N.Y. Social Services Law 366-d)
Personnel are prohibited from 1) offering or paying anything of value, whether in cash or in kind, to another party in return for the referral of a client to Adult Resources Center, Inc. Likewise, personnel are prohibited from 2) soliciting or receiving anything of value, whether in case or in kind, from another party in return for the referral of a person served by Adult Resources Center, Inc. to another health care provider.
The following are examples of conduct that violates this policy, but violations are not limited to, the following:
Personnel should refer clients for medical care to other providers based solely on the medical needs of the client and in accordance with Adult Resources Center, Inc. policies and procedures.
The acceptance of gifts from vendors or prospective vendors of Adult Resources Center, Inc. may constitute an improper kickback under state and federal law. Accordingly, personnel may not solicit or receive any such gifts except what is permitted under Adult Resources Center, Inc. policies and procedures.
Certain common business arrangements between parties exchanging referrals may be structured to fit within “safe harbors” to the anti-kickback statute. Complying with a safe harbor ensures that no portion of the compensation flowing under the arrangement may be characterized as an improper inducement for referrals.
The Anti-kickback statute is complex and Adult Resources Center, Inc. expects that there may be questions that arise for a particular activity or arrangement. Personnel are encouraged to ask their supervisors for any guidance and if necessary may contact the Compliance Officer for assistance.
Personnel who do not comply with this policy will be subject to disciplinary action by Adult Resources Center, Inc. Depending upon the facts and the circumstances of each case, Adult Resources Center, Inc. may reprimand, suspend or dismiss any employee who fails to comply with this policy.
The False Claims Act is violated if a person knowingly makes, uses or causes to be made or used, a false record statement to get a false or fraudulent claim paid or approved by the federal government. (31 U.S.C. 3729) The potential penalties for violating the False Claims Act include treble damages (damages equal to three times the amount of the false claims), civil penalties of up to $11,000 per claim and exclusion from federal health care programs. In addition, the federal government may impose administrative sanctions of up to $5,500 plus twice the amount of the false claim under the Federal Program Civil Remedies Act of 1986 (31 U.S.C. 3801)
Several New York State laws also prohibit the making of false claims and statements. Criminal penalties may be imposed for knowingly making a false entry into a business record or filing a false document with a government agency (Article 175 of the Penal Law), committing a fraudulent insurance act (Article 176 of the Penal Law) or engaging in health care fraud (Article 177 of the Penal Law).
The list above is a sample of some items and is not all – inclusive. All personnel and independent contractors are strictly prohibited from engaging in any conduct that violates the False Claims Act. There can be criminal as well as civil and administrative penalties for violations of this Act.
Personnel are expected to report to Medicaid or any other federal healthcare program any claim or report that appears to be fraudulent or false as well as any conduct that appears to violate the False Claims Act. Any of the mechanisms that have been described are acceptable. All reports received from employees will be evaluated and investigated as necessary pursuant to this policy.
Personnel have the legal right to file qui tam lawsuits if they become aware that Adult Resources Center, Inc. has submitted claims for reimbursement to Medicaid or other government programs in violation of the False Claims Act. In a qui tam lawsuit, the employee “relator,” files the cause under seal and requests that the federal government intervene and take over the prosecution of the matter. The “relator” may receive a portion of the funds if there is a government recovery. Adult Resources Center, Inc. will not impede any employee from filing a qui tam lawsuit by threats of retaliation or otherwise.
However, all employees are encouraged to report and attempt to resolve any False Claims violations through the internal procedures established by Adult Resources Center, Inc. prior to filing such case.
Adult Resources Center, Inc. provides training to employees under the Personnel training guidelines. This training will include a component addressing the False Claims Act as well as State laws punishing the making of false claims or statements. Human Resources will work with the Compliance Officer to ensure that the Personnel Policies Handbook contains information on the False Claims Act and the State laws.
The Compliance Officer will ensure that there are periodic compliance audits conducted to cover the submission of accurate claims and cost reports to the Medicaid program, as well as any other activities deemed by the Compliance Officer to raise potential risks under the False Claims Act. The Compliance Officer will oversee the development and implementation of a corrective action plan to address any compliance identified through such audits.
Under the False Claims Act, Adult Resources Center, Inc. may avoid treble damages and civil penalties if it discloses to the relevant federal healthcare program any false or fraudulent claims, and makes appropriate restitution of any overpayments, within 30 days of discovery of the false claim. Accordingly, the Compliance Officer will promptly investigate all reports of potential False Claims Act violations to provide Adult Resources Center, Inc. with an opportunity to make disclosure and restitution within the 30-day period.
The False Claims Act is complex and Adult Resources Center, Inc. expects that there may be questions that arise for a particular activity or arrangement. Personnel are encouraged to ask their supervisors for any guidance and if necessary may contact the Compliance Officer for assistance.
Personnel who do not comply with this policy will be subject to disciplinary action by Adult Resources Center, Inc. Depending upon the facts and the circumstances of each case, Adult Resources Center, Inc. may reprimand, suspend or dismiss any employee who fails to comply with this policy.
It is the expectation of Adult Resources Center, Inc. that all employees shall conduct themselves in a mature, professional manner at all times, whether in the program, on the facility or out in the community. The conduct and actions of every employee reflects on Adult Resources Center, Inc. and the people we serve. Our employees are the first line of contact with the program participants and we expect them to provide a suitable and satisfactory role model to emulate.
Adult Resources Center, Inc. policy regarding Conflict of Interest is that no employee or Board member of Adult Resources Center, Inc. shall benefit by the actions of the Board or the Management of Adult Resources Center, Inc..
For employees, in the event that circumstances arise that best meet the needs of the Individuals through the purchase of goods or services from a firm in some way connected to the employee, this should be made clear to the management of Adult Resources Center, Inc..
For Board members, in the event that circumstances arise that best meet the needs of the consumers through the purchase of goods or services from a firm in some way connected to the Board member, this would be made clear to the Board of Directors prior to a vote. The person with the potential conflict should abstain from being present during the discussion as well as voting on the issue
See Form A-1 and A-2 attached to be completed by the Board of Directors members as well as the employees on an annual basis.
If the Executive Director’s wife is the CFO of a paper supply company that Adult Resources Center, Inc. may include in the bidding to select as the company to supply the agency with paper goods the Executive Director should note this on the Conflict of Interest Policy.
If a Board member has a child in one of the residences and there is an issue that arises with the child and there may be any type of action taken the member should exclude themselves from the conversation and abstain from any vote that is taken.
The purpose of this policy is to protect the interest of the Adult Resources Center when it is contemplating entering into a Transaction (as defined below) that might, directly or indirectly, benefit the private or outside interests of one of the Adult Resources Center employees. This policy is also designed to ensure that any outside activities of employees do not conflict with their duty of loyalty to the Adult Resources Center.
The Adult Resources Center makes business decisions impartially, fairly and without favoritism, for the purpose of advancing the Adult Resources Center’s mission and interests. All employees must conduct themselves in a way that avoids conflicts of interest and protects the Adult Resources Center’s resources as well as its reputation for fair and ethical business conduct. No Transaction between the Adult Resources Center and any vendor or other outside party shall be influenced, or appear to be influenced, by an employee’s personal interest or relationships. Any personal or outside investments, relationships, transactions or interest, whether direct or indirect, that would or could have an adverse affect on the Adult Resources Center or an employee’s prudent, objective and independent business judgment constitute an unacceptable conflict of interest and are prohibited.
The “Family” of an individual includes (i) such individual’s parents, spouse, children, brothers and sisters, (ii) the parents, brothers and sisters of the individual’s spouse and (iii) the spouses of the individual’s parents, children, brothers and sisters.
A person has a “Substantial Financial Interest” in any corporation, firm, association or other entity if such a person receives compensation (i.e., wages, fees, other direct or indirect remuneration, gifts or favors that are substantial in nature, etc.) from or has, directly or indirectly, through business, investment or Family, an aggregate beneficial equity interest of 10 percent or more in such corporation, firm, association or other entity.
The term “Transaction” means any contract, investment, loan, lease, joint venture or other business or financial arrangement, whether direct or indirect.
Prohibited Activities Representing a Conflict of Interest
Personnel are prohibited from engaging in any of the following activities:
In order for the Adult Resources Center to be able to monitor potential Conflicts of Interest, all personnel shall promptly report to the Compliance Officer any existing, proposed or potential Transaction of which they are aware that could represent a Conflict of interest under this policy.
The Adult Resources Center will request that certain personnel, including personnel responsible for purchasing goods or services on behalf of the Adult Resources Center complete a Disclosure Statement or an annual basis in order to identify actual or potential conflicts of Interest. The Compliance Officer will develop and maintain a list of job positions requiring completion of the Disclosure statement, and coordinate the dissemination and review thereof. Personnel required to complete the Disclosure Statement must do so in a truthful, complete and timely manner. (See Form #3)
Questions regarding interpretation or application of this policy should be referred to the Adult Resources Center for clarification.
Personnel who do not comply with this policy will be subject to disciplinary action by the Adult Resources Center. Depending on the facts and circumstances of each case (and in compliance with any applicable collective bargaining agreements), the Adult Resources Center may reprimand, suspend or dismiss any employee who fails to comply with this policy.
Issued By: Francois Ledee
Date Issued: 5/14/12
Amendment to existing Conflict of Interest Policy
The purpose of this policy is to establish safeguards to prevent the employment of individuals who have engaged in fraud or other dishonest conduct. This policy should include current employees, new hires, independent contractors and vendors.
The basic screening (per the policies and procedures of the agency should be performed)
An additional screening should be the List of Excluded Individuals and Entities (LEIE) and the Excluded Parties List System (EPLS). There is also a NYS Medicaid Fraud Database that should be checked. All employment application forms will require applicants for employment to indicate whether they have been excluded from participation in the Medicare or Medicaid program or otherwise disbarred by a federal health care program. Applicants will certify on such forms that the information they have provided regarding such exclusions is accurate and complete.
Upon receipt of notification from the U.S. Department of Health and Human Services Office of Inspector General that personnel have been excluded from a federal health program, Adult Resources Center, Inc. will promptly terminate their employment. If any personnel obtains information indicating that other personnel are subject to such an exclusion, the person must promptly notify the Compliance Officer, who will be responsible for investigating the matter.
Human Resources along with the Compliance Officer will designate which positions are subject to pre-employment criminal background and/or credit history checks. All Department directors should receive a listing of such positions within their department. Any changes to the list should be communicated immediately. All criminal background checks and credit history checks should be completed by Human Resources.
As part of the employment application, Adult Resources Center, Inc. should obtain written authorization by the candidate and provide them with the name, address and telephone number of the consumer reporting agency used by Adult Resources Center, Inc. together with a complete and accurate disclosure of the nature and scope of the investigation requested by Adult Resources Center, Inc. as well as a written summary of the candidate’s rights under the Fair Credit Reporting Act.
Before taking any adverse action, in whole or in part, of the information on the consumer report, Adult Resources Center, Inc. will provide the candidate with a copy of the report, along with a written description of their rights under the applicable law. Candidates will be afforded a reasonable time period to review the report for errors that might affect an adverse employment decision.
All records relating to criminal background and credit checks shall be retained in files separate from the employee’s personnel file. These records will be treated as confidential and may only be disclosed with the approval of the Human Resources Director, consistent with applicable laws.
Personnel who do not comply with this policy will be subject to disciplinary action including reprimand, suspension or dismissal.
The Compliance Officer is the person that is designated by the agency as having the overall responsibility of the compliance program. The Compliance Officer works with the Governance Compliance Committee, the Board of Directors, the Executive Director, managers, staff, legal team, police, regulatory bodies, and regulatory and quality auditors.
The Compliance Officer serves as the internal resource to whom employees may communicate about compliance issues and concerns and serves as a channel of communication to receive direct compliance issues to appropriate for investigation and resolution.
The following is a listing of Compliance Officer responsibilities. It should not be viewed as an all – inclusive list:
The Governance Compliance Committee is a specific Group of senior level management along with the Executive Director and the Compliance Officer. There may also be a board member included on this committee if deemed necessary. The members should be made up of representations from all major services, a Human Resources representative, a Finance Representative, and an IT representative.
The Committee should meet regularly (monthly or quarterly) and there should be minutes recorded and maintained.
The purpose of the Governance Compliance Committee is to advise and assist the Compliance Officer with the implementation of the Compliance Plan. The Committee assists with, and makes recommendations for the development of polices which are set by the Board of Directors.
The Governance Compliance Committee is responsible for:
Compliance training is a critical element to the Adult Resources Center, Inc. Compliance Plan. Every employee, independent contractor, agent and vendor is expected to be familiar and knowledgeable about Adult Resources Center, Inc.’ Compliance plan and to have a solid working knowledge of his or her responsibilities under the Plan. Compliance policies and standards will be communicated to all employees through training programs that are mandatory.
There will be an agency-wide training to all new employees and then an annual refresher will be given to employees. These trainings will be organized by the individual departments to focus on specific department functions.
As part of the orientation, each employee and independent contractor will receive a written copy of this Compliance Plan, policies and procedures and specific standards of conduct that affect his/her position. As a routine part of orientation, new employees and independent contractors are required to attend a mandatory training on compliance during which the Compliance Plan and Code of Ethics are reviewed during orientation and annually thereafter. Each employee is required to document all relationships that are or could be perceived to be a conflict of interest during the orientation and annually thereafter. Each agent and vendor will receive a notification of the Compliance Plan and will receive a copy upon entering into an agreement.
The following are items that should be discussed during the general training for all administrative personnel and members of the Board of Directors:
All education and training relating to the Compliance Plan will be verified by attendance and a signed acknowledgement of receipt of the Compliance Plan.
Attendance at compliance training sessions is mandatory and a condition of continued employment.
Adult Resources Center, Inc. should ensure that the Compliance Officer has sufficient opportunities to receive training on compliance issues through attendance at outside conferences and subscriptions to trade periodicals as well as by any other necessary means.
The Compliance Officer will be responsible, on a regular basis, for preparing and distributing to relevant employees any updates addressing new fraud and abuse or other compliance issues of which the Compliance Officer becomes aware. These updates should cover any changes in government contracts, new interpretations of laws or rules, revisions to Adult Resources Center, Inc. policies and procedures, and industry trends and developments. Department directors should notify the Compliance Officer of any significant matters they deem appropriate for inclusion in updates.
There will be open lines of communication between the Compliance Officer and every employee, independent contractor, agent and vendor subject to this Plan. Every employee, independent contractor, agent and vendor has an obligation to refuse to participate in any wrongful course of action and to promptly report the actions according to the procedure documented below.
If any of the above listed parties is asked to participate in any activity that could violate or is suspected to violate any Adult Resources Center, Inc. policy or any law or regulation, they are required to report this activity immediately. Employees should first contact their immediate supervisor if possible and independent contractors, agents, and vendors should notify the Corporate Compliance Officer immediately. If this person is not available, or it is believed that the supervisor may be involved with the activity, the Corporate Compliance Officer should be notified.
When there is a complaint made, immediately, the supervisor should document the issue and report it to the Corporate Compliance Officer.
The Corporate Compliance Officer shall document the information necessary to conduct an appropriate investigation of all complaints. Adult Resources Center, Inc. will, as much as is possible, protect the anonymity of the employee or vendor who reports the complaint or question.
All reports of fraudulent, abusive or other improper conduct, will be promptly reviewed and evaluated by the Compliance Officer. The Compliance Officer will determine in consultation with outside counsel and other Adult Resources Center, Inc. employees if necessary, whether the report warrants an internal investigation. If an internal investigation is warranted, the Compliance Officer coordinates the investigation and will issue a written report of its findings and propose corrective action if appropriate.
All personnel and independent contractors are expected to fully cooperate in all government audits and investigations. Any employee who fails to provide such cooperation will be subject to termination of employment.
All subpoenas and other governmental requests for Adult Resources Center, Inc. documents should be forwarded immediately to the Executive Director and the Compliance Officer. Employees are strictly prohibited from destroying, improperly modifying or otherwise making inaccessible any documents that the employee knows are the subject of a pending government subpoena or document request. Employees are also forbidden from directing or encouraging any other person to take such action.
If any personnel receive a request from a government investigator for an interview they must immediately notify their supervisor who should notify the Executive Director and the Corporate Compliance Officer. If necessary an attorney will be contacted to coordinate and schedule all interviews. Personnel are expected to answer all questions posed by government investigators truthfully and completely.
The identity of the person making the complaint will be safeguarded to the fullest extent that is possible. Employees, independent contractors, agents and vendors will be protected against retaliation of any kind. Any threat of retaliation against a person who acts pursuant to his or her responsibilities under this Plan is acting against the Adult Resources Center, Inc. Compliance Plan. This can result in discipline up to and including termination of employment if the retaliation is proven.
Employees who fail to comply with Adult Resources Center, Inc.’ Compliance Plan, or who have engaged in conduct that has the potential of impairing Adult Resources Center, Inc.’ status as a reliable, honest, and trustworthy service provider will be subject to disciplinary action, up to and including termination. Any discipline will be appropriately documented in the employee’s personnel file, along with a written statement of reason(s) for such discipline. The Corporate Compliance Officer shall maintain a record of all disciplinary actions involving the Compliance Plan and report at least annually, or as needed, to the Board of Directors regarding such actions.
Managers and their equivalent will be disciplined for failure to adequately instruct their subordinates or failure to detect noncompliance with applicable policies and legal requirements, where reasonable diligence on the part of the manager or equivalent would have led to the earlier discovery of any problems or violations and would have provided Adult Resources Center, Inc. with the opportunity to correct problems or violations.
Performance evaluations (per the Personnel Manual) will be utilized annually after the probationary period evaluation, to assist the Department Head and the Personnel Department in determining eligibility for promotion, salary increases and other terms and conditions of employment.
In addition to the elements that are included within the core evaluation, the promotion of, adherence to, and the elements of the Corporate Compliance Plan should be a factor in evaluating the performance of Adult Resources Center, Inc. employees, independent contractors, agents, and vendors.
The ongoing evaluation of the Plan is critical in detecting non-compliance. This is imperative to having the Plan be a success. There should be routine internal audits of the Plan to help identify areas of non-compliance with policy and procedure and to monitor compliance with the ever changing government regulations. This ongoing evaluation shall include internal auditing and monitoring of the following:
The audits will examine Adult Resources Center, Inc. compliance with specific rules and policies through on-site visits; employee, independent contractor, agent and/or vendor interviews; review of contracts, personnel records, training records, billing and other financial records; and client record documentation reviews.
At the beginning of each year, the Compliance Officer should develop a work plan, setting forward the internal audits for the upcoming year. The Compliance Committee approves the work plan. The audits should cover aspects of agency operations that pose a heightened risk of non-compliance, including but not limited to, Medicaid billing, cost reporting and access to medical care. A written report is prepared summarizing the finding of each audit, recommending any appropriate corrective action.
All employees are required to participate in and cooperate with internal audits as requested by the Compliance Officer. This includes assisting in the production of documents, explaining program operations or rules to auditors and implementing corrective action plans.
The Compliance Officer along with the Compliance Committee shall determine whether there is a basis to suspect that a violation of the Compliance Plan has occurred.
If it is determined that a violation may have occurred, the matter shall be discussed with the Governance Compliance Committee and with the Executive Director. In the event that the violation or potential violation appears to have merit, the Compliance Officer, with the input and approval of the Executive Director, will refer the matter to legal counsel who, with the assistance of the appropriate personnel, shall conduct a more detailed investigation. The investigation may include, but is not limited to, the following:
If advice is sought from any governmental agency, the request and any written or oral responses should be documented and communicated to the Governance Compliance Committee for discussion and potential further action
At the conclusion of the investigation involving legal counsel, counsel should be asked to write a written report to summarize the findings, conclusions, and recommendations and rendering an opinion as to whether a violation of the law has occurred. Any written report should be sent to the Executive Director as well as the Corporate Compliance Officer.
If Adult Resources Center, Inc. identifies an overpayment has been received by any third party payor, including Medicaid, Medicare, private parties, or other funding sources, the overpayment shall be promptly and fully repaid to the affected payor. Systems that allowed for the overpayment will be examined, modified, and monitored so as to prevent such overpayments in the future.
A record of the investigation, regardless of whether a report is made to a governmental agency should be maintained. This should include the record of the investigation along with copies of all pertinent documentation. The record will be considered confidential and privileged to the fullest extent permitted by law and will not be released without prior approval of the Executive Director and legal counsel. All compliance records will be kept in a secure area accessible to authorized personnel only.
The False Claims Act provides protections to qui tam realtors who are discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in terms and conditions of their employment as a result of their furtherance of any action under the False Claims Act. Federal law also prohibits intimidation and retaliation against whistleblowers.
In compliance with federal and state law, Adult Resources Center, Inc. will not permit any intimidation or retaliation against any individual who raises questions or concerns about misconduct. Adult Resources Center, Inc. will not assume intimidation tactics or take any retaliatory action against an employee if the employee, in good faith, discloses information about Adult Resources Center, Inc.’s policies, practices, or activities to a regulatory, law enforcement, or other similar agency or public official. Protected disclosures includes those that, in good faith, assert that the employer is in violation of a law that creates a substantial and specific danger to the public health and safety or which constitutes healthcare fraud under the law, or that assert that the employee believes constitute improper quality of consumer care. This policy applies to all employees, vendors/contractors, consultants and agents of Adult Resources Center.
An employee’s disclosure is protected only if the employee (or former employee) first brought up the matter with a supervisor and gave the employer a reasonable opportunity to correct the alleged violation, unless the danger is imminent to the public or patient and the employee believes in good faith that reporting to a supervisor would not result in corrective action.
Additional details regarding these laws may be obtained by contacting Human Resources, the Corporate Compliance Officer, or visiting the New York State Department of Labor website.
The Health Insurance Portability and Accountability Act (HIPAA) is a federal health regulation. It is intended to assure the portability of health insurance, to reduce health care fraud, and to guarantee the privacy and security of health information and implement standards for health information transaction.
All employees of Adult Resources Center, Inc. are covered under HIPAA.
The HIPAA Compliance Plan contains Practice policies, procedures, and standards of conduct designed to ensure the agency’s compliance with applicable rules, policies and procedures established by this Plan or behavior in violation of any HIPAA law, regulation or rule may result in disciplinary action. Willful failure by any employee to comply with the policies and procedures contained in this plan, will result in termination. Consult with the Compliance Officer if you have any questions about the agency’s commitment to effective compliance routines.
The agency strives at all times to maintain the highest degree of integrity in interactions with Individuals served and the delivery of service that the agency provides. The agency as a whole, along with all its Board members and employees will strive to maintain compliance with all laws, rules, regulations and requirements affecting the consumer care provided and the handling of consumer information. The protection of the privacy of an individual’s health information is of utmost concern to the agency.
There should be an individual that is identified to fulfill the role of Privacy and Security Officer. The following are the responsibilities of that role:
Every employee of the agency is expected to be familiar with the agency’s commitment and to cooperate with the Compliance Officer. Failure to comply fully may result in disciplinary action appropriate to the non-compliance-up to and including possible termination.
The agency will conduct periodic training on an ongoing basis to help employees to perform their functions in compliance with the standards of the agency and applicable regulations as well as to understand that HIPAA compliance is a condition of continued employment.
All information obtained by the agency including manuals, changes in regulations shall be promptly made available to all Affected Employees. Employees who receive information which they believe is relevant to HIPAA compliance efforts are required to furnish the information to the Compliance Officer.
All employees are expected to read this HIPAA Compliance Plan and understand its principles. If there are any questions or further clarification is needed the agency strongly encourages employees to seek answers to and/or clarification of any questions by the Compliance Officer.
An employee who is aware of actual or a suspected violation of the Compliance Plan is required immediately to report this to the Compliance Officer for investigation. Violations may include: an actual or suspected violation of Federal or State legislation, regulations, or requirements pertaining to the security, integrity, or confidentiality of individually identified health information. If the Compliance Officer is not immediately available or the reporting employee is concerned that the Compliance Officer are involved with the violation they may report to any of the Governance Compliance Committee members or the Executive Director.
There should be no retaliatory action taken against any employee that makes a report, if the report is made based upon a good faith belief that a Violation has occurred, is occurring, or is likely to occur in the near future, and the employee follows the procedures required herein. In addition, whenever possible the agency will make all reasonable efforts to keep confidential the identity of the reporting employee.
The Compliance Officer shall consult with legal counsel with respect to any reported Violation to ascertain the most appropriate means of investigating and responding to such a report. All investigations should be performed in a timely manner. Based upon the findings of the investigation, as appropriate remedial action will be taken to ensure that the violation ceases immediately and that the violation will be prevented from occurring in the future. All reports of violations (suspected or deemed actual after investigation), investigative findings, and remedial actions taken shall be documented and maintained by the Compliance Officer.
An employee who is found to have committed actual violations shall be subjected to immediate disciplinary action. The extent of the disciplinary action to be taken shall be determined by the Governance Compliance Committee. In addition to the disciplinary action(s) set forth above, and on the advice of legal counsel, the agency may turn an employee who has committed a violation over to the appropriate authority for criminal prosecution, as appropriate or as required by law.
To ensure ongoing HIPAA Compliance, the Compliance Personnel shall conduct regular auditing of agency functions and operations subject to HIPAA laws and regulation. These functions/operations include, but are not limited to the following:
Audits will include complete evaluation of agency procedures, a detailed examination of randomly selected transactions, and a report of the findings for the Compliance Officer’s records. If based upon audit, the agency if found to be non-compliant with any HIPAA law or regulation, Compliance Personnel, in conjunction with legal counsel, as appropriate, shall take prompt remedial action.
If any employee of the agency receives oral or written inquiry regarding the agency’s compliance with any HIPAA law or regulation or any other governmental or private payor requirement the employee should immediately notify the Compliance Officer prior to responding to the inquiry.
FORM A Conflict of Interest Affirmation
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