Mission -Rockland Hospital Guild, Inc. (RHG) is a not-for-profit agency providing housing and support services to individuals living with a serious and persistent mental illness, so that they may transition to a productive and permanent setting in the community. We are licensed by the New York State Office of Mental Health to provide these services. RHG is committed to providing the highest quality residential care and services to our recipients, and to conduct business with integrity and in compliance with all applicable federal and state laws and regulations.
Intent -This Code of Conduct is a guide for employees/interns, Board members, and consultants of RHG, and is a resource for performing your duties and responsibilities consistent with appropriate ethical, professional, and legal standards. These obligations apply to relationships with program participants and their family members, providers/colleagues, members of the community, fellow employees, consultants, vendors, Board Members, and contractors. This Code is the foundation of our Corporate Compliance Program. It has been developed to ensure that ethical and professional standards are met, and to comply with applicable funding requirements, laws, and regulations. While this Code is intended to be comprehensive and easily understood, it may not fully cover a particular subject. In many cases, a subject may be complex and additional guidance may be necessary to provide sufficient direction. Employees are encouraged to seek out guidance from a supervisor or the compliance officer. This Code of Conduct is mandatory and must be followed.
Ethics -It is RHG policy to abide by all laws and regulations applicable to its business and to conduct business with the highest degree of integrity and ethical standards. To this end all employees and consultants must comply with all laws, regulations, and policy that govern their work, and act in the best interest of the individuals we serve, and the greater community. Employees must report any alleged violations of this Code and assist our compliance and management team in investigating alleged and suspected violations.While all RHG employees are obligated to follow our Code of Conduct, we expect our leaders and managers to set the example and to be a model. They should help to create a culture within RHG that promotes the highest standards of ethical conduct and compliance. This culture must encourage everyone in the organization to identify and raise concerns when they arise. Employees who are members of professional disciplines (Nurses, Social Workers, Mental Health Counselors, MD’s, etc.) must adhere to their professional code of ethics, ethical guidelines, and standards of practice. Employees must provide services only within the scope of their professional training, competence, and expertise.
Conflict of Interest-All RHG employees, Board members, consultants, and contractors shall avoid situations where their personal interests could conflict, or appear to conflict, with their responsibilities, obligations, or duties to RHG. No employee shall use their position and affiliation with RHG for personal benefit, apart from the normal compensations provided through employment. All employees are required to follow the RHG’s Conflict of
Interest Policy, and to contact the Corporate Compliance Officer with any questions or conflicts regarding personal interests. All employees are required to disclose any financial interest that they, or any immediate family member may have in any establishment that does business with RHG, to the Compliance Officer or their Supervisor. All employees are required to complete the Conflict of Interest Disclosure Statement annually.
Outside Activities and Employment- Employees must not conduct non–RHG related or personal activities during their work hours. Any such activities may negatively impact the quality of your work and ability to provide care to our residents. Outside employment must not conflict with your responsibilities to RHG, with your work hours, or duties to the individuals we serve. Decisions of admission, discharge, and service provision for our recipients should not be based on any outside employment.
Use of Agency Resources- Agency funds, equipment, supplies, business information, and other RHG assets are to be used only on the recipients we serve, for providing services to those we serve, and in the course of business. Employees are strictly prohibited from using RHG funds and assets for their own personal use or gain, and from giving RHG assets to any other entity except in an approved transaction or in the ordinary course of business.
Confidentiality -Identifying and Confidential Information - All employees shall maintain the confidentiality of information and documents of individuals we serve in accordance with Health Insurance Portability and Accountability (HIPAA) and related statutes. Medical, clinical, or business information shall be released only to persons authorized by law or by the client’s written consent.
RHG employees, affiliated treatment providers, or other care providers shall be provided with the minimum amount of information necessary to provide care (HIPAA ‘minimum necessary rule’).
During the course of employment an employee may have knowledge of confidential and protected information about a recipient of services. Except as otherwise required by law, identifying and confidential information on individuals we serve shall not be released without an appropriately signed “Authorization to Disclose Confidential Information”.
Disclosure of Business and Personnel Information - Except as otherwise required by law (e.g. the Freedom of Information Act), protected personnel information and business information about the operations of RHG acquired by employees from any source shall be disclosed within RHG only, on a need-to-know basis, and solely for purposes related to the performance of job duties. Such information may be disclosed outside the agency only as permitted or required by law and RHG policy.
Responsibility to Individuals We Serve
Each RHG employee, volunteer, and contractor has an obligation to:
Non-Payment Issues- Individuals in housing operated by the Rockland Hospital Guild shall not be denied restorative services while residing in Rockland Hospital Guild housing regardless of their financial situation.
Should an instance arise where a resident is unable to meet any financial obligation, such as rent due to the Rockland Hospital Guild, a payment review committee shall convene. Members of the committee are to include the Residence Counselor, Supervisor, and Financial Manager. This committee will review the debt in question, determine forgiveness or a repayment plan of the arrears, and inform the consumer of the decision. For those with two months or more in arrears, a failure or refusal on the part of the Resident to consider a repayment plan may result in the Resident receiving a 30-day notice of intent to terminate residency.
Business Practices-Financial Standards - All financial information must reflect actual transactions and conform to generally acceptable accounting principles. No undisclosed or unrecorded funds or assets may be established. Transactions must be authorized, recorded, and documented as provided by law and RHG policy.
Kickbacks - RHG employees, Board members, and contractors are prohibited from offering, soliciting, or accepting money or anything else of value from any RHG vendor or provider except:
An employee may share in a gift of goods or services from a vendor or provider if, and only if:
We do not accept payments for referrals. No employee or any other person acting on behalf of RHG is permitted to solicit or receive anything of value, directly or indirectly, in exchange for the referral of potential recipients or vendors. Similarly, when making referrals to another provider, we do not take into account the volume or value of referrals that the provider has made (or may make) to us.
Procurement – Vendors of goods and services shall be selected based on objective criteria, including quality, technical excellence, price, delivery, and adherence to schedules, service, and maintenance of adequate sources of supply. Employees will follow the RHG Procurement of Goods/Services Procedure (Bid Policy) which adheres to the NY State OMH ‘Prudent Buyer Concept’.
Billing and Claims – RHG is committed to charging, billing, and submitting claims for reimbursement only when the services have been provided and documented in the manner required by laws, regulations, policies, and applicable standards of care. All employees must follow the applicable rules for submission of bills and claims for reimbursement, whether those claims are submitted to Medicaid for payment to RHG, or to RHG for payment. Any employee that knows or suspects that a bill or claim for reimbursement is incorrect is required to report the matter immediately to a supervisor or to the Compliance Officer.
Record Maintenance - Each employee is responsible for the timeliness, integrity, and accuracy of RHG documents and records, to comply with regulatory, funding, and legal requirements, and in defense of our professional and ethical business practices. Employees may not alter or falsify information on any record or document. Program recipient and business documents and records are retained in accordance with applicable laws and our record retention policies. Program Participant and business documents include paper documents such as case records, letters and memos, computer-based information such as e-mail or computer files on hard drives, disks or tapes, and any other medium that contains information about the organization and/or its business activities. It is important to retain and destroy records according to policy. No Employee should tamper with records, nor move or destroy them prior to the specified timeline.
Medicaid Exclusions – In keeping with our commitment to conduct business with integrity and in compliance with all applicable federal and state regulations, all employees, interns, Board members, consultants, contractors, vendors, and treatment providers affiliated with our programs are checked for exclusion by the Medicaid program. This is done monthly by the RHG Administrative Assistant through a review of lists maintained by the NYS Office of the Medicaid Inspector General (OMIG) and Federal Office of the Inspector General (OIG). These exclusion records are maintained as required by law. Employees, vendors, and persons affiliated with RHG found to be on the exclusion list are checked for accuracy of the exclusion and terminated if they are in fact excluded from participation. Employees have a duty to report any event that could potentially result in their being determined to be a person excluded from the Medicaid program.
Internal Auditing and Monitoring:
Auditing and monitoring the agency’s operations are key to ensuring compliance and adherence to policies and ethical business practices. Auditing and monitoring can also identify areas of potential risk and those areas where additional training and oversite is required. Practices will include, but are not limited to:
In any instance where it is found that billing is not supported by documentation, billing will be withheld for that service. The Finance Director will void any claim, and instances where unsupported billing has occurred, monies will be returned, adhering to protocols and process for self-disclosure.
Duty to Report
All employees have a duty to report any suspected fraud, waste, or abuse of resources, and have a responsibility to report activity by any employee, contractor, or vendor that appears to violate applicable laws and regulations, including this Code of Conduct. Participating, encouraging, directing, and facilitating non-compliant behavior is prohibited and is subject to sanctions and/or disciplinary action as outlined in the Employee Handbook and Compliance Plan.
Anyone who submits a good faith report of suspected non-compliance is protected from retaliation by both law and RHG Policy. Reporting should be made to the Compliance Officer, Finance Director, or management staff.
Non-Intimidation and Non-Retaliation (Whistleblower Protections)
The RHG has a policy of non-intimidation and non-retaliation against individuals for good faith participation in the Compliance Program, and for reporting suspected violations of federal and state laws, and regulations. All staff, volunteers, consultants, and Board members can freely discuss, report to, and raise questions with the Compliance officer, Supervisors. and the Executive Director about any situation they feel may be in violation of Federal and NY State law, Rockland Hospital Guild policy and/or any regulatory requirements.
Employees, Board members, vendors or consultants who report any action or suspected action by Rockland Hospital Guild that is illegal, fraudulent, or in violation of any policy shall not be subject to intimidation, harassment, discrimination, or other retaliation, or adverse employment consequence.
Any violation of this non-intimidation policy should be immediately reported to the Compliance Officer, who will preserve the confidentiality of any reported information. Reports may be made in person, by phone, letter, email, or by leaving a message on the designated Compliance phone line. Any violations of this policy may result in disciplinary action up to and including termination.
Any employee may be subject to disciplinary action, up to and including termination, if it is found that their actions (or inactions) constituted a violation of federal and state laws and regulations, or a failure to adhere to RHG’s compliance standards. Compliance related discipline applies to all employees, and may include the following:
· a written reprimand
· termination of employment or relationship with RHG
· referral for criminal prosecution
· civil litigation
Workplace Conduct and Employment Practices
Conflict of Interest
A conflict of interest may occur if your outside activities or personal interests influence or appear to influence your ability to make objective decisions in the course of your job responsibilities. A conflict of interest may also exist if the demands of any outside activities hinder or distract you from the performance of your job or cause you to use RHG resources for other than RHG purposes. It is your obligation to ensure that you remain free of conflicts of interest in the performance of your responsibilities at RHG. If you have any questions about whether an outside activity might constitute a conflict of interest, you should discuss with your supervisor or the compliance officer before pursuing the activity. You may not without permission from the Compliance Officer, accept, solicit, or offer anything of value from anyone doing business with RHG, including any client, referring party, vendor, contractor or other third party, if the gift or gratuity relates to, or results from your affiliation with RHG.
Diversity and Equal Employment Opportunity
Our employees provide us with an array of talents and skills that contribute to our success. We are committed to providing an equal opportunity work environment where everyone is treated with fairness, dignity, and respect, regardless of gender, race, religion, color, national origin, ancestry, age, sexual orientation, marital status, veteran status, or physical or mental handicap . We will comply with all laws, regulations, and policies related to non-discrimination in all of our personnel actions. Such actions include hiring, staff reductions, terminations, evaluations, recruiting, compensation, corrective action, discipline, and promotions. No one shall discriminate against any individual with a disability with respect to any offer, or term, or condition of employment. We will make reasonable accommodations for the known physical and mental limitations of otherwise qualified individuals with disabilities.
Some of our staff routinely have access to prescription drugs, controlled substances, and other medical supplies. Many of these substances are governed and monitored by specific regulatory organizations and must be administered by physician order only. It is extremely important that these items be handled properly and only by authorized individuals, to minimize risks to us and to participants. If you become aware of the diversion of drugs from the workplace, you must report the incident immediately to your supervisor or the Compliance Officer.
Harassment and Workplace Violence
Each employee has the right to work in an environment free of harassment. RHG will not tolerate harassment by anyone based on the diverse characteristics or cultural backgrounds of those who work with us. Degrading or humiliating jokes, disparaging comments or slurs, intimidation, or other harassing conduct is not acceptable in our workplace.
Any form of sexual harassment is strictly prohibited. This prohibition includes unwelcome sexual advances or requests for sexual favors in conjunction with employment decisions. Moreover, verbal or physical conduct of a sexual nature that interferes with an individual’s work performance or creates an intimidating, hostile, or offensive work environment is strictly prohibited.
Harassment also includes incidents of workplace violence. Workplace violence includes robbery and other commercial crimes, stalking cases, violence directed at the employer, terrorism, and hate crimes committed by current or former colleagues. As part of our commitment to a safe workplace for our employees, we prohibit employees from possessing firearms, other weapons, explosive devices, or other dangerous materials on RHG premises.
Employees who observe or experience any form of harassment or violence should report the incident to their supervisor or to the Compliance Officer immediately.
Health and Safety
All RHG employees must comply with government regulations and rules, and with RHG policies or required agency practices that promote the protection of workplace health and safety. Our policies have been developed to protect you from potential workplace hazards. You should become familiar with and understand how these policies apply to our specific job responsibilities and seek advice from your supervisor or the Compliance Officer when you have a question or concern. It is important for you to advise your supervisor and the Administrative Assistant of any workplace injury or any situation presenting a danger of injury so that timely corrective action may be taken to resolve the issue. All situations of presenting a safety hazard should be reported to the Administrative Assistant and supervisor immediately.
The following activities are expressly forbidden:
Political Activities and Contributions
RHG’s political participation is limited by law. RHG funds or resources are not to be used to contribute to political campaigns or for gifts or payments to any political party or any of their affiliated organizations. Organizational resources include financial and non-financial donations such as using work time and telephones to solicit for a political cause or candidate or the loaning of RHG property for use in the political campaign. No employee shall directly or indirectly contribute RHG property, equipment, funds, resources or other tangible or intangible assets or the use thereof to political campaigns, candidates, political parties or any agent or affiliate thereof. No political advertising is allowed on Agency property. On occasion RHG may ask colleagues to make personal contact with government officials or to write letters to present our position on specific issues. In addition, it is a part of the role of some RHG employees to interact with government officials. If you are designated to make these communications on behalf of the organization, be certain that you are familiar with any regulatory constraints and observe them.
Summary of Relevant Laws: The False Claims Act (31 U.S.C. §§ 3729-3733)
The False Claims Act is a federal law designed to prevent and detect fraud, waste and abuse in federal healthcare programs, including Medicaid. Under the False Claims Act, anyone who “knowingly” submits false claims to the Government is liable for damages up to three times the programs' loss plus $11,000 per claim filed. Under the civil FCA, each instance of an item or a service billed to Medicaid counts as a claim, so fines can add up quickly. False Claims suits can be brought against individuals and entities. The False Claims Act does not require proof of a specific intent to defraud the Government. Providers can be prosecuted for a wide variety of conduct that leads to the submission of a false claim.
Some examples include:
· Knowingly making false statements;
· Falsifying records;
· Submitting claims for services never performed or items never furnished;
· Using false records or statements to avoid paying the Government;
· Falsifying time records used to bill Medicaid; or
· Otherwise causing a false claim to be submitted.
Whistleblower/Non-Retaliation or “Qui Tam” Provisions:
In order to encourage individuals to come forward and report misconduct involving false claims, the False Claims Act contains a “Qui Tam” or whistleblower/non-retaliation provision. The Government, or an individual citizen acting on behalf of the Government, can bring actions under the False Claims Act. An individual citizen, referred to as a whistleblower or “Relator,” who has actual knowledge of allegedly false claims may file a lawsuit on behalf of the U.S. Government. If the lawsuit is successful, and provided certain legal requirements are met, the whistleblower may receive an award ranging from 15% - 30% of the amount recovered.
The False Claims Act prohibits discrimination and/or retaliation by RHG against any employee for taking lawful actions under the False Claims Act. Any employee who is discharged, demoted, harassed, or otherwise discriminated against because of lawful acts by the employee in False Claims actions is entitled to all relief necessary to make the employee whole. Such relief may include, but is not limited to reinstatement, double back pay, and compensation for any special damages, including litigation costs and reasonable attorney fees.
Administrative Remedies for False Claims (31 USC Chapter 38. §§3801-3812):
This federal statute allows for administrative recoveries by federal agencies including the Department of Inspector General and Department of Health and Human Services, which operates the Medicare and Medicaid Programs. The law prohibits the submission of a claim or written statement that the person knows or has reason to know is false, contains false information or omits material information. RHG may impose a monetary penalty of up to $5,000 per claim and damages of twice the amount of the original claim. Unlike the False Claims Act, a violation of this law occurs when a false claim is submitted, not when it is paid. Also unlike the False Claims Act, the determination of whether a claim is false, and imposition of fines and penalties is made by the administration of RHG, and not by prosecution in the federal court system.
New York State False Claims Act (State Finance Law §§187-194):
The New York State False Claims Act closely tracks the Federal False Claims Act. It imposes penalties on parties that file false and fraudulent claims for payment from any state or local government, including Medicaid. Penalties are $6,000 – $12,000 per claim and the recoverable damages are three times the value of the amount falsely received including consequential damages sustained by state or local government.
The law also allows for qui tam lawsuits by individuals.
Social Service Law §145-b False Statements
It is a violation to knowingly obtain or attempt to obtain payment for items or services furnished under any Social Services program, including Medicaid, by use of a false statement, deliberate concealment or other fraudulent scheme or device. The State or the local Social Services district may recover up to three times the amount of the incorrectly paid claim. In the case of non-monetary false statements, the local Social Service district or State may recover three times the amount incorrectly paid. In addition, the Department of Health may impose a civil penalty of up to $2,000 per violation. If repeat violations occur within five years, a penalty up to $7,500 may be imposed if they involve more serious violations of the Medicaid rules, billing for services not rendered, or providing excessive services.
Social Service Law § 366-b, Penalties for Fraudulent Practices
Any person who, with intent to defraud, presents for payment any false or fraudulent claim for furnishing services or merchandise, knowingly submits false information for the purpose of obtaining Medicaid compensation greater than that to which he/she is legally entitled to, or knowingly submits false information in order to obtain authorization to provide items or services shall be guilty of a Class A misdemeanor. Any person who obtains or attempts to obtain, for himself or others, medical assistance by means of a false statement, concealment of material facts, impersonation, or other fraudulent means is guilty of a Class A misdemeanor.
Penal Law Article 155, Larceny
The crime of larceny applies to a person who, with intent to deprive another of property, obtains, takes or withholds the property by means of a trick, embezzlement, false pretense, false promise, including a scheme to defraud, or other similar behavior. This law has been applied to Medicaid fraud cases.
Penal Law Article 175, Written False Statements
There are four crimes in this Article that relate to filing false information or claims. Actions include falsifying business records, entering false information, omitting material information, altering RHG’s business records, or providing a written instrument (including a claim for payment) knowing that it contains false information. Depending upon the action and the intent, a person may be guilty of a Class A misdemeanor or a Class E felony.
Corporate Compliance Plan
The Rockland Hospital Guild, Inc. receives funds to provide residential and restorative services to individuals living with a serious and persistent mental illness. This Corporate Compliance Policy has been designed and implemented to detect and prevent fraud, waste, and abusive practices within the agency, and to provide guidance to employees, Board members, and persons associated with the Rockland Hospital Guild in preventing fraud, waste, and abuse.
The Rockland Hospital Guild Corporate Compliance Program is a systematic program that was implemented to prevent, detect, address, and report violations of the law within the agency. The purpose of the plan is to ensure that employees/volunteers, Board members, and persons associated with the Rockland Hospital Guild conduct themselves according to all applicable ethical and legal requirements.
The Rockland Hospital Guild conducts business in an ethical manner and is committed to complying with federal, state and local regulations. As part of this commitment, we educate and train employees, Board members, volunteers and persons associated with RHG, on the compliance program’s standards, assist them in complying with its provisions, and provide an environment in which all can comply without fear of retaliation.
Corporate Compliance Plan
Implementation of Written Policies and Code of Conduct
Written policies, including a Code of Conduct and a Code of Ethics, have been developed and implemented to convey expected behaviors and practices that are to be followed by all employees, in keeping with our commitment to conducting business with integrity and in compliance with all applicable federal and state laws and regulations.
The Rockland Hospital Guild provides each employee with their own copy of the Code of Conduct, Code of Ethics, and the Employee Handbook that each is expected to adhere to. Each employee signs for their copy and agrees in writing to adhere to the Codes of Conduct and the Code of Ethics while in the Rockland Hospital Guild's employ.
Corporate Compliance Officer
A Corporate Compliance Officer has been designated by Rockland Hospital Guild (RHG), and is responsible for overseeing the Compliance Program; reviewing and updating agency policies and procedures; overseeing the risk assessment related to Compliance and recommending changes in procedures as a result of Risk Assessment; overseeing/conducting internal audit procedures relative to Compliance issues; maintaining agency policies and procedures; facilitating the implementation of Compliance training; investigating matters related to Compliance issues, including hotline reports, employee, consumer, and/or payor complaints; and coordination of the Compliance Committee duties.
The Rockland Hospital Guild's Compliance Officer reports directly to the Executive Director, and to the Board of Directors at quarterly Board meetings. Any communication to the Executive Director and Board of Directors remains confidential.
All compliance concerns are forwarded to the Compliance Officer, who reviews and investigates any issues as they are reported.
The Corporate Compliance Officer acts as a liaison with consultants and governmental agencies in the event of an audit or investigation.
Johanna Bowen is the assigned Corporate Compliance Officer for RHG. She can be contacted at the Guild's administrative offices, 2 Irving's Way, Orangeburg, NY, (845) 680-6226, ext. 103, cell/text (845) 608-0320, or by email: johanna.bowen@Rocklandguild.org.
Corporate Compliance Committee
The Rockland Hospital Guild has a designated Compliance Committee that meets quarterly or more frequently as compliance concerns and violations are brought to the Compliance Officer. The Committee members include the Program Supervisors of each of the Rockland Hospital Guild's residential programs, a House Manager, the Finance Director, the Benefits Manager, the Administrative Assistant, and the Executive Director. The Compliance Committee is headed by the Compliance Officer, who coordinates the committee activities.
The Committee reviews any claims of fraud or abuse, and the efforts to investigate and correct the systems or issues involved. Complaints communicated to and investigated by the Compliance Officer, and reviewed by the Compliance Committee, remain confidential.
The Committee members review updates and changes in compliance issues and policy on an ongoing basis. Program Supervisors are expected to share any changes with all their employees.
Training and Education of Employees
All Rockland Hospital Guild employees, consultants, Board members, and interns/volunteers are educated about compliance requirements in the health care industry relating to the federal and state laws with which the Rockland Hospital Guild must comply. This training includes discussion of the Federal and New York State False Claims Act, Civil Monetary Penalties, Billing Issues Risk Areas and Medical Necessity Medicaid Criteria, as well as The Whistleblower Protections Act.
Rockland Hospital Guild employees are informed that any employee who violates these laws/regulations risks not only prosecution, penalties and civil actions on an individual basis, but subjects the Rockland Hospital Guild to the same legal actions. Employees who have questions about any of these laws/regulations are instructed to consult with the corporate compliance officer.
Any Rockland Hospital Guild employee who violates these laws will have also been advised during their new employee orientation and annual compliance training that a violation may lead to disciplinary action up to and including immediate termination of position. A record of this training is maintained in the Rockland Hospital Guild's administrative office in the employee's file.
Training updates and refreshers are conducted annually. Any changes will be brought to the employees by their immediate supervisor as the changes occur, and in the annual training.
Anonymous / Confidential Reporting and Communication with the Corporate Compliance Officer
Every employee at the Rockland Hospital Guild is a partner in fraud prevention and in maintaining compliance with the governing laws/regulations. All employees have a duty to report any violation of the laws and regulations, Code of Conduct, and Code of Ethics.
Each employee can report to their program supervisor, who is then responsible for bringing the report to the compliance officer.
Individuals wishing to file a report of fraud or noncompliance with agency policy can contact the Compliance Officer directly. There is no requirement that the individual making the report identify him/herself in any way. All complaints can remain anonymous and will remain confidential to the extent possible. Complaints can be made by contacting the agency compliance phone line at extension 103, by emailing the compliance officer at email@example.com, by mail to 2 Irvings Way, Orangeburg, NY, 10962, or by leaving a note in the Administration building
All of the channels available to Rockland Hospital Guild employees to report concerns can remain anonymous and confidential, and are addressed in the annual compliance training.
All Rockland Hospital Guild employees, interns, consultants, and Board members are responsible for reporting any suspected fraud or non-compliant behavior to either their immediate supervisor or to the corporate compliance officer. This includes reporting those employees who may be encouraging, directing, facilitating, or permitting non-compliant behavior. Failure to report illegal, unethical or non-compliant behavior to either their immediate supervisor or to the corporate compliance office will result in corrective and/or disciplinary action.
Once a report is made, the compliance officer will conduct an investigation maintaining employee confidentiality. When the investigation is complete, the compliance officer will bring the completed investigation report to the full compliance committee for review. The committee will then determine any follow-up or disciplinary action to be taken. The level of disciplinary action will be dependent on the situation. The Compliance committee, recognizing the seriousness of any offense in this arena, could recommend suspension or termination of employment.
No employee will be subject to any disciplinary action for good faith reporting of compliance concerns to his/her supervisor or the corporate compliance officer.
Upon completion of the investigation, the corporate compliance committee will identify and implement steps to prevent a situation of this type occurring in the future.
Internal Auditing and Monitoring
Internal auditing and monitoring the agency’s operations are key to ensuring compliance and adherence to policies and ethical business practices. Internal auditing and monitoring can also identify areas of potential risk and those areas where additional training and oversite is required.
Quality Assurance/Utilization Review
Utilization reviews of resident records are conducted to make sure there is documentation of medical necessity, billable services, and the additional care, as required by the state licensing agencies and Medicaid. The utilization review is completed at regularly scheduled intervals. Feedback is given to residential managers for correction. Training is provided where indicated to assist staff with improvement of documentation.
In any instance where it is found that billing is not supported by documentation, billing will be withheld for that service. The Finance Director will void any claim, and instances where unsupported billing has occurred, monies will be returned, adhering to protocols and process for self-disclosure.
Responding to Compliance Issues, Corrective Action, Refunding Overpayments
An allegation of non-compliance brought to the Compliance officer will trigger an investigation. Confidentiality of employee identity will be maintained during the investigation process to the extent possible. Once the investigation is completed, the Compliance committee will determine follow-up and/or disciplinary action as required. The results of the investigation will be brought by the executive director and to the Board of Directors.
When an audit or internal investigation results in a substantiated finding, it is policy to initiate corrective action promptly, including making restitution of any overpayment amounts, notifying the appropriate governmental agency, instituting disciplinary action, and implementing systemic changes to prevent a recurrence of a similar violation.
All verified violations of the compliance plan are subject to corrective action, which may include a report to governmental agencies or referral to law enforcement authorities. Disciplinary action may include written reprimand, suspension, termination of employment, restitution, referral for criminal investigation, or civil litigation.
Non- Intimidation and Non-Retaliation
The Rockland Hospital Guild will comply with the Whistleblower Protections afforded under both federal and state law. No individual who brings a qui tam civil action against the Rockland Hospital Guild on behalf of the people of the United States or State of New York will be discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms or conditions of his/her employment due to reporting violations of the False Claims Act.
The Rockland Hospital Guild has a policy of non-intimidation and non-retaliation against individuals for good faith participation in the Compliance Program. All staff, volunteers, consultants, and Board members can freely discuss, report to, and raise questions with the Compliance officer, Supervisors. and the Executive Director about any situation they feel may be in violation of Federal and NY State law, Rockland Hospital Guild policy and/or any regulatory requirements.
No staff person, Board member, volunteer or consultant, or member of the Rockland Hospital Guild Community who reports any action or suspected action to any government agency by Rockland Hospital Guild that is illegal, fraudulent, or in violation of any policies shall suffer intimidation, harassment, discrimination, or other retaliation, or adverse employment consequences.
Any violations of this non-intimidation policy should be immediately reported to the Compliance Officer, who will administer this policy and preserve the confidentiality of any reported information. Reports may be made in person, by phone, letter, email, or by leaving a message on the designated Compliance phone line. Any violations of this policy may result in disciplinary action up to and including termination.
Rockland Hospital Guild
2 Irving's Way - Orangeburg, NY 10962
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