1. Program Description
The HOME CARE SERVICES FOR INDEPENDENT LIVING compliance program embodies its commitment to conducting business in the manner proscribed by the applicable laws, rules, regulations, and other directives of the federal, state and local governments and agencies. An expression of this commitment is the code of conduct ("Code") described herein which is applicable to all individuals, including HOME CARE SERVICES FOR INDEPENDENT LIVING's managers, members, officers, directors, employees, volunteers, and independent contractors working for or providing services to HOME CARE SERVICES FOR INDEPENDENT LIVING ("staff members").
This Code is intended to provide general guidelines to assist staff members in understanding and appreciating the high standards with which HOME CARE SERVICES FOR INDEPENDENT LIVING conducts its business. Although the Code of Conduct can neither cover every situation in the daily conduct of our many varied activities nor substitute for commonsense, individual judgment or personal integrity, it is the duty of every staff member to adhere, without exception, to the principles set forth herein.
The Code includes information regarding the program and its implementation, and the investigation and resolution process.
The Code identifies the Compliance Officer as the employee responsible for monitoring the program daily and performing periodic audits of its policies and procedures and outlines the additional duties of the position as pertains to the Code. How HOME CARE SERVICES FOR INDEPENDENT LIVING shall respond to and investigate issues brought to its attention, via employee reports or company audits are detailed within. How actual or potential issues will be addressed in the present and what steps shall be take into mitigate their impact in the future is also contained in the Code. Policies regarding the appropriate methods for reporting issues to the overseeing agencies, and procedures related to overpayments are also included.
Included in the Code are details of the training and education programs offered by HOME CARE SERVICES FOR INDEPENDENT LIVING through which all staff members can ensure they understand their responsibilities and duties under the Code, and the professional standards which HOME CARE SERVICES FOR INDEPENDENT LIVING expects all its employees to conduct themselves. Training curricula will include information regarding compliance issues, expectations, and the compliance program operation. Sessions will be conducted on a periodic basis, as dictated by necessity, and will be included in employee orientations.
The Code articulates the expectations for reporting compliance issues and assisting in their resolution and the procedures by which employees can fulfill these duties. Specifics of the reporting process - how employees may make reports and to whom - are outlined as well. Further enumerated are the lines of communication via which reports may be made and the protections afforded employees in this process. Information regarding the disciplinary policies of the code is included as well.
The Code of Conduct shall be amended and updated as necessary. At such times HOME CARE SERVICES FOR INDEPENDENT LIVING will notify all staff members that changes have been made, and the policy shall be made available for all employees to review if they wish. A staff member will be made available to assist any employee in accessing and understanding the changes. However, the final responsibility to comply with the standards, policies and procedures contained in this Code falls on everyone. As such all HOME CARE SERVICES FOR INDEPENDENT LIVING staff members must take great care to understand the Code and conduct and the high standards expected of them.
HOME CARE SERVICES FOR INDEPENDENT LIVING encourages members, managers, officers, directors, employees, contractors, and agents to raise questions or concerns, and seek clarification regarding these laws or related policy issues with the Compliance Officer or designated party.
This compliance program is more fully described and can be found in its entirety in the HOME CARE SERVICES FOR INDEPENDENT LIVING Compliance Program Manual ("Compliance Manual"), available for review in the office of the Administrator or Compliance Officer.
HOME CARE SERVICES FOR INDEPENDENT LIVING expects that the Code of Conduct will be a part of the daily activities of its staff members. The Code of Conduct is in addition to, and does not limit, specific policies and procedures of HOME CARE SERVICES FOR INDEPENDENT LIVING Staff members must perform their duties in accordance with all such policies and procedures.
It is the duty of every manager, member, officer, director, employee, independent contractor, volunteer and agent to uphold the standards set forth in the Code of Conduct and to report violations by following the reporting procedures outlined in the Compliance Manual. Alleged violations of the Code of Conduct or other policies and procedures of HOME CARE SERVICES FOR INDEPENDENT LIVING will be investigated by persons designated by, and pursuant to procedures established by HOME CARE SERVICES FOR INDEPENDENT LIVING. We will make efforts to maintain the confidentiality of the identity of any individual who reports perceived or actual violations. However, confidentiality of identity cannot be guaranteed.
It shall be a violation of the Code of Conduct to take any action in reprisal against anyone who reports suspected violations of the Code of Conduct or other HOME CARE SERVICES FOR INDEPENDENT LIVING policies and procedures, assists in the investigation of a compliance issue or assists with remedial actions in good faith.
Failure to abide by the Code of Conduct or the guidelines for behavior which the Code of Conduct represents may lead to disciplinary action. Disciplinary action, up to and including termination, will be determined on a case-by-case basis. If HOME CARE SERVICES FOR INDEPENDENT LIVING determines that a violation may have included criminal violations of law or regulation, HOME CARE SERVICES FOR INDEPENDENT LIVING will seek the advice of counsel and cooperate with law enforcement authorities about the investigation and prosecution of the offender.
While the duty remains the responsibility of everyone, HOME CARE SERVICES FOR INDEPENDENT LIVING shall implement programs necessary to foster further awareness of applicable laws and regulations and to monitor and promote compliance of such laws and regulations. Any questions about the legality or propriety of any actions undertaken by, or on behalf of HOME CARE SERVICES FOR INDEPENDENT LIVING should be referred immediately to the Compliance Officer.
It is the duty of HOME CARE SERVICES FOR INDEPENDENT LIVING and its staff members to uphold all applicable Federal, State and Local laws, rules, regulations, and standards ("laws and regulations"). Everyone must be aware of the legal requirements and restrictions applicable to his or her respective position and duties. The HOME CARE SERVICES FOR INDEPENDENT LIVING employees who conduct employee orientations have been educated in the specifics of the laws so they can answer any questions new hires may have. The Compliance Officer will be available in the event further assistance is required. Training and educational sessions will be conducted as needed, but no less frequently then annually, to ensure all employees are aware of their responsibilities under the law.
The following policies and procedures govern the application of this code of conduct.
It is the policy of HOME CARE SERVICES FOR INDEPENDENT LIVING to provide all its members, managers, officers, directors, staff, contractors, and agents with the means to report actual or perceived violations of HOME CARE SERVICES FOR INDEPENDENT LIVING Code of Conduct, Compliance Program, policies and procedures and applicable laws and regulations.
Anyone with knowledge of an event, occurrence or activity that appears to violate applicable laws and regulations, HOME CARE SERVICES FOR INDEPENDENT LIVING Code of Conduct or any of its policies or procedures should promptly communicate the actual or perceived violation to the Compliance Officer. Reports can be made anonymously by calling the compliance hotline at 347-732-3374.
In compliance with the law, HOME CARE SERVICES FOR INDEPENDENT LIVING policy prohibits retaliatory action, in any form, against any individual who makes a report, in good faith, to the agency or any governmental official or agency. The Federal False Claims Act, New York False Claims Act, and New York State Labor Law §740 specifically prohibit and provide remedies for such retaliatory action. Improper retaliation includes actual or threatened discharge, demotion, suspension, harassment, discrimination, or other adverse employment action. Activities protected against retaliation by Federal and State law and regulation include: disclosing or reporting - or making a threat of such - to a supervisor, the agency or to a governmental official or agency an activity, policy, or practice that is in violation of the law; testifying or providing information for a hearing, investigation or inquiry; initiating or assisting in any action or investigation; and/or objecting to or refusing to participate in any such illegal activity.
HOME CARE SERVICES FOR INDEPENDENT LIVING has a zero-tolerance policy regarding retaliation and will aggressively investigate such matters and disciplinary action will be taken when appropriate. HOME CARE SERVICES FOR INDEPENDENT LIVING expects its staff members, managers, officers, directors, employees, contractors and agents to promptly report any possible instances of retaliatory action immediately to the Administrator the Compliance Officer or other designated party.
All members, managers, officers, directors, employees, contractors, and agents are required to promptly report all known or suspected violations of HOME CARE SERVICES FOR INDEPENDENT LIVING billing and claims - submission policies to the Administrator, Compliance Officer, immediate supervisor -or other designated party, in writing or through the anonymous telephone hotline at 347-732-3374.
I fan issue does arise, it is the policy of HOME CARE SERVICES FOR INDEPENDENT LIVING to promptly disclose all relevant information to all appropriate agencies.
Investigation and Resolution Processes:
It is the policy of HOME CARE SERVICES FOR INDEPENDENT LIVING to make a prompt and thorough inquiry into any report concerning activity which may be contrary to applicable laws or regulations. Upon receipt of a report which suggests that improper conduct has occurred, an investigation either under the direction and control of legal counsel or the Compliance Officer shall be commenced. The investigative techniques used shall be implemented to facilitate the correction of any practices not in compliance with applicable laws or regulations.
Billing and Claims Reimbursement
It is the policy of HOME CARE SERVICES FOR INDEPENDENT LIVING to comply with all relevant billing and claim reimbursement rules, regulations, and requirements. All personnel involved in coding, billing and claims submissions must maintain high ethical standards and must know and adhere to all requirements for the health care industry, including all rules and regulations pertaining to coding, billing, claims submission and reimbursement, including, among others, Medicare, and Medicaid regulations. All billing personnel are expected to attend training and education sessions. Billing personnel will be regulatory monitored to ensure that they are not engaging in any activity which may be fraudulent or abusive under the Medicare and Medicaid regulations. Billing department personnel and billing consultants will not offer any financial incentive to submit claims regardless of whether they meet applicable coverage criteria for reimbursement or accurately represent the services rendered.
All Staff Members are required to promptly report all known or suspected violations of billing policies to their immediate supervisor, Compliance Officer or Administrator, or other designated party.
HOME CARE SERVICES FOR INDEPENDENT LIVING and its staff members have a duty to create and maintain records and documentation in accordance with legal, professional, and ethical standards. Any individuals whose job duties involve billing procedures, whether it be a part of their specific job description or in an executive role, shall ensure that all filings for reimbursement for care are reasonable, necessary, and appropriate, that services are provided by properly qualified persons, and that services are billed correctly and supported by adequate documentation.
All claims for reimbursement to government and to private insurance payers must be true and accurate and conform to all applicable laws and regulations. HOME CARE SERVICES FOR INDEPENDENT LIVING and its staff members are prohibited from knowingly presenting or causing to be presented claims for payment or approval which are false, fictitious, fraudulent, or otherwise not in compliance with applicable laws and regulations.
Activities That May Violate the Law:
The following is a non-exhaustive list of examples of improper billing and claims activities:
Fraud and Abuse:
HOME CARE SERVICES FOR INDEPENDENT LIVING has adopted Policies and Procedures for preventing and detecting fraud, waste, and abuse of the Federal health care programs, including Medicare and Medicaid. All members, managers, officers, directors, employees, contractors, and agents must strictly follow these policies. These policies and procedures are available for review upon request. To review these policies and procedures, contact the Compliance Officer.
In accordance with the requirements of relevant false claims laws, and to further ensure the accuracy and appropriateness of claims submitted, HOME CARE SERVICES FOR INDEPENDENT LIVING staff members, managers, officers, directors, employees, contractors, and agents must strictly adhere to the following:
All documentation utilized to support claims for reimbursement shall be periodically reviewed by the clinical and billing staff, in coordination with the Compliance Officer or other designated party, to assess adherence to these standards. The agency will maintain a process for pre- and post-submission review of claims to ensure that claims submitted for reimbursement accurately reflect medically necessary services provided, are supported by sufficient documentation, and are in conformity with any applicable coverage criteria for reimbursement.
HOME CARE SERVICES FOR INDEPENDENT LIVING expects its staff members to refrain from any conduct which may violate applicable federal and state laws and regulations, with special emphasis on those related to fraud and/or abuse.
These laws generally prohibit:
More specific guidance with respect to laws and regulations applicable to fraud and abuse can be found in HOME CARE SERVICES FOR INDEPENDENT LIVING Compliance Manual. A compendium of applicable federal and state laws applicable to the fraud and abuse area will be included in the orientation package and will be available to all staff members by contacting the HR department or the Compliance Officer.
Retention of Records:
It is the policy of HOME CARE SERVICES FOR INDEPENDENT LIVING that all employees, contracted health professionals, agents and others associated with the agency maintain and preserve all documents, including compliance, business and medical records, and secure them against loss, destruction, unauthorized access, unauthorized reproduction, corruption or damage. HOME CARE SERVICES FOR INDEPENDENT LIVING will also comply with regulations concerning document retention periods.
The primary components of HOME CARE SERVICES FOR INDEPENDENT LIVING record maintenance, access and retention policies and procedures include, but are not limited to, the following:
The Compliance Officer shall be accountable for the Compliance Program; its content, implementation and application, the response to - and investigation of- reports, the ongoing monitoring, periodic reviews and updating of the policies contained therein and its lawfulness, are responsibilities attached to that position.
The Compliance Officer is further tasked with the duty to report compliance issues to the appropriate governing bodies, and maintain compliance to the applicable laws.
The monitoring of the compliance policy shall include the following daily tasks:
· Frequent checking of the compliance hotline voicemails;
· Observation of the HOME CARE SERVICES FOR INDEPENDENT LIVING working environment to uncover conditions which may foster or facilitate the occurrence of violations; and
· Assessing the efficiency of agency responses to and investigations and the resolution of, reports;
HOME CARE SERVICES FOR INDEPENDENT LIVING shall conduct periodic reviews designed to address relevant compliance issues; reviews will generally be conducted internally but will be referred to external investigative bodies when deemed necessary. Reviews shall be conducted in four stages:
· Past reviews shall be examined to evaluate the efficiency and timeliness of agency responses. Further assessments shall be conducted to uncover the root causes of occurrences. Self-evaluations shall be conducted to identify future risk areas;
· Procedures and policies shall be amended to address issues uncovered in the prior steps; and
· Upon its completion, the auditing process itself will be evaluated, and augmented as needed. Attention shall be paid to identifying and addressing potential conflicts of interest among the Compliance Staff which may affect their ability to effectively conduct future audits.
4. Training and Education
All HOME CARE SERVICES FOR INDEPENDENT LIVING employees will receive comprehensive training and education regarding compliance issues, expectations, and the compliance program operation. The compliance program will be explained in depth to all incoming employees as part of their orientation. Current HOME CARE SERVICES FOR INDEPENDENT LIVING staff including members, managers, officers, directors, employees, contractors, agents, and other healthcare practitioners shall be required to participate in a minimum of one (1)hour of basic compliance training and education annually. Attendance at all sessions is mandatory and failure to participate will result in disciplinary action, up to and including termination. Individuals involved in specialty fields such as coding, claims development and billing will require additional compliance training and education addressing documentation, claims, billing, and fraud and abuse issues. Additional training attendance may be required aspart of an employee performance improvement measure or action plan. In addition to periodic training and in-service programs, HOME CARE SERVICES FOR INDEPENDENT LIVING will notify its staff members whenever compliance standards change, and any relevant documentation will be made available to all.
5. Professional and Ethical Standards
As professionals, all staff members have a duty to support HOME CARE SERVICES FOR INDEPENDENT LIVING goals to provide nursing and other home care services of the highest quality that respond to the needs of our patients. The services provided must be reasonable and necessary for the care of each patient, and such care must be provided by properly qualified individuals. All such care must be properly documented as required by law and regulation, payer requirements, professional standards and the policies and procedures of HOME CARE SERVICES FOR INDEPENDENT LIVING.
HOME CARE SERVICES FOR INDEPENDENT LIVING and its staff members shall conduct all activities in accordance with the highest ethical standards of their respective professions always and in a manner which shall uphold the reputation and standing in the community it serves.
HOME CARE SERVICES FOR INDEPENDENT LIVING and its staff members are in possession of, or have access to, a wide variety of confidential and sensitive information. Pursuant to the relevant laws, statutes, rules and regulations, among them the provisions of HIPAA regulations as mandated by Federal Law, dissemination of any confidential information, patient information especially, to any unauthorized persons is strictly forbidden.
It is the duty of HOME CARE SERVICES FOR INDEPENDENT LIVING and its staff members to protect the privacy rights of the patients. HOME CARE SERVICES FOR INDEPENDENT LIVING and its staff members shall maintain the confidentiality of patient medical records and information, as well as proprietary information, by actively protecting and safeguarding such information in a manner designed to prevent the unauthorized disclosure of such information.
If there are any questions or concerns concerning the disclosure of information, the question or concern should be referred to an individual's supervisor, the Administrator, the Compliance Officer, or the Privacy Officer.
7. Business Practices
HOME CARE SERVICES FOR INDEPENDENT LIVING business practices must be conducted with honesty and integrity and in a manner that upholds the reputation with patients, payers, vendors, and competitors. HOME CARE SERVICES FOR INDEPENDENT LIVING expects its staff members to be loyal to the organization’s interests. Staff members should not use their position to profit personally or to assist others in profiting in any way at the expense of HOME CARE SERVICES FOR INDEPENDENT LIVING Staff members must refrain from activities which create conflicts of interest with HOME CARE SERVICES FOR INDEPENDENT LIVING or give the appearance of impropriety.
Staff members involved in business transactions or behalf of HOME CARE SERVICES FOR INDEPENDENT LIVING shall not offer or pay, nor solicit or receive any gifts, favors or other improper inducements in exchange for influence or assistance in a transaction or the referral of business. If there is any doubt or concern about whether specific conduct or activities are ethical or otherwise appropriate, the doubt or concern should be referred immediately to an individual's supervisor, the Administrator, or the Compliance Officer.
When HOME CARE SERVICES FOR INDEPENDENT LIVING decides to enter into an agreement or arrangement with another healthcare entity or practitioner to provide services, that decision must be free of any improper influence. Thus, if you or any immediate family member is already an employee, consultant, owner, contractor or even a passive investor of an entity that (i) engages in any business or maintains any relationship with HOME CARE SERVICES FOR INDEPENDENT LIVING (ii) provides to, or receives from HOME CARE SERVICES FOR INDEPENDENT LIVING any patient referrals, or(iii) competes with HOME CARE SERVICES FOR INDEPENDENT LIVING a "Conflict of Interest Disclosure StatementForm" and submit it to the Compliance Officer. If you or your family member intends to become such an employee, consultant, owner, contractor or an investor, you must first obtain certain permission from the Administrator or Compliance Officer by completing a "Conflict of Interest Disclosure Statement Form." In this way, HOMEC ARE SERVICES FOR INDEPENDENT LIVING can assured that our business relationships are free from improper influences.
8. Conflicts of Interest
It is the policy of HOME CARE SERVICES FOR INDEPENDENT LIVING that all Staff Members avoid all activities that conflict with their responsibilities and obligations to HOME CARE SERVICES FOR INDEPENDENT LIVING and its Patients.
The policies and procedures relating to conflicts of interest include, but are not limited to, the following:
9. Employment Practices
HOME CARE SERVICES FOR INDEPENDENT LIVING is committed to providing equal employment opportunities for all persons, without regard to race, color, creed, religion, sexual orientation, national origin, age, sex, marital status, handicap, or disability. HOME CARE SERVICES FOR INDEPENDENT LIVING is committed to providing patient care and a workplace environment which emphasizes the dignity and respect of every individual. In that regard, harassment and/or other types of prohibited discrimination in any form or context will not be tolerated.
Violence in the workplace will not be tolerated and such behavior will result in immediate disciplinary action, which may include termination.
HOME CARE SERVICES FOR INDEPENDENT LIVING is committed to providing a healthy and safe workplace. HOME CARE SERVICES FOR INDEPENDENT LIVING and its staff members will comply with federal, state, and local laws and regulations that promote the protection of health and safety. Staff members are expected to report workplace injuries or any situation presenting a danger of injury.
Employee and Other Association with the Agency Screening:
It is the policy of HOME CARE SERVICES FOR INDEPENDENT LIVING to ensure that its members, managers, officers, directors, employees; agents and independent contractors are properly screened in accordance with agency procedures, and in compliance with applicable laws and regulations, prior to employment or engagement with HOME CARE SERVICES FOR INDEPENDENT LIVING and periodically during their tenure with HOME CARE SERVICES FOR INDEPENDENT LIVING Offers of employment or engagement, as well as continued employment and engagement, shall be contingent upon satisfactory screening.
Individuals Excluded from Federal and State Health Care Benefits Programs:
It is the policy of HOME CARE SERVICES FOR INDEPENDENT LIVING not to enter into employment, contractual or business arrangements, in any capacity, with individuals or entities that are barred or excluded from participating in federal or state health care benefit programs.This shall be accomplished through screening programs, which include reviewing the U.S. Office of Inspector General's (OJG) List of Excluded Individuals/Entities (LEIE), the Office of Medicaid Inspector General's Providers Not Allowed to Bill list and other applicable sources of such information prior to hiring, engaging or otherwise transacting business with any person or entity, and by conducting such review periodically after employing, contracting with or otherwise engaging any individual or entity.
Please note that nothing in this Code of Conduct is intended to nor shall be construed as providing any additional employment or contract right to staff members or other persons.