EFFECTIVE DATE: 3/26/07
Approved by the NLH&NH Board of Directors
The federal government and the State of New York have enacted laws to combat fraud, waste and abuse of the Medicare and Medicaid programs by providers. The laws require providers, including Nathan Littauer Hospital and Nursing Home, to implement policies and procedures to ensure compliance with the new laws and regulations. Legislators determined that providers may be able to detect and correct payment and billing mistakes and fraud if providers had programs in place to look for these problems. The programs would resolve payment discrepancies and detect inaccurate billings as quickly and efficiently as possible to prevent future recurrences.
Nathan Littauer Hospital and Nursing Home for many years has had an Organizational Code of Ethics to clearly state the institution’s responsibility to our patients, residents, staff, physicians and the communities we serve. This statement is available to all employees in the Guide to the Organization. The Code includes a section on Corporate Compliance which reads:
The Board of Directors affirms the organization’s commitment to legal compliance and ethical and responsible conduct with regard to the use of hospital funds and assets. All members of the Board of Directors, the Medical Staff and employee staff must fully comply with all federal, state and local law and administrative regulations in the conduct of the business of the hospital. All are expected to observe the highest standards of business and professional ethics in the performance of their respective duties.
The Hospital and Nursing Home does not knowingly fail to comply with any state or federal laws and regulations. The Compliance Program ensures adherence by periodically assessing and auditing our billing, coding and collections processes both internally and by contracting with external firms. The Hospital and Nursing Home also reviews the results of audits conducted by payors and regulators to determine if any processes are in need of improvement.
The Hospital and Nursing Home welcomes any information from either internal or external sources which might uncover a process or practice of non-compliance. Only through that knowledge can an area be brought into full compliance.
I. Federal Laws
False Claims Act: The federal False Claims Act imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from Medicare, Medicaid or other federal health programs. The penalty for filing a false claim is $5000 – 10,000 per claim, and the recoverable damages are between two and three times the value of the amount falsely received.In addition, the false claim filer may have to pay the government’s legal fees.
Administrative Remedies for False Claims: This statute allows for administrative recoveries by federal agencies. If a person submits a claim that the person knows is false or contains false information, or omits material information, then the agency receiving the claim may impose a penalty of up to $5000 for each claim. The agency may also recover twice the amount of the claim.
II. New York State Laws
Social Service Law: 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.
III. Whistleblower Protection:
1. New York Labor Law: An employer may not take any retaliatory action against an employee if the employee discloses information about the employer’s policies, practices or activities to a regulatory, law enforcement or other similar agency or public official. Protected disclosures are those that assert that the employer is in violation of a law that creates a substantial and specific danger to the public health and safety. The employee’s disclosure is protected only if the employee first brought up the matter with a supervisor and gave the employer a reasonable opportunity to correct the alleged violation.
2. Federal False Claims Act: An employee who is “discharged, demoted, suspended, threatened, harassed or in any manner discriminated against” because of the employee’s lawful acts under the False Claims act is entitled to full compensation.
The Corporate Compliance Officer at Nathan Littauer Hospital and Nursing Home is Michael Ostrander, who is the Chief Financial Officer and reports to the President and CEO. The Corporate Compliance Officer is responsible for the day-to-day operation of the program. He must report to the Board of Directors periodically on the activities of the program.
A telephone line and internal Extension 4990 has been identified so that anonymous reports on potential compliance issues can be confidentially reported. Anyone can certainly report a potential compliance issue in person to the Corporate Compliance Officer or to their Department Manager. Department Managers would then be responsible to report the issue to the Corporate Compliance Officer.
All reports will be investigated. If an area of non-compliance is found, it will be resolved promptly and thoroughly and procedures, policies and systems implemented to reduce the potential for recurrence. As required, compliance issues will be reported to the appropriate state or federal office. Any areas of non-compliance that resulted in the Hospital or Nursing Home being overpaid for services will lead to a refund of those overpayments.
The Compliance Program includes training and education for all affected employees and members of the Board of Directors. New employees and members of the Board shall also receive education as part of their initial orientation to the organization.
All employees and Board Members are responsible to act in accordance with the provisions of this Corporate Compliance policy, the Code of Ethics and the Conflict of Interest Policy.
No one will be disciplined, subjected to intimidation or face retaliation for any good-faith participation in the Corporate Compliance Program at Nathan Littauer Hospital and Nursing Home or for reporting to appropriate officials as allowed by the federal or state laws.
Conversely, any employee who knowingly fails to report suspected problems, participates in non-compliant behavior or encourages, directs, facilitates or permits non-compliant behavior or practices will be subject to disciplinary action, including suspension and termination.