Standard of Conduct

Compliance Program                                                                            2018

 

 Allegheny Lutheran Social Ministries

998 Logan Boulevard

Altoona, PA 16602

814.696.4500                        814.696.9461 (fax)

www.alsm.org

 

Table of Contents

 

Scope……………………………………………………………………………………………………… 1

Structure…………………………………………………………………………………………………. 2

Compliance Officer ………………………………………………………………………………….. 2

Management……………………………………………………………………………………………. 2

Introduction…………………………………………………………………………………………….. 2

A Shared Responsibility…………………………………………………………………………….. 3

A Personal Obligation……………………………………………………………………………….. 3

Care Excellence………………………………………………………………………………………… 4

Persons’ served Rights………………………………………………………………………………. 4

Abuse and Neglect…………………………………………………………………………………….. 5

Persons’ served Confidentiality…………………………………………………………………… 6

Elder Justice Act…………………………………………………..………….…………………………6

Persons’ served Property……………………………………………………………………………. 7

Providing Quality of Care…………………………………………………………………………… 7

Medical Services……………………………………………………………………………………….. 7

Professional Excellence…………………………………………………………………………….. 8

Hiring and Employment Practices…………………………………………………………….. 8

Employee Screening………………………………………………………………………………… 8

Employee Relations…………………………………………………………………………………. 9

Workplace Violence………………………………………………………………………………… 9

Workplace Safety……………………………………………………………………………………. 9

Drug and Alcohol Abuse………………………………………………………………………….. 9

Organization Relations…………………………………………………………………………… 10

Proprietary Information…………………………………………………………………………. 10

Gifts………………………………………………………………………………………………………. 10

Conflict of Interest…………………………………………………………………………………… 11

Use ALSM Property…………………………………………………………………………………. 11

Computers and the Internet…………………………………………………………………….. 12

Vendor Relationships………………………………………………………………………………. 11

Marketing and Advertising………………………………………………………………………. 12

Billing and Business Practices…………………………………………………………………. 13

Referrals and Kickbacks………………………………………………………………………….. 14

Inducements of Prospective Persons’ Served……………………………………………….14

Copyright Laws……………………………………………………………………………………….. 14

Financial Practices and Controls……………………………………………………………….. 14

Fair Dealing…………………………………………………………………………………………….. 15

Protection and Proper Use of Assets………………………………………………………….. 15

Document Creation, Use and Maintenance………………………………………………… 15

Licensure and Certification………………………………………………………………………. 15

Voluntary Disclosure……………………………………………………………………………….. 15

Government Investigations………………………………………………………………………. 16

Disciplinary Action……………………………………………………………………………………. 15

Compliance Questions………………………………………………………………………………. 16

Conclusion……………………………………………………………………………………………….. 17

 

Scope

Allegheny Lutheran Social Ministries (ALSM) Compliance Program Plan covers the compliance issues, laws and regulations and guidelines that are relevant to a provider of senior and children services including Senior Living Communities and Programs and Children’s Services that may provide a wide range of programs that support seniors and children at various levels. This includes but is not limited to Medicare and Medicaid regulatory issues, guidelines from the Office of Inspector General, Housing and Urban Development (HUD), Internal Revenue Service and the Office of Civil Rights of the Department of Health and Human Services, Occupational Safety and Health Administration as well as other regulatory and business issues.

All individuals, including team members, vendors, contractors, volunteers, directors, officers and the Board of Trustees (BOT) are considered to be members of our team.

The scope of the program includes:

Policies and procedures that guide ALSM in appropriate business practice and promote compliance with laws and governmental regulations;

Recommendations and resources for training programs that are mandatory for team members to ensure understanding of ALSM’s Code of Conduct

Distribution of ALSM’s Code of Conduct to all team members and with a written acknowledgment of its receipt by the team member;

Processes that include appropriate disciplinary monitoring and review of potential fraud and abuse issues conducted to identify need for corrective action as well as additional training.

Mechanisms established to provide team members with a means to report potential noncompliance issues or other areas of concern without fear of retribution

Guidelines that have been developed for prevention of, and when required, response to identified compliance issues. This includes an annual review of the Compliance Program and modifications to the Program as appropriate;

Designation of a Compliance Officer and a Compliance Committee charged with the responsibility for developing, operating and monitoring the Compliance Program within ALSM.

Any questions regarding the policies in this Code of Conduct or references should be directed to your immediate supervisor, the Compliance Officer or member of the Compliance Committee

This Code of Conduct applies to every person at every level of ALSM. This includes team members, board of trustees, volunteers, independent contractors, subcontractors and vendors who may provide or are involved with operations or billing. The term persons served refers to individuals who receive the various types of care and other services that ALSM provides.

 

Compliance Officer and Management

The CEO carries the overall responsibility for creating a culture that values and emphasizes compliance and integrity and ensures privacy.

Rebecca Young, Vice President, Human Resources was appointed by the CEO and Board as the Compliance Officer.  The CEO and BOT are responsible for coordinating compliance activities in conjunction with the Compliance Officer. These activities include at annual audits, responses to compliance line and overseeing ALSM’s Compliance Committee. The Compliance Officer also functions as the Privacy Officer.

ALSM’s Compliance Committee is comprised of members of the management team. The Compliance Officer chairs the committee. The committee meets at least quarterly.

 

Allegheny Lutheran Social Ministries

Code of Conduct

 

Introduction

ALSM’s Code of Conduct is the foundation of the Compliance Program. It is a guide to appropriate workplace behavior. ALSM’s Code of Conduct applies to everyone including all team members, management, officers, board of trustees (BOT), volunteers, contractors and vendors.  ALSM complies with all required federal, state and local laws and regulations that apply to the programs and services. Monetary and/or criminal penalties for violations of these laws and regulations will apply to ALSM and/or those doing business on ALSM’s behalf

ALSM’s Compliance Program provides guidance for adherence to principles, standards, training and tools necessary in meeting legal, ethical and professional responsibilities. As a team member, you are responsible for supporting ALSM’s Compliance Program in every aspect of workplace behavior. Your performance review and continued working relationship includes understanding and adhering to the compliance plan as it applies to your job responsibilities and all your interactions with ALSM.

ALSM’s Code of Conduct supplements the team member Handbook and the specific procedures that apply to departmental job responsibilities. As a business partner or contracted partner it provides guidelines and expectations for our continued relationship. ALSM’s Code of Conduct discusses the importance of 

Care Excellence – providing quality, compassionate, respectful and clinically appropriate care.

Professional Excellence – maintaining ethical standards of healthcare and business practices.

Regulatory Excellence – complying with federal and state laws, regulations and guidelines that govern healthcare, housing services and other services we provide.

 

A Shared Responsibility

ALSM team members are responsible to act ethically in our relations with

Persons’ served and their representatives and families;

Colleagues and coworkers;

Volunteers;

Healthcare payers, including the federal and state governments;

Regulators, surveyors and monitoring agencies;

Physicians and non physician practitioners;

Vendors and suppliers;

Business associates; and

The Communities and Programs we serve.

All team members are required to complete training and adhere to ALSM’s Code of Conduct and Compliance Program as a condition of continued employment and business relationship.  Every team member is responsible for ensuring compliance with ALSM’s Code of Conduct and all related procedures. Any team member who violates any of these standards and/or procedures is subject to discipline up to and including termination of employment.

A Personal Obligation

Each team member is responsible for following and enforcing ALSM’s Code of Conduct in our daily work.

As a team member, you must help ensure that you are doing everything practical to comply with applicable laws. If you observe or suspect a situation that you believe may be unethical, illegal, unprofessional or wrong, or you have a clinical, ethical or financial concern, you must properly report it.

Reporting Guidelines 

#1 – Talk to your supervisor, s/he is most familiar with the laws, regulations and policies that relate to your work.

#2 – If you are not able to talk to your supervisor seek out another member of the leadership team or someone from human resources.

#3 – if you still have a concern, contact the Compliance Officer or member of ALSM’s Compliance Committee.

 

If none of the above steps resolve your questions or concerns, or if you prefer, call the toll free Compliance Line at 800-826-6762 for assistance. All calls are confidential.

Anyone may file a report in good faith through the Compliance Line without fear of reprisal, retaliation or punishment for your actions. Anyone, including a supervisor who retaliates against a team member for contacting the Compliance Line or reporting compliance issues in another manner, will be subject to discipline as per ALSM’s performance accountability procedure.

The Compliance Line is staffed by an outside agency and is available 24 hours, 7 days a week. Each call is confidential and each complaint is thoroughly investigated.

Care Excellence

Our most important job is providing quality care to persons served.  We work to achieve the best possible outcomes while following all applicable rules and regulations including Medicare Conditions of Participation.

Persons Served Rights

Those receiving healthcare and other services have clearly defined rights.

  • There will be no distinction in the admission, transfer or discharge of a persons’ served, or in the care we provide on the basis of race, gender, age, religion, national origin, disability, color, marital status, veteran status, medical condition, sexual orientation or other protected class status, insurance or financial status;
  • All persons served will be treated in a manner that preserves their dignity, autonomy, self-esteem and civil rights;
  • Persons’ served will be protected from physical, emotional, verbal or sexual abuse or neglect;
  • Persons’ served privacy and confidentiality will be maintained;
  • The rights of persons’ served will be respected with regard to client’s personal property and money; protection from loss, theft, improper use and damage;
  • Respect the right of persons served and their legal representatives to be informed of and participate in decisions about their care and treatment;
  • Respect the right of persons served and/or their legal representatives to access their medical records as required by the Health Information Portability and Accountability Act (HIPAA);
  • Recognize that persons served have the right to consent or refuse care and the right to be informed of the medical consequences of such refusal;
  • Protect persons’ served rights to be free from physical and chemical restraints; and
  • Respect the persons’ served right to self-determination and autonomy.

 

Abuse and Neglect

ALSM will not tolerate any type of abuse or neglect – physical, emotional, verbal or sexual of those persons’ served by team members, family members, legal guardians, friends or any other person.

The Pennsylvania Department of Health defines abuse as the following:

  1. The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish
    1. Verbal abuse is the use of oral, written or gestured language that willfully includes disparaging and derogatory terms to persons served or their support system, or within their hearing distance, regardless of their age, ability to comprehend, or disability.
    2. Physical abuse includes hitting, slapping, pinching and kicking. It also includes controlling behavior through corporal punishment.
    3. Mental abuse includes, but is not limited to, humiliation, harassment, threats of punishment or deprivation
    4. Involuntary seclusion is separation of a person served from others or from her/his room or confinement to her/his room (with or without roommates) against the persons’ served will, or the will of the persons’ served legal representative.
  2. The deprivation by an individual, including a caretaker, of goods or services which are necessary to maintain physical, mental, and psychosocial well-being
    1. Involuntary seclusion is the separation of the persons served from others or from her/his room or confinement to her/his room (with or without roommates) against the persons’ served will, or the will of the persons’ served legal representative.
    2. Neglect is purposeful withholding of food, fluids or services necessary to maintain physical or mental health.
  3. Sexual abuse includes, but is not limited to, sexual harassment, sexual coercion, or other sexual abuse which is intentionally, knowingly or recklessly causing or attempting to cause rape, involuntary deviate sexual intercourse, sexual assault, statutory sexual assault, aggravated indecent assault or incest.
  4. Misappropriation of persons’ served property means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a persons’ served belongings or money without the persons’ served consent.
  5. Other situations that may indicate abuse include, but are not limited to:
    1. Serious bodily injury which creates a substantial risk of death or which causes serious permanent disfigurement or protracted loss or impairment of the function of a body member or organ
    2. Serious physical injury causing a person severe pain or significantly impairs a person’s physical functioning, either permanently or temporarily
    3. Suspicious death may result from an unusual serious physical injury or action inconsistent with normal operations

Any team member who abuses or neglects persons’ served is subject to termination. In addition, legal or criminal action may be taken.

Abuse and neglect MUST BE REPORTED IMMEDIATELY to your supervisor or other member of management under the mandatory reporting requirements in the state of Pennsylvania.   DO NOT call the Compliance Line for issues of abuse or neglect.

Report them immediately!

Elder Justice Act

The Elder Justice Act requires timely reports of any reasonable suspicion of a crime against a resident of a long term care facility. You must report your reasonable suspicion to the PA Department of Health and local law enforcement within two (2) hours if the suspected crime involves serious bodily injury or within 24 hours if the suspected crime does not involve serious bodily injury.

Persons’ served Confidentiality/HIPAA

Every team member must treat all persons’ served information, including any documents or records that contain client-identifying information, medical records and charts as confidential.  Team members are only to use and disclose medical, financial or personal information only in a manner consistent with the HIPAA/HITECH Privacy and Security policies and procedures and state and federal law.

Any unauthorized exposure of PHI which compromises the security or privacy of information is a potential breach.

If you become aware of a breach of any protected or sensitive information it is important that you report it immediately to your supervisor or the Privacy Officer.

If the disclosure results in a breach, ALSM must investigate and comply with all state and federal HIPAA regulations for breach notification.

Persons’ Served Property

Team members must respect the personal property of persons’ served from loss, theft, damage or misuse. Team members who have access to property or funds must maintain accurate records and accounts and follow accounting procedures as defined by our financial procedures.

Providing Quality of Care

ALSM’s primary commitment is to provide the care, services and products necessary to help each person served reach or maintain his/her highest possible level of physical, mental and psychosocial well-being.  ALSM has procedures in place and provides training and education to support each team member in achieving this goal.

Team members will be informed about procedures specific to their job responsibilities as part of your employment orientation and training.

ALSM’s care standards include:

  • Accurately assessing the individual needs of each person served and developing interdisciplinary care plans that meet those assessed needs;
  • Reviewing goals and plans of care to ensure that the persons’ served ongoing needs are met;
  • Providing only medically necessary, physician prescribed services and products that meet the persons’ served clinical needs;
  • Confirming that services and products (including medications) are within accepted standards of practice for the persons’ served clinical condition;
  • Ensuring that services and products are reasonable in terms of frequency, amount and duration;
  • Measuring clinical outcomes and persons’ served satisfaction to confirm that quality of care goals are met;
  • Providing accurate and timely clinical and financial documentation and record-keeping;
  • Ensuring that persons’ served care is given only by properly licensed and credentialed providers with appropriate background, experience and expertise;
  • Reviewing persons’ served care procedures and clinical protocols to ensure that they meet current standards of practice; and
  • Monitoring and improving clinical outcomes through a Quality Assurance/Quality Improvement Committee with established benchmarks.

Medical Services

We are committed to providing comprehensive, medically necessary services for our persons’ served. The Medical Director provides oversight to physicians and other medical services as defined by state and federal regulations. The Medical Director oversees the care and treatment practices and is actively involved in the Quality Assurance/Quality Improvement Committee

Professional Excellence

The ethical behavior of every team member reflects on the reputation of ALSM and the services we provide. Whether you work directly with a person served or in other areas that support persons’ served; you are expected to maintain ALSM’s values and standards of honesty, integrity and professional excellence, everyday.

Hiring and Employment Practices

ALSM is committed to fair employment practices. When hiring and evaluating, we:

  • Comply with federal, state and local Equal Employment Opportunity laws, hiring the best qualified individuals regardless of race, color, age, religion, national origin, gender identity, sexual orientation. All promotions, transfers evaluations, compensation and disciplinary actions also follow this policy.
  • Conduct employment screenings to protect the integrity of our workforce and welfare of our persons’ served and team members.
  • Require all who need licenses or certifications to maintain their credentials in compliance with state and federal laws; documentation of licenses or certifications must be provided.

Employee Screening

ALSM is prohibited by federal law from employing, or retaining, or contracting with anyone who is excluded from any federal or state funded programs.  Screening procedures have been implemented and are conducted prior to hire and a minimum of quarterly thereafter, to identify such individuals. These standards also apply to temporary healthcare workers. These policies and procedures are intended to ensure that we do not contract with, employ or bill for services ordered, rendered or supervised by anyone:

  • Confirmed with a positive drug test;
  • Convicted of a violent crime, including assault, abuse or rape;
  • Convicted of a criminal offense related to healthcare, including fraud, neglect or abuse of clients;
  • Convicted of a felony in the preceding seven years;
  • Convicted of an offense considered exclusionary by state statutes regulation or standard;
  • Excluded from or ineligible to participate in federal healthcare programs;
  • Disbarred or excluded by a duly authorized licensing agency

Licensure and/or Certification Verification 

ALSM is committed to ensuring that only qualified professionals provide care and services to persons’ served. Practitioners and other professionals caring for our persons’ served must abide by all applicable licensing, credentialing and certification requirements. In addition, every effort is made to validate licenses and certification through the appropriate state or federal agency.

As long as you are employed or affiliated with ALSM, you must immediately report to your supervisor if you are convicted of an offense that would preclude employment in a healthcare facility; if action has been taken against your license or certification; or if you are excluded from participation in a federal or state healthcare program. Any team member who is alleged to have committed a serious criminal act will be suspended or, if convicted of a felony, terminated.

Employee Relations

To maintain an ethical, comfortable work environment, staff must:

  • Refrain from any form of sexual harassment or violence in the workplace;
  • Treat all colleagues and coworkers with equal respect, regardless of their national origin, race, color, religion, sexual orientation, age, gender identity or disability;
  • Protect the privacy of other team members by keeping personal information confidential and allowing only authorized individuals access to the information; and
  • Not supervise or be supervised by an individual with whom they have a close personal relationship.

Workplace Safety

Maintaining a safe workplace is critical to the well-being of our persons’ served, visitors and coworkers. That is why procedures have been developed that describes ALSM’s safety requirements. Each team member is educated and trained on the safety regulations and emergency plans regarding fire and disaster in their work area.

In addition to ALSMs procedures, we must abide by all environmental laws and regulations. Team members are expected to follow ALSM’s safety guidelines and to take personal responsibility for helping to maintain a secure work environment. Safety violations or hazards shall be reported to your supervisor immediately.

Drug and Alcohol Abuse 

We are committed to maintaining a workforce dedicated and capable of providing quality persons’ served services and performing other applicable duties. Team members are prohibited from consuming any substance that impairs their ability to provide quality services or otherwise perform their employment.

Team members may never use, sell or bring on company property, alcohol, illegal drugs and/or narcotics or report to work under the influence of alcohol, illegal drugs and/or narcotics. Team members who appear to have work performance problems related to drug or alcohol use, a drug and alcohol screening will be conducted and appropriate action will be taken if necessary.

Illegal, improper or unauthorized use of any controlled substance that is intended for persons’ served is prohibited. If a team member becomes aware of any improper diversion of drugs or medical supplies, s/he must immediately report the incident to their department supervisor, the Compliance Officer or the Compliance Line.

Organizational Relations 

Professional excellence at ALSM includes:

  • Complying with federal tax law to maintain tax exempt status under section 501c3 of the IRC.
  • Maintaining company privacy and keeping proprietary information confidential;
  • Avoiding outside activities or interests that conflict with responsibilities to ALSM and reporting such activity or interest prior to and during employment;
  • Allowing only designated management staff to report to the public or media; and
  • Requiring that ALSM comply with the licensing and certification laws that apply to its business.

Proprietary Information

In the performance of their duties team members, may have access to, receive or entrusted with confidential and/or proprietary information, that is owned by ALSM and that is not presently available to the public. This type of information should never be shared with anyone outside ALSM without authorization from a member of the Executive or Leadership team.

Examples of proprietary information that should not be shared include:

  • Persons’ served and team member data and information;
  • Details about clinical programs, procedures and protocols;
  • Policies, procedures and forms;
  • Training materials;
  • Current or future charges or fees or other competitive terms and conditions;
  • Current or possible negotiations or bids with payers or other clients;
  • Compensation and benefits information for staff;
  • Stocks or any kind of financial information; and/or
  • Market information, marketing plans or strategic plans.

Business Courtesies and Gifts

Team members may not accept any tip or gratuity from persons’ served; neither may they receive gifts from nor give gifts to persons’ served other than that of a nominal value (nominal is defined as not more than $35); nor may they borrow money from nor lend money to persons’ served; nor may they engage with persons’ served in the purchase or sale of any item. Team members may not accept any gift from a persons’ served under a will or trust instrument except in those cases where the team member and persons’ served are related by blood or marriage.

Team members may accept gifts that have been donated by persons served so long as the gifts provided to team members are of equal value and the contributions by persons’ served are voluntary and anonymous such that there is no way for a team member who may  benefit from the contribution to determine who made the contribution.

Team member may not serve as a persons’ served executor, trustee, administrator, or guardian or provide financial services or act under a power of attorney for a persons’ served except in those cases where the team member and persons’ served are related by blood or marriage unless otherwise prohibited by state law.

Under no circumstances will a team member solicit business courtesies, entertainment or gifts that depart from the Business Courtesies and Gifts policy

Conflict of Interest

A conflict of interest exists any time your loyalty to ALSM is, or even appears to be, compromised by a personal interest. There are many types of conflict of interest and these guidelines cannot anticipate them all, however the following provide some examples:

  • Financial involvement with vendors or others that would cause you to put their financial interests ahead of ours;
  • Team member/Officer participation in public affairs or corporate or community directorships or public office;
  • An immediate family member who works for a vendor or contractor doing business with ALSM and who is in a position to influence your decisions affecting the work of ALSM;
  • Participating in transactions that put your personal interests ahead of ALSM or cause loss or embarrassment to ALSM;
  • Taking a job outside of ALSM that overlaps with your normal working hours at or interferes with your job performance; or
  • Working for ALSM and another vendor that provides goods or services at the same time.

All team members must ensure that they remain free from actual or perceived conflicts of interest.

 

Use of Property 

Property – everything from office supplies and computers to company vehicles – represents a significant expense and should only be used for legitimate business purposes. Everyone must make sure that they:

  • Only use ALSM property for ALSM business purposes;
  • Exercise good judgment and care when using supplies, equipment, vehicles and other property; and
  • Respect copyright and intellectual property laws;
  • Never copy or download software without appropriate approval

Computers and the Internet

Team members are expected to use computers, email and internet systems appropriately and according to the established policy and procedure.  Team members are not permitted to use the internet for improper or unlawful activity or download or play games on ALSM computers.

Internet use can be tracked and monitored and you should have no expectation of privacy when you use our computers, email, internet and intranet system.  ALSM Team members are encouraged to become familiar with and abide by ALSM’s Social Media procedure.

Vendor Relationships 

We take responsibility for being a good client and dealing with vendors honestly and ethically. We are committed to fair competition among prospective vendors and contractors for our business. Arrangements between ALSM and its vendors must always be approved by management. Certain business arrangements must be detailed in writing, approved by management and the Compliance Officer or designee. Agreements with contractors and vendors who receive persons’ served information, with the exception of care providers, will require a Business Associate Agreement with ALSM as defined by Health Insurance Portability and Accountability Act.   Contractors and vendors who provide persons’ served care, reimbursement or other services to persons’ served beneficiaries of federal and/ or state healthcare programs are subject to ALSM’s Code of Conduct and must

  • Maintain defined standards for the products and services they provide to ALSM and the persons’ served;
  • Comply with all policies and procedures as well as the laws and regulations that apply to their business or profession;
  • Maintain all applicable licenses and certification and provide evidence of current workers compensation and liability insurance as applicable; and
  • Require that their team members comply with ALSM’s Code of Conduct and the Compliance Program and related training as appropriate.

Marketing and Advertising

We use marketing and advertising activities to educate the public, increase awareness of our services and recruit new team members.  These materials and announcements, whether verbal, printed or electronic will present only truthful, informative, non-deceptive information.

We abide by the HIPAA privacy rules in our marketing practices and provide individuals instructions on how to opt out of future communications.

 

Regulatory Excellence

Billing and Business Practices

We are committed to operating with honesty and integrity. Therefore, all team members must ensure that all statements, submissions and other communications with persons’ served, prospective persons’ served, the government, suppliers and other third parties are truthful, accurate and complete.

We are committed to ethical, honest billing practices and expect every team member to be vigilant in maintaining these standards at all times. We will not tolerate any deliberately false or inaccurate billing.  Any team member who knowingly submits a false claim, or provides information that may contribute to submitting a false claim such as falsified clinical documentation, to any payer – public or private – is subject to termination. In addition, legal or criminal action may be taken

Prohibited practices include, but are not limited to:

  • Billing for services or items that were not provided or costs that were not incurred;
  • Duplicate billing – billing for item or services more than once;
  • Billing for items or services that were not medically necessary;
  • Assigning an inaccurate code or persons’ served status to increase reimbursement;
  • Providing false or misleading information about a persons’ served condition or eligibility;
  • Failing to identify and refund credit balances;
  • Submitting bills without supporting documentation;
  • Soliciting, offering, receiving or paying a kickback, bribe, rebate or any other remuneration in exchange for referrals; and/or
  • Unlawfully inducing business associates.
If you observe or suspect that false claims are being submitted or have knowledge of a prohibited practice, you must immediately report the situation to a supervisor, a member of the Compliance Committee, the Compliance Officer or the Compliance Hotline.

 

Referrals and Kickbacks

Team members and related entities often have close associations with local healthcare providers and other referral sources. To demonstrate ethical business practices, we must make sure that all relationships with these professionals are open, honest and legal.

Persons’ served referrals are accepted based solely on the clinical needs and our ability to provide the services required by the persons’ served and our ability to provide the identified services.  ALSM never solicits, accepts offers or gives kickbacks of any kind.

A “kickback” is an item or service of value including cash, goods, supplies, gifts, “freebie” or bribes that is received in exchange for a business decision such as a persons’ served referral. Accepting kickbacks is not only against policies and procedures but also against the law. To assure adherence to ethical standards in our business relationships, team members must:

  • Verify all business arrangements with physicians or other healthcare providers or vendors in a written document; and
  • Comply with all state and federal regulations when arranging referrals to physician-owned businesses or other healthcare providers.

Team members cannot request, accept, offer or give any item or service that is intended to influence – or even appears to influence – the referral, solicitation or provision of healthcare service paid for any private or commercial healthcare payer or federal or state healthcare program, including Medicare and Medicaid, or other providers

Inducements to Prospective Residents

You may not provide anything of value including goods, services, or money to prospective residents or any beneficiary of a federal or state healthcare program that you know or should know will likely influence that person’s selection of a provider of healthcare services.

Copyright Laws

Print and electronic materials are protected by copyright laws. Team members are expected to respect these laws and not reproduce electronic print or print material without the permission from the writer or publisher.

Financial Practices and Controls

Ensuring that financial and operating information is current and accurate is an important means of protecting assets. All team members must make sure that all information provided by bookkeepers, accountants, reimbursement staff, internal and external auditors and compliance staff are accurate and complete. We must also comply with federal and state regulations when maintaining accounting records and financial statements and cooperate fully with internal and external audits.

Fair Dealing

All team members must deal fairly with persons’ served, suppliers, competitors and other team members. No team member, manager or director shall take unfair advantage of anyone through manipulation, concealment, abuse of privileged information, misrepresentation of material facts, or any other unfair dealing practice. 

Protection and Proper Use of Assets

All team members must protect the assets of ALSM and ensure their authorized and efficient use. Theft, carelessness and waste have a direct impact on ALSM’s viability. All assets must be used solely for legitimate business purposes.

Document Creation, Use and Maintenance

Every team member is responsible for the integrity and accuracy of documents, records, and e-mails including, but not limited to, client medical records, billing records, and financial records. No information in any record or document may ever be falsified or altered.

Team members must not disclose internally or externally, either directly or indirectly, confidential information except on a need to know basis and in the performance of their duties.  Team members must never disclose confidential information externally unless expressly directed to do so by legal counsel. Upon termination of employment a team member must promptly return all confidential information to ALSM.

Examples of confidential business information includes potential or threatened litigation, litigation strategy, purchases or sales of substantial assets, business plans, marketing strategies, departmental plans, financial management, training materials, fee schedules, department performance metrics and administrative policies

Licensure and Certification

We are committed to ensuring that only qualified professionals provide care and services to persons’ served. Practitioners and other professionals treating persons’ served must abide by all applicable licensing, credentialing and certification requirements. In addition, every effort is made to validate licenses and certification through the appropriate state or federal agency and screening of all team members through the OIG and GSA data bases and PA State Medicaid Database.

Voluntary Disclosure

It is the policy of ALSM to voluntarily report fraudulent conduct it uncovers that affects any federal or state healthcare program. Reporting will be completed within the time frames as identified under the Patient Protection and Affordable Care Act.

Government Investigations

We are committed to cooperating with reasonable requests from any governmental inquiry, audits or investigations. Team members are encouraged to cooperate with such requests, keeping in mind that each team member

  • has the right to speak or decline to speak, as all such conversation is voluntary;
  • has the right to speak to an attorney before deciding to be interviewed;
  • can insist that an attorney be present if he/she agrees to be interviewed.

In complying with policy you must not:

  • Lie or make false or misleading statements to any government investigator or inspector;
  • Destroy or alter any records or documents in anticipation of a request from the government or the court;
  • Attempt to persuade another team member or any person to give false or misleading information to a government investigator or inspector; or
  • Be uncooperative with a government investigation.

If a team member receives a subpoena or other written request for information from the government or a court, contact your supervisor, or the Compliance Officer before responding.

Disciplinary Action 

Disciplinary action will be taken against any team member who fails to act in accordance with this Code of Conduct, the Compliance Program, supporting policies and procedures and applicable federal and state laws. Disciplinary action may be warranted in relation to violators of the Compliance Program and to those who fail to detect violations or who fail to respond appropriately to a violation, whatever their role in ALSM. Disciplinary action will utilize standard disciplinary processes or termination of business relationships and agreements. The Compliance Officer, in conjunction with the President/CEO, is empowered to initiate the disciplinary action through the immediate supervisor and to monitor appropriate implementation of the disciplinary process.

Compliance Questions

As a team member, if you are unsure whether a particular activity or practice violates the law or the Compliance Program, the team member should seek guidance from his or her department supervisor or the Compliance Officer. Team members will not be penalized for asking compliance-related questions.

Conclusion

The compliance program is critical for ALSM’s continued success. Each team member is crucial to ensuring the integrity of ALSM. ALSM’s Code of Conduct and the Compliance Program set standards for the legal, professional, and ethical conduct of our business. Some key points to remember are:

ALSM and all its team members are committed to personal and organizational integrity, to act in good faith, and to be accountable for their actions. ALSM’s Code of Conduct and the Compliance Program prepares us to deal with the growing complexity of ethical, professional, and legal requirements of providing care in the health and human services field. The Compliance Program is an ongoing initiative designed to foster a supportive work environment, provide standards for clinical and conduct, and offer education and training opportunities for team members.

The success of ALSM’s Compliance Program depends on the commitment of our team members to act with integrity, both personally and professionally. Team members must ensure that ALSM is doing everything practical to comply with applicable laws. Team members are expected to satisfy this duty by performing job responsibilities in accordance with professional standards, the regulations and the policies and procedures of ALSM.