STANDARDS OF CONDUCT
A. Unacceptable Conduct
There are a number of types of conduct which would be considered unacceptable as a matter of common sense. Examples of Unacceptable Conduct are:
- Intentionally or knowingly making false or erroneous entries on reports, patient charts or other agency records.
- Unauthorized alteration or destruction of agency records including patient charts.
- Coding or billing which violates Medicare rules or regulations or other federal rules or regulations.
- Behavior detrimental to the operation.
B. Conflict of Interest
In order to perform their duties with honesty and fairness and in the best interest of the agency, employees must avoid conflicts of interest in their employment. Conflicts of interest may arise from having a position or interest in or furnishing managerial or consultative services to any concern or business from which the agency obtains goods or services or with which it competes or does business, from soliciting or accepting gifts, excessive entertainment or gratuities from any person or entity that does or is seeking to do business with the agency and from using agency property for personal or private purposes. Conflicts also may arise in other ways. If an employee has any doubt or any question about any of his or her proposed activities, guidance or advice should be obtained from the Compliance Officer, Brenda Brooks-Lyday, who shall, if need be, refer the matter on for review by the management team.
C. Health Care Records
A patient’s health care record is the property of the agency that created it and shall be maintained to serve the patient, necessary health care providers, the institution and third party payers such as Medicare, Medicaid or private payors in accordance with legal, accrediting and regulatory agency requirements. The information contained in the health care record belongs to the patient and the patient is entitled to the protection of that information. All patient care information is regarded as confidential and available only to authorized users such as treating or consulting physicians and employees who may be providing patient care and to third party payers in order to facilitate reimbursement. The operations, activities, business affairs and finances of the agency should also be kept confidential and discussed or made available only to authorized users.
D. Fraud and Abuse
Employees shall refrain from conduct, which may violate the fraud and abuse laws. These laws prohibit (1) direct, indirect or disguised payments in exchange for the referral or patients; (2) the submission of false, fraudulent or misleading claims to any government entity or third party payer, including claims for services not rendered, claims which characterize the service differently than the service actually rendered or claims which do not otherwise comply with applicable program or contractual requirements; and (3) making false representations to any person or entity in order to gain or retain participation in a program or to obtain payment or excessive payment for any service.
E. Business Ethics
Employees must accurately and honestly represent the agency and should not engage in any activity or scheme intended to defraud anyone of money, property or honest services.
F. Financial Reporting
All financial reports, accounting records, research reports, expense accounts, time sheets and other documents must accurately and clearly represent the relevant facts or the true nature of a transaction. Improper or fraudulent accounting, documentation or financial reporting is not only contrary to agency policy, it may be in violation of applicable laws. Sufficient and competent documentation shall support all cost reports.
G. Protection of Assets
The agency will make available to employees assets and equipment necessary to conduct agency business including such items as computer hardware and software, billing and medical records, in both hardcopy and in electronic format, fax machines, office supplies. Employees should strive to use agency assets in a prudent and effective manner. Agency property should not be used excessively for personal reasons or be removed from the agency without written approval from a management team member.
H. Anti-Competitive Conduct
The agency will not engage in anticompetitive conduct that could produce an unreasonable restraint of trade of a substantial lessening of competition. Evaluation of anti-competitive conduct requires legal guidance. Communication by employees with competitors about matters that could be perceived to have the effect of lessening competition or could be considered as collusion or an attempt to fix prices should take place only after consultation with legal counsel.
I. Credit Balance Reporting
The agency will comply with Federal and state laws and regulations governing credit balance reporting and refund all overpayments in a timely manner.
No employee shall offer any financial inducement, gift, payoff, kickback, or bribe intended to induce, influence or reward favorable decisions of any government personnel or representative, any customer, contractor or vendor in a commercial transaction or any person in a position to benefit the agency or the employee in any way. Employees are strictly prohibited from engaging in any corrupt business practice either directly or indirectly. No employee shall make or offer to make any payment or provide any other thing of value to another person with the understanding or intention that such payment or other thing of value is be used for an unlawful or improper purpose. Appropriate commissions, rebates, discounts and allowances are customary and acceptable business inducements provided that they are approved by the Management Team and that they do not constitute illegal or unethical payments. Any such payments must be reasonable in value, competitively justified, properly documented, and made to the business entity to which the original agreement or invoice was made or issued. Such payments should not be made to individual employees or agents of business entities.
K. Questions Regarding Compliance
Serenity has adopted a number of other agency wide policies and procedures. Employees may obtain copies in the Compliance office. Additional standards and policies may be applicable only to particular departments and copies may be obtained from supervisors or directors in those departments. It is particularly important that coding, billing and submission of claims to Medicare, Medicaid and other third party payers, be appropriate, accurate and in compliance with applicable laws and regulations. These Standards of Conduct apply to all employees, including supervisors, managers, directors and administrators. They also apply to temporary and contract employees and where practical to independent contractors doing business with the agency and to Medical Directors of Serenity. These Standards are not intended to cover every situation that may be encountered and employees should comply with all applicable laws and regulations whether or not specifically addressed in the Standards. Questions about the existence, interpretation or application of any law, regulation, policy or standard should be directed, without hesitation, to an employee’s supervisor, manager or director or to the Compliance Officer. Questions or concerns regarding Compliance may be relayed to the Compliance Officer anonymously by utilizing the Compliance Box located in the copy/fax room. Because laws, regulations and policies are constantly evolving, this Compliance Program will be revised and updated as needed. Revisions will be communicated timely to agency employees. Failure to comply with the Standards of Conduct or to conduct business in an honest, ethical, reliable manner can result in civil fines or criminal penalties against the agency and its employees or disciplinary action by the agency, including termination. Supervisors are responsible for ensuring that their employees receive a copy of this Program and participate in mandatory training related to the Program.
L. False Claims Act
The Federal False Claims Act is a law that prohibits a person or entity, such as the agency from “knowingly” presenting or causing to be presented a false or fraudulent claim for payment or approval to the Federal Government and from “knowingly” making, using or causing to be made a false record or statement to get a false or fraudulent claim paid or approved by the Federal Government. These prohibitions extend to claims submitted to federal health care programs, such as Medicare and Medicaid. The terms “knowing” and “knowingly” are having knowledge of the information, acts in deliberate ignorance of the truth or falsity of the information and acts in reckless disregard of the truth or falsity of the information. A person or entity found guilty of violation can be obligated to civil penalty up to $11,000 plus three times the amount of actual damages. A person or entity can also find themselves excluded from the Medicare and Medicaid programs if found in violation.
The agency understands that employees may not report concerns if they feel that they will be subject to retaliation or retribution or harassment for reporting the concern. To reassure employees who wish to report concerns through the Compliance Box, or directly to the Compliance Officer, a non-retaliation/non-retribution policy has been established. Supervisors, managers or employees are not permitted to engage in retaliation, retribution or any form of harassment directed against an employee who reports a compliance concern. Anyone who is involved in any act of retaliation or retribution against an employee that has reported suspected misconduct in good faith, will be subject to disciplinary action. Employees have the responsibility to report, in good faith, concerns about actual or potential wrongdoing. The agency is committed to a policy that encourages timely disclosure of such concerns and prohibits any action directed against an employee, manager or staff member for making a good faith report of a concern. Any manager, supervisor or employee who engages in retribution, retaliation or harassment against a reporting employee is subject to discipline up to and including dismissal on first offense. All instances of retaliation, retribution or harassment against reporting employees will be brought to the attention of the Compliance Officer who will, in conjunction with Legal and Human Resources, investigate and determine the appropriate discipline, if any. If an employee reports a concern regarding his or her own inappropriate or inadequate actions, reporting those concerns does not exempt him or her from the consequences of those actions. However, prompt and forthright disclosure of an error by an employee, even if the error constitutes inappropriate or inadequate performance, will be considered a positive constructive action by the employee. Compliance with and the promotion of the Standards of Conduct will be a factor in evaluating the performance of agency employees. Following the Standards of Conduct is not hard to do. Employees should not be apprehensive or frightened.
Brenda Brooks-Lyday is the Compliance Officer for Serenity Health Management, LLC, Serenity Home Health, LLC and Serenity Hospice Care, LLC. She can be reached by calling any of the phone numbers listed on this website.
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The word "hospice" was once used to describe a place of refuge for people on a difficult journey. Our excellent care and deep compassion for patients and families offer a place of comfort on the end-of-life journey. Recognizing that in hospice care, the main guardians are the family caregiver and the hospice team, care is most often provided in the home setting rather than in hospitals and hospice care facilities. The Serenity Hospice Care team will support the patient and family wherever they are.
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Hutchinson, Kansas 67501
Fax: (620) 899-2202