Code of Ethics (PDF 94 kb)
The Corporate Compliance Program enhances Prospect’s strong commitment to providing the highest quality of care and service by creating a work environment that emphasizes ethical, legal and prudent practices. Although it is recognized that no code of conduct or compliance plan can substitute for a person’s own internal sense of fairness, honesty and integrity, Prospect Center provides guidance and education to all parties involved to promote ethical behavior and reduce the likelihood of fraud, abuse, and health care violations.
What is Fraud and Abuse?
Fraud is defined as intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. Fraud occurs when a person participates in, knows or suspects but fails to report, and/or facilitates or encourages non-compliant behavior.
Abuse is provider practices that are inconsistent with sound fiscal, business or medical practices that result in an unnecessary cost to the Medicaid program, in reimbursement for services that are not medically necessary, or that fail to meet professionally recognized standards for health care. Consistent/repetitive errors or improper behavior also constitute abuse.
What is My Duty Regarding the Compliance Program?
All persons associated with Prospect are responsible for understanding and complying with the Agency’s compliance program, meeting all regulatory requirements, reporting all known or suspected violations of fraud or abuse, and assisting in the resolution of compliance issues. In fact, failure to perform these duties is a violation in itself.
Policies and Procedures
Prospect has adopted standards of ethical practice (Code of Ethics) for its employees and others in relation to the Agency in order to maintain the highest level of integrity and ethical behavior. The standards are the foundation of the Agency’s values, and they are expected to be adhered to. Policies and procedures which address the relevant areas of compliance have also been written and adopted in order to assist employees and others in carrying out their respective duties.
How Do I Identify Compliance Issues?
Examples of compliance violations that would need to be reported include, but are not limited to, the following:
- Inappropriately revealing or using confidential information regarding Agency employees or clients.
- Billing for services not provided for or for more time than was actually provided.
- Being unlicensed and performing services that only a licensed professional should render.
- Falsifying client, employee or financial documentation.
- Unauthorized financial transactions involving Agency or consumer funds.
- Accepting a bribe from a vendor or contractor.
How Do I Report an Issue?
Compliance concerns can be reported to the organization’s Compliance Officer at (518) 944-2129. If you would prefer to submit a written report, please include the following information:
- Name of person reporting allegation and job title
- Nature of the concern
- Who the concern regards
- When and where the events occurred
- What Code of Ethics standard is involved (if applicable)
- What action, if any, has been taken to address the issue
All written concerns should be addressed to the organization’s Compliance Officer, placed in a sealed envelope marked “PERSONAL”, and mailed to the appropriate address (see contact information at the bottom of this page). If a person feels more comfortable disclosing information anonymously, they can send their concern in writing by following the procedure outlined above and omitting their name.
Non-Intimidation / Non-Retaliation Policy
Prospect Center strives to create an environment that encourages confidence in raising, questioning, acting upon, and/or assisting in the resolution of a compliance concern; therefore, the Agency will ensure that a person will not be intimidated or retaliated against if they come forward or assist with a compliance issue, as long as their actions are conducted in “good faith”. Prospect Center will not tolerate any employee actions made maliciously or falsely against another individual. Please note that this policy does not protect people who whistleblow on themselves. All reports will be treated as confidential, to the extent permitted by law, and will be shared with others only on a need-to-know basis in accordance with agency policy.
How Will the Agency Respond?
The action taken by the Agency will depend on the nature of the concern; however, all concerns will be taken seriously and addressed appropriately. The Agency will investigate all suspected or known compliance matters. If a violation is found, appropriate action will be taken to correct the issue, as well as to prevent a recurrence and any overpayments found will be promptly refunded. Fraudulent behavior will lead to immediate action, up to and including referral to the appropriate law enforcement agency, NYS Medicaid Inspector General’s office, and/or NYS Department of Health.
Identifying Areas of Risk
The Agency conducts self-evaluations and audits of client and employee records as they relate to billing documentation and claims processing in order to prevent and/or detect compliance issues. Any issues found are corrected, a plan is put into place to prevent a recurrence, and any overpayments are promptly refunded. The Agency also conducts an annual risk assessment, which is an analysis of potential or actual risks and vulnerabilities that the Agency may face if proper controls are not in place. These risks apply to the current audit environment, concerns regarding existing policies and procedures, new or changed federal/state laws and regulatory requirements, and the findings from our internal evaluations/audits.
Training and Education
Prospect provides training and education to its employees and others in relation to the agency on an on-going basis in order to ensure that everyone is familiar with and kept up-to-date on the compliance program.
Disciplinary Policy for Good Faith Participation
Prospect encourages good faith participation in the compliance program through appropriate discipline when violations and/or fraud occur. Disciplinary action is fairly and firmly enforced.
False Claims Act
The False Claims Act prohibits anyone to knowingly submit (or cause another to submit) false claims for payment or approval of government funds. It also allows private citizens with knowledge of potential violations to file their own personal lawsuits of fraud, abuse or waste on behalf of the government with potential proceeds coming to them if the lawsuit finds in the government’s favor. ‘Whistleblowers’ are protected against discharge, demotion, suspension, threat, harassment, or other discrimination with regard to their employment as a result of their furtherance of an action under this Act. In addition, it makes it a violation to employ or contract with anyone who is excluded from participation in a federally sponsored healthcare program, as well as requires staff in certain positions to meet specific qualificiation in order to bill for Medicaid services. For further information on the Federal and State False Claims Act, visit the NYS Medicaid Inspector General’s website at www.omig.state.ny.us.
Center for Disability Services, 22 Corporate Woods, Albany, NY 12211
Phone: (518) 944-2129
E-mail: [email protected]