About Our Vendor Compliance Policy
Pursuant to the Deficit Reduction Act of 2005, Resurrection Health Care is required to provide certain information to all its contractors and agents. If you are a contractor, subcontractor, agent or other entity who, on behalf of RHC, furnishes or otherwise authorizes the furnishing of:
- Medicaid-reimbursed health care items or services,
- billing or coding functions, or
- are involved in the monitoring of health care provided by RHC,
you are required to review and, as possible, adopt our compliance policies and procedures.
A summary of these policies and procedures is below. Print a copy of this policy, or obtain one by contacting our Compliance Office at 847-813-3717.
I. Purpose and Introduction
Resurrection Health Care and its affiliates (hereinafter referred to as "RHC") are committed to conducting its business with integrity and in accordance with all federal, state and local laws. Our Compliance Program is a reflection of our Mission and Core Values. We believe our organizational integrity is a critical element of our accountability to our sponsors, our community and ourselves.
As part of the Compliance Program, RHC has instituted a number of policies, including a Compliance Code of Conduct (Code of Conduct), which specifically address the conduct expected from all employees, contractors and agents. This section is intended to serve as a general summary of the RHC Compliance Program.
The RHC Compliance Program includes the following key elements:
- RHC will establish compliance standards and procedures, which reflect a culture of integrity and are reasonably capable of preventing and detecting violations of law or standards of conduct;
- RHC leadership, including its governing body, will be knowledgeable about the content and exercise reasonable oversight over the operation of the Compliance Program and will assign specific individual(s) the overall responsibility, authority and resources to implement the Compliance Program, including regular reporting to the governing body, or its delegate, on the implementation and effectiveness of the Program;
- RHC will use due care not to delegate substantial authority to or do business with individuals whom RHC knew or should have known had a likelihood to engage in illegal activities;
- RHC will take reasonable steps to communicate its standards and procedures to all employees, contractors and agents and will establish needed training programs;
- RHC will take reasonable steps to achieve compliance with its standards by: (i) periodically evaluating the effectiveness of the Program; (ii) utilizing monitoring and auditing systems; and (iii) implementing a reporting system to allow employees, contractors and agents to confidentially report and, as appropriate, anonymously report, without fear of retaliation, matters not in compliance with the Compliance Program;
- RHC will consistently promote and enforce its standards through the use of both appropriate incentives to perform in accordance with the Program requirements and appropriate disciplinary guidelines and procedures in response to instances of non-compliance;
- RHC will take reasonable steps to respond appropriately to any reports of non-compliance and to prevent further similar incidents from occurring in the future.
RHC expects its department directors, managers and supervisors, as well as contractors and agents, to understand the Compliance Program and to comply with its requirements, including the Code of Conduct. These individuals are expected to assist in promoting an organizational culture that encourages a commitment to compliance. For example, RHC management must set an example for all other employees by following the Code of Conduct and ensuring that their employees understand and follow the Code of Conduct.
II. Key Elements of the Compliance Code of Conducts
The Compliance Code of Conduct applies to all employees of RHC. The Code of Conduct is intended to promote RHC's commitment to compliance and a culture of integrity in all employee and business interactions. A brief description of the Code of Conduct follows.
- Commitment to Compliance and Organizational Integrity
All employees, contractors and agents are expected to conduct themselves in a manner that adheres to and promotes both the letter and spirit of the Code of Conduct policy.
- Accurate Claim Submission and Financial Accounting
Periodic audits will be performed to evaluate compliance with policies regarding proper claim preparation and submission and financial accounting. The following are key matters concerning billing:
- Only reasonable and necessary services are billed,
- Coding of services and items are accurate and appropriate,
- Appropriate payors are billed, and
- Documentation of services is accurate and complete.
- Conflicts of Interest
All employees are expected to abide by RHC's Conflict of Interest policy. The System Compliance Officer is available to discuss potential conflicts of interest with RHC Board members, leaders, medical staff and employees.
- Fraud and Abuse/Physician and Vendor Relations
RHC has established procedures to monitor compliance with various legal requirements, including the anti-kickback, Stark, tax exemption and antitrust laws and regulations. As appropriate, RHC employees, contractors and agents are expected to understand the prohibitions on offering, paying or receiving any money, gifts or services in return for the referral of patients or to induce the purchase of items or services.
- HIPAA Compliance and Business Confidentiality
The System Compliance Officer will lead RHC's implementation of appropriate directives and processes to achieve compliance with the Administrative Simplification Standards of the Health Insurance Portability and Accountability Act (HIPAA). In addition, employees, contractors and agents may not engage in the unauthorized disclosure of confidential business information, including trade secrets, commercially sensitive information or financial information about RHC.
- Employee Rights
RHC's policies on employees' rights and obligations require a working environment free from harassment, illegal drugs, alcohol and unlawful discrimination. Accordingly, RHC shall have procedures in place to ensure compliance with certain federal laws governing employment and the workplace as issued by the Human Resources division.
- Patients'/Residents' Rights
Department managers shall ensure that each employee, contractor and agent working in their department(s) is aware of state and federal laws and facility licensing requirements concerning patient / resident rights, including requirements under Medicare and the federal HIPAA standards.
- Antitrust and Trade Regulation
RHC shall implement policies to prevent employees from intentional or inadvertent violations of the antitrust laws. These policies will specifically address the prohibition of sharing price, cost or fee information with any competitor.
- Non-profit/Tax-exempt Status
RHC shall implement policies regarding RHC's compliance with laws and regulations governing its non-profit tax-exempt status. In particular, employees will receive direction on the prohibitions on involvement in campaigns for political office. In addition, periodic monitoring of RHC compliance with its tax-exempt charitable purposes will occur.
III. Essential Components of the Compliance Program
The following are key components of RHC's Compliance Program.
- System Compliance Officer and Compliance Liaisons
RHC has designated a System Compliance Officer and several Compliance Liaisons. The System Compliance Officer has the ultimate responsibility for overseeing the Compliance Program and its supporting policies, including compliance with the Code of Conduct. Compliance Liaisons are appointed for various RHC affiliates to assist in implementing the Compliance Program.
- Compliance Oversight Committee and Affiliate Committees
The RHC Finance Committee ultimately is responsible for evaluating and taking action upon matters brought to its attention, including allegations of criminal conduct or violations of RHC policy. The RHC Finance Committee shall receive periodic updates from the System Compliance Officer. In addition, regular oversight of the Compliance Program is delegated to the RHC Compliance Oversight Committee, which meets periodically to provide general direction for the program. The Compliance Program also is supported by designated Compliance Committees at RHC business units.
- Communication of Information/Training Programs
The System Compliance Officer will establish communication and training programs to ensure employees, contractors and agents are familiar with the Compliance Program and its supporting policies, including the Code of Conduct.
- Reporting of Violations and Non-Retaliation Policy
Every employee, contractor and agent is required to report any known or suspected violation of the Code of Conduct to an appropriate representative of RHC. As feasible and to the extent possible, these reports will be kept anonymous. In addition, employees may not be subject to any reprisal for a good faith report of a suspected violation of the Code of Conduct or other Compliance policies. To assist in meeting this standard, the following practices shall be implemented:
- Employees may discuss with their supervisors any questions regarding the Compliance Program. Contractors and agents may report suspected compliance issues to their RHC supervisor, the RHC Compliance Officer or, as appropriate, to the RHC Officer responsible for the vendor agreement to which the contractor or agent is subject.
- Employees may report to their supervisors, to the System Compliance Officer or their designated Compliance Liaison any violation of the Code of Conduct or other Compliance policies. Reports may be made via the confidential electronic incident reporting system available in the RHC Intranet. Supervisors or Compliance Liaisons who receive such reports shall immediately report the information to the System Compliance Officer. If requested, anonymity for the reporter shall be maintained to the fullest extent possible.
- All members of RHC leadership shall promote an "open door policy," which permits an employee to discuss any suspected violation of the Code of Conduct or other Compliance policies.
- A policy of non-retaliation against anyone making a good faith compliance report shall be enforced consistent with Human Resources policies.
- Discipline for Violations
RHC will determine and document all disciplinary actions taken against its employees for violations of the Compliance Program in accordance with RHC Human Resources policies.
- Non-employment or Retention of Sanctioned Individuals or Vendors
RHC shall prohibit the employment of individuals, contractors or agents or use of vendors that have been convicted of a criminal offense related to health care or are listed by a federal agency as debarred, excluded or otherwise ineligible for participation in federally-funded health care programs.
IV. Steps Taken to Address Potential Violations
- Immediate Response Necessary
Any employee, contractor or agent who is aware of a potential violation of the Compliance Program is responsible for reporting that information immediately. The System Compliance Officer may consult, as appropriate, with RHC legal counsel regarding any issue raised by the report of a potential violation of the Compliance Program.
- Investigation of Violations
All employees, contractors and agents are expected to provide timely and diligent assistance, as needed, in the investigation of an alleged violation of the Compliance Program. Even a preliminary investigation must be conducted with assistance and direction from the System Compliance Officer and, as appropriate, RHC legal counsel.
- Notice to Employees
If the need arises, it may be appropriate to inform RHC employees, contractors and agents that the government is conducting an investigation of certain matters. In this instance, RHC will inform employees of their rights and obligations with respect to requests for interviews from governmental investigators. In addition, employees are requested to refer any contact from a government official regarding an investigation to the System Compliance Officer or RHC legal counsel.
- Preservation of Documents
RHC has instituted appropriate document retention policies with which all RHC employees must comply. All RHC leaders shall ensure compliance with this policy within their department.
V. Federal and State False Claims Laws
The federal False Claims Act (31 USC 3729-33), the federal Program Fraud Civil Remedies Act (31 USC 3801) and the Illinois Whistleblower Reward and Protection Act (740 ILCS 175) (collectively, "false claims laws") make it illegal for any person or organization to knowingly make a false record or file a false claim with the government for payment. "Knowing" means that the person or organization:
- Knows the record or claim is false, or
- Seeks payment while ignoring whether or not the record or claim is false, or
- Seeks payment recklessly without caring whether or not the record or claim is false.
The government created these laws as a way to reduce the instances of waste, fraud and abuse within government-funded programs. These laws are intended to encourage all of us to be vigilant in reporting and investigating possible instances of false claims.
Under certain circumstances, an inaccurate Medicare, Medicaid, VA, or Federal Employee Health Plan claim could be considered a false claim. An example of a possible false claim is someone knowingly billing Medicare for services that were not provided.
A person who knows a false claim was filed for payment can file a lawsuit in court on behalf of the government and, in some cases, receive a reward for bringing original information about a violation to the government's attention. Penalties are severe for violating false claims laws. The penalty can be up to three times the value of the false claim, plus fines from $5,500 to $11,000, per claim.
The false claims laws protect anyone who files a false claim lawsuit from being fired, demoted, threatened or harassed by their employer for filing the suit. An employee who was harmed by their employer for filing a false claims lawsuit may file a lawsuit against their employer. If the court finds the employer retaliated, the court can order the employer to compensate the employee, including re-hiring of the employee.
The RHC Compliance Program signals our commitment to organizational integrity throughout Resurrection Health Care. RHC believes that an effective compliance program - with active employee participation in the Program -- is an essential component of its Mission and Core Values. An effective compliance program improves RHC operations and reduces the risk of future criminal and civil liabilities and promotes our commitment to organizational integrity.