At St. Elizabeth Healthcare, we are committed to providing high quality healthcare and services consistent with our mission, vision, and values and with honesty and integrity.
Healthcare is a complex, highly-regulated industry, which continually faces changes in technology, delivery systems, standards of care, rules and regulations, funding and reimbursement, and finally and most importantly, the service needs of our patients and their families. With that complexity in mind, and at the direction of our Board of Trustees, St. Elizabeth has established a Corporate Compliance Program to assist us in our efforts to adhere to applicable laws, government regulations, and our own policies. Our Corporate Compliance Program is rooted in our mission and values, and re-affirms the values or honesty and integrity and professional standards that already exist among those associated with St. Elizabeth Healthcare.
Our Corporate Compliance Program serves two main purposes:
- to communicate the commitment of management to compliance with laws, regulations, standards of care, ethical business practices and the basic standards expected in the workplace; and
- to ensure that all those associated with St. Elizabeth understand their responsibility for complying with these laws and regulations and specifically for their responsibility as part of the Corporate Compliance Program.
Our Corporate Compliance Program has the full endorsement of the Board of Trustees, as well as our Administrative Council. While the Corporate Compliance Program may not cover the specifics of every situation you may encounter, it does provide a resource to direct you when you have questions. The management team stands ready to answer your questions about this document and the Corporate Compliance Program in general. Speak with your supervisor anytime you have a question regarding a possible violation of laws, regulations, standards of care, or ethical business practices. Additionally, we have a Corporate Compliance Officer and a toll-free compliance hotline as further resources to help resolve such issues. The Compliance Officer can be reached at (859) 301-5580, or reports may be made anonymously to the compliance hotline at 1 (877) 815-2414. Management will not tolerate retaliation against those who report compliance issues in good faith.
At St. Elizabeth Healthcare, we pledge our full commitment to upholding our Corporate Compliance Program as we fulfill our mission of healthcare excellence.
How to Make a Report or Inquiry
St. Elizabeth Healthcare requests, expects, and encourages associates to report any suspected violations of laws, statutes, rules, or applicable regulations. No concern regarding conduct or compliance is too small. St. Elizabeth uses the following 3-step Reporting process to learn of potential problems. When faced with a potential compliance issue:
- Contact your supervisor or team leader. Our supervisors are attentive to problems and can typically solve them and provide appropriate follow-up. If your supervisor is unable to solve the problem, you should feel free to contact their supervisor.
- If your supervisor is not able to resolve your problem, or if you would prefer not to report the issue to your supervisor, call the Corporate Compliance Officer, at (859) 301-5580.
- In some cases, you may want to report a situation without revealing your identity. For those concerns, call the Compliance Line at 1 (877) 815-2414. This number is available 24 hours a day, 365 days a year.
Consistent with our obligations under the law, St. Elizabeth Healthcare will keep confidential the identity of any individuals about whom allegations of violations have been brought, unless or until it has been determined that violations have occurred.
Compliance Line: 1 (877) 815-2414
The Compliance Line is a confidential, toll-free phone number established for reporting suspected violations of laws, statutes, rules, and/or regulations. St. Elizabeth’s Compliance Line can be reached by calling 1-(877) 815-2414. Calls may be made to the Compliance Line 24 hours a day, 365 days a year. St. Elizabeth Healthcare has contracted with an outside company for its operation of the Compliance Line. Strict guidelines and procedures protect those who wish to remain anonymous. Calls to the Compliance Line are not traced or recorded. Even if callers choose to identify themselves, their identity will be kept confidential to the fullest extent possible or as permitted by law.
Unfortunately, a reporting system of this type is subject to possible abuse. From time to time, individuals may attempt to harm or slander another individual through false accusations, malicious rumors, or other irresponsible actions. Such attempts, if proven, will be subject to discipline.
Frequently Asked Questions
What is the purpose of the Compliance Line?
The Compliance Line provides a way for associates to make anonymous compliance-related inquiries.
Who should use the Compliance Line?
Any associate wishing to report suspected misconduct or make a compliance-related inquiry. Other options are to report concerns to supervisors or the Corporate Compliance Officer. If an associate is uncomfortable with the direct approach, the associate should call the Compliance Line.
Why is the Compliance Line important to St. Elizabeth Healthcare?
St. Elizabeth Healthcare is committed to conducting all of its activities in compliance with applicable Federal, State, and local laws, statutes, and regulations. The Compliance Line provides St. Elizabeth with an additional way for associates to communicate compliance-related concerns.
What should be reported to the Compliance Line?
Call the Compliance Line to report violations related to St. Elizabeth’s policies, applicable Federal, State, and local laws, statutes, and regulations, which include, but are not limited to, the following:
- Medicare/Medicaid rules and regulations
- Joint Commission standards
- Medical Staff by-laws
- Stark anti-kickback statutes
- Health and safety laws
- Environmental laws
- Antitrust laws
- Theft, bribes, and kickbacks
- Fraudulent transactions
- Conflicts of interest
- Any potential criminal violations
Do callers have to give their names?
No. Callers will be assigned a special code number to protect each caller’s identity. Callers are not required to identify themselves. However, should a caller need to make any follow-up calls or should St. Elizabeth need to contact the caller for additional information related to the report, the identification code will be essential.
What happens when a call is made?
Calls are documented, and a written report is forwarded to the St. Elizabeth Corporate Compliance Officer. After review, the Compliance Officer determines the appropriate action to take, such as investigation, referral to the Corporate Compliance Committee, etc.
Should a call be made even if all the facts are not yet known?
Call even if you are not sure of the problem. The Corporate Compliance Officer will look into all provided information and take appropriate action as may be required.
What happens if a caller is mistaken?
As long as associates have an honest concern, associates will not be reprimanded or disciplined for giving incorrect information in the course of reporting their concern. The only time someone will be disciplined for calling the Compliance Line is if the person knowingly and intentionally reports something they know is false or misleading in order to harm someone else.
How can reports be made to the Compliance Line?
Call the Compliance Line at 1 (877) 815-2414.
Federal False Claims Act & KY Fraud and Abuse Laws
Federal False Claims Act
The Federal False Claims Act (FCA) is a Federal law that prohibits, among other things, the knowing filing of a false or fraudulent claim for payment, the knowing use of a false record or statement to obtain payment on a false or fraudulent claim paid by the United States, or the conspiracy to defraud the United States by getting a false or fraudulent claim allowed or paid. The FCA allows any person who discovers that a government contractor is defrauding the Federal government to report it, and then to sue the wrongdoer on behalf of the U.S. government. In general, the FCA covers fraud involving any federally-funded contract or program, with the exception of tax fraud.
In FCA lawsuits, known as qui tam suits, the Federal government has the right to join the private citizen’s lawsuit. If the government is then able to collect from the fraudulent contractor, the law allows the whistleblower to share in the proceeds. If the government declines, the individual may proceed on his or her own. The FCA also contains an anti-retaliation provision which protects those who make FCA-protected disclosures or file a qui tam suit.
Knowingly violating Medicare laws and the Medicare Fraud and Abuse Statute also violates the FCA. Hospitals, doctors, home healthcare agencies, and laboratories that seek and receive reimbursement for Medicare and Medicaid funds are subject to the False Claims Act. Some of the ways a healthcare provider can violate the FCA include:
- knowingly billing for services not rendered;
- misrepresenting the type of goods or services rendered;
- misrepresenting the nature of the patient's illness;
- failing to provide correct data on annual hospital or nursing home cost reports to the government, if the errors were knowing or intentional; or
- providing substandard care.
Any persons or entities with evidence of fraud against Federal programs or contracts may file a qui tam lawsuit, as long as the government or another private party has not already filed a lawsuit based on the same evidence.
Those who violate the False Claims Act can be required to pay three times the dollar amount that the government was defrauded (known as “treble damages”) and civil penalties of $5,500 to $11,000 for each false claim. A qui tam suit is a civil action, not a criminal action. For that reason, imprisonment is not a potential sanction in a qui tam case. However, filing a qui tam action may trigger a criminal investigation and prosecution by the government which could lead to criminal fines or jail time for the wrongdoer(s).
Any associate who discovers wrongdoing that violates the FCA is protected from being discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment by his or her employer because of lawful acts done by the employee in furtherance of an FCA action. The anti-retaliation provision protects employees who engage in lawful acts in furtherance of a FCA action. This includes investigation for, initiation of, testimony for, assistance in, or harassed because of an FCA action filed or to be filed. The protection against retaliation extends to whistleblowers whose allegations could legitimately support an FCA case even if the case is never filed.
Those who violate the FCA are liable for three times the dollar amount that the government is defrauded and civil penalties of $5,500 to $11,000 for each false claim. A qui tam plaintiff can receive between 15 and 30 percent of the total recovery from the defendant, whether through a favorable judgment or settlement.
Under the anti-retaliation section of the FCA, any employee who is discharged, demoted, harassed, or otherwise discriminated against because of lawful acts by the employee in furtherance of an action under the Act is entitled to all relief necessary to make the employee whole, which may include reinstatement, double back pay, and compensation for any special damages, including litigation costs and reasonable attorneys’ fees.
Kentucky Fraud and Abuse Laws
The Commonwealth of Kentucky also has enacted laws to protect the financial integrity of the Kentucky Medical Assistance Program through the investigation and prosecution of healthcare providers who fraudulently bill or abuse the Medicaid system to obtain benefits or payment for services.
The Kentucky Fraud and Abuse Laws define “Fraud” as “an intentional deception or misrepresentation made by a recipient or a provider with the knowledge that the deception could result in some unauthorized benefit to the recipient or provider or to some other person. It includes any act that constitutes fraud under applicable federal or state law.”
Examples of fraud under the Kentucky Fraud and Abuse Laws would include those activities listed above as examples of violations of the FCA.
Those found to have violated the Kentucky Fraud and Abuse laws shall be liable for (a) restitution in the amount of the excess payments, plus interest; (b) a civil payment in an amount up to three times the amount of excess payments; (c) a civil payment of five hundred dollars ($500) for each false or fraudulent claim submitted for providing treatment, services, or goods; and (d) payment of legal fees and costs of investigation and enforcement of civil payments.
In addition, those found to have violated the Kentucky Fraud and Abuse Laws will be removed as a participating provider in the Medical Assistance Program for two months to six months for a first offense, for six months to one year for a second offense, and for one year to five years for a third offense.
Any person who has reasonable cause to believe that a violation of the Kentucky Medicaid Fraud and Abuse laws is being committed, should report the violation to the Medicaid Fraud Control Unit or the Medicaid Fraud and Abuse hotline. The identity of the person making such a report will be kept confidential by the party receiving the report.
Employers are not permitted, without just cause, to discharge or in any manner retaliate against any employee who in good faith makes such a report, or who participates in any proceeding with regard to any such report or investigation. An employee injured by any act in violation of the prohibition against employer retaliation may pursue a civil cause of action to enjoin further violations, and to recover the actual damages sustained, together with the costs of the lawsuit, including reasonable attorney’s fees.
All associates are required to comply with Federal and State healthcare fraud, abuse, and false claims laws. Activities that are prohibited include, but are not limited to:
- Intentionally or knowingly making false or fraudulent claims for payment or approval; and
- Submitting false, fraudulent or misleading information for the purpose of gaining the right to participate in a plan or obtain reimbursement for services (including submitting claims for services not rendered and submitting claims that characterize the service differently from the service actually rendered).
Rights & Remedies under the ARRA of 2009
The American Recovery and Reinvestment Act of 2009 (ARRA) provides funding for research and other healthcare needs. In order to accept ARRA funding, employers must have in place policies prohibiting retaliation against employees/associates who make good faith reports of misconduct. St. Elizabeth Healthcare already has such a policy, # 300.045, “Associate, Provider or Contractor/Vendor Discipline for Corporate Compliance Program-Related Infractions,” and will provide appropriate support to reporting associates to protect against retaliation and respond to concerns of retaliation or unfair treatment linked to the associate’s reporting.
The ARRA expressly states that:
Receivers of stimulus funds may not discharge, demote or otherwise discriminate against an employee as reprisal for disclosing information that the employee reasonably believes is evidence of:
- gross mismanagement of an agency contract or grant relating to covered funds;
- a gross waste of covered funds;
- a substantial and specific danger to public health or safety related to the implementation or use of covered funds;
- an abuse of authority related to the implementation or use of covered funds; or
- a violation of law, rule, or regulation related to an agency contract or grant awarded or issued relating to covered funds.
Under ARRA, an employee may make a disclosure of the information described above to one or more of the following: the Recovery Accountability and Transparency (RAAT) Board; an Inspector General of a federal agency; the Comptroller General; a member of Congress; a State or Federal regulatory or law enforcement agency; a person with supervisory authority over the employee or such other person working for the employer who has the authority to investigate, discover or terminate misconduct; a court or grand jury; or the head of a Federal agency or their representatives.
St. Elizabeth Healthcare has a confidential reporting hotline that may be used for this purpose (toll-free 1-877-815-2414), where anonymous reports may be made. In addition, associates also have the option of reporting concerns directly to the Office of Inspector General for the United States Department of Health and Human Services through the OIG Hotline (http://www.oig.hhs.gov/fraud/hotline). The choice of which reporting option(s) to use rests with the individual making the report.
A full description of rights and remedies provided under the ARRA is available from the US Government Printing Office: Division A, Title XV, section 1553, Protecting State and Local Government and Contractor Whistleblowers. Additional information regarding whistleblower protection related to ARRA funds may be found at http://www.recovery.gov.
Code of Conduct
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to view the Code of Conduct.