RIGHTS, RESPONSIBILITIES AND POLICIES

Our Mission

 

The mission of MidState Medical Center is to promote, restore, and maintain the health and well-being of the people of central Connecticut by striving to improve health status and provide health care services, information, and support of the highest quality.

 

Patient Rights

 

MidState Medical Center recognizes that its patients should be treated with dignity and their rights respected. We welcome the opportunity to express in a formal way, your rights:

 

• To treatment without discrimination as to race, color, religion, sex, national origin, diagnosis, or source of payment
• To considerate and respectful care
• To fair and compassionate care at all times and under all circumstances
• To expect reasonable, safe continuity of care
• To have a family member or representative of your choice and your own physician notified promptly of your admission to the hospital
• To obtain from your physician complete current information concerning your diagnosis
• To receive from your physician information necessary to give informed consent prior to the start of any procedure and/or treatment
• To know the name of the person responsible for the procedure and/or treatment
• To refuse treatment to the extent permitted by law and be informed of the medical consequences of such action
• To expect that within its capacity the hospital will make a reasonable response to your requests for services
• To privacy concerning your medical care
• To expect that all communications and records pertaining to your care be treated as confidential
• To expect a quick response to complaints of pain
• To be free from all forms of abuse or harassment
• To be free from seclusion and restraints of any form unless medically necessary or needed to insure the patient's physical safety when less restrictive interventions have been determined to be ineffective
• To an interpreter if you do not speak or understand the predominant language of the community
• To express complaints about care and services provided, and then have the Medical Center investigate such complaints
• To have the Medical Center provide you written notice of its decision that contains the name of the hospital contact person, the steps taken on your behalf to investigate the complaint, the results of the investigation and the date of its completion
• If you wish to speak to us about a complaint or concern, please let your nurse know, or call our patient representative line at 203 694 8350.

Patient Responsibilities

 

As a partner with us in your treatment, you as a patient have the responsibility:

 

• To provide, to the best of your knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to your health
• To report unexpected changes in your condition to the responsible practitioner
• To work with your doctor and nurse to develop a plan to manage your pain
• To report whether you clearly understand a planned course of action and what is expected of you
• To follow the treatment plan recommended by those responsible for your care
• To assure that financial obligations of your care are fulfilled as promptly as possible
• To be considerate of the rights of other patents and hospital personnel and to assist in the control of noise, number of visitors, and being respectful of the property of others

 

MidState Medical Center's focus is on you, the patient, and the recognition of your dignity as a human being. Should you have any questions about these rights and responsibilities, please do not hesitate to call extension 203 694 8350.

 

Sign language, oral interpreters, TTY, other auxiliary aids and services are available, free of charge, to people who are deaf or hard of hearing. Interpreters for non-English speaking persons are also available.

 

Contact the Care Management Department

Monday - Friday  8 a.m. - 4:30 p.m.

Call 203 694 8244 or the medical center operator at "O."

 

 

Introduction to the Standards...

 

MidState Medical Center has a value system in place, which allows us to successfully achieve our mission. These values, which drive our daily work actions, include such things as service, partnership, stewardship, integrity and innovation. Things like truth, compassionate care and treating individuals with respect and dignity are the basis for our value system.

 

This Code of Conduct is an important part of our values. It spells out our expectations for how we should conduct ourselves in the work place, with all parties. The seven standards in this document provide specific guidance to our employees. They have been approved by the Board of Directors and the hospital's Management.

 

Please keep the following in mind as you read these standards:

 

MidState Medical Center refers to all operating units and business units.

The hospital may, at any time, add to or change this Code of Conduct without prior notice. However, you will be told of changes as quickly as is reasonably possible.

Nothing in this Code of Conduct is intended to provide, or should be construed as providing, any additional employment rights to employees or others.

Disciplinary actions for violating these standards can be found in the hospital's Human Resource policies manual. Those who violate the standards in this Code of Conduct may be terminated or have their privileges suspended, or even removed. In some cases, those who violate the Code of Conduct may be guilty of violating civil and/or criminal law.

 

This document covers a wide variety of situations that you face in your daily work. Please review it carefully and use it whenever you have questions about business conduct. Each employee must read the Compliance Policy and Compliance Manual. After reading it, the employee must sign a statement swearing they received the Manual and that they understand the Compliance Policy and will comply with the policies. If you have questions about situations you face, please contact the Director of Compliance or the Director of Internal Audit

 

In addition to these business ethics, the Medical Staff Office maintains the Clinical Ethics Committee Manual.

 

 

Overview of the Standards...

 

This section provides a summary of the seven primary standards that make up MidState Medical Center's Code of Conduct. Additional sections of this document provide further details.

 

 

Standard 1: Legal Compliance

We conduct all of our business in strict compliance with all federal and state laws. We are committed to preventing fraud and abuse. These laws and regulations apply to discrimination, fraud and abuse, the environment, antitrust, political activities and taxation.

 

Standard 2: Business Ethics

We are committed to the highest standards of business ethics. At all times, employees must exercise honesty in their work and must never do anything that cheats any person or organization of money or property. All employee actions, whether or not included in this Code of Conduct, must comply with this mandate. We have an obligation to report any actual or perceived improper or inaccurate coding or billing practices to Management, Human Resources, the Director of Compliance or the Employee Helpline.

 

Standard 3: Confidentiality

Our employees must maintain strict confidentiality of patient, employee and business-privileged information.

 

Standard 4: Conflicts of Interest

Our employees must conduct their business activities so as to avoid actual and/or possible conflicts of interest. Employees must never use their positions to profit personally or to assist others to do so at the expense of the corporation.

 

Standard 5: Business Relationships

All of our business transactions with all third parties must be free from anything improper.

 

Standard 6: Protection of Assets

Our employees must always strive to protect and preserve the assets of the corporation through efficient and effective use of resources. They must properly and accurately record the true nature of all financial transactions.

 

Standard 7: Quality of Care

We are committed to providing high quality of care, as defined by our mission and vision, and to respect the rights of our patients. We have an obligation to report any actual or perceived improper activities associated with these seven standards to Management, Human Resources, the Director of Compliance or the Employee Helpline.

 

 

DETAILED STANDARDS

 

STANDARD 1:

LEGAL COMPLIANCE

 

We conduct all of our business activities in strict compliance with all federal and state laws and regulations. The following standards are meant to guide employees in legal compliance. These following standards describe some, but not all, applicable laws employees must be aware of in conducting hospital business.

 

Standard 1.1 - Discrimination

We believe in fair and equitable treatment of employees, volunteers, patients, families, business associates and the general public.

 

Our policy is to hire, train and promote employees and volunteers based on their abilities, achievements, experience and conduct without regard to race, color, creed, religion, national origin, sex, martial status, economic status, disability, age or any other classification protected by law. Layoffs and terminations will be imposed against those who discriminate within the workplace.

 

We will treat patients without regard to race, color, creed, religion, national origin, sex, martial status, economic status, disability, age or any other classification protected by law.

 

We will not tolerate any form of harassment or discrimination. Any employee accused of harassment or discrimination against others will be investigated in accordance with Human Resource policies.

 

Standard 1.2 - Fraud and Abuse

We expect all employees to refrain from any conduct that may violate fraud and abuse laws, which prohibit such things as:

 

• Submitting false, misleading or fraudulent claims to the government or third party payor (e.g., submitting claims that do not correctly characterize the actual services provided, submitting claims for services not performed, submitting claims that do not otherwise comply with applicable requirements, etc.)
• Paying or providing services in exchange for patient referrals
• Making false representations to any person or company in order to gain or retain participation in a program or to obtain payment for a service

 

For additional guidance, please refer to the Medicare and Medicaid policies.

 

Standard 1.3 - Environmental

Employees are expected to conserve and recycle. We respect the environment and attempt to conserve natural resources in managing and operating our business. All waste is disposed of according to applicable laws and regulations. We will work cooperatively with authorities to correct any contamination for which we may be responsible.

 

Standard 1.4 - Antitrust

All of our employees must refrain from conduct, which violates antitrust laws or similar laws regulating competition. Such conduct includes:

 

• Unfair trade practices, including bribery, misappropriation of trade secrets, deception, intimidation or similar unfair practices
• Agreements to fix prices
• Bid-rigging
• Collusion with competitors or vendors

 

Standard 1.5 - Political Activities

We expect our employees to refrain from any activities that may jeopardize our tax-exempt status. Employees may not contribute any of our money, goods or services to any political candidate, party or organization in violation of the law. This does not mean that employees cannot personally participate in, or contribute to any political candidate, party or organization. We have many contacts and dealings with governmental agencies and officials. All such contacts and related transactions must be conducted in an honest and ethical manner. Any attempt to influence governmental agencies or officials by improper means is strictly prohibited. No business courtesies, such as meals and entertainment, shall be extended to these individuals. We analyze legislation, make recommendations and take public positions on issues that have a direct affect on our business. All such activities are to be conducted in an honest and ethical manner.

 

Standard 1.6 - Taxation

As a tax-exempt company, we have a legal and ethical obligation to:

 

• Comply with the laws that permit us to have a tax-exempt status 
• Engage in activities to further our charitable purpose
• Ensure that our resources are used to further the public good

 

Our employees must avoid engaging in arrangements in excess of fair market value. Employees must not use hospital resources for private or personal interests.

 

We must accurately report all business matters to the appropriate authorities and file all tax and information returns according to applicable laws.

 

 

STANDARD 2:

 

BUSINESS ETHICS

 

We are committed to the highest standards of business ethics. At all times, employees must exercise honesty in their work and must never do anything that cheats any person or organization of money or property. All employee actions, whether or not included in this Code of Conduct, must comply with this mandate.

 

Standard 2.1 - Honest Communication

Our employees are expected to communicate with honesty in their job responsibilities. They must not make false, misleading or confidential statements to any person or company doing business with us.

 

Standard 2.2 - Misappropriation of Proprietary Information

Our employees must not give privileged information belonging to the hospital, our patients or any other person or part of our operation. They must not use any contract, document, computer program, price list, customer list, publication, product or piece of information in violation of a third party's interest in such item. Our employees must not use confidential business information received from competitors in violation of a promise not to compete, or anything else that an employee may have obtained from a competitor.Our employees must not improperly copy documents or computer programs in violation of copyright or licensing agreements.

 

 

STANDARD 3:

 

CONFIDENTIALITY

 

Our employees must maintain strict confidentiality of patient, employee and business-privileged information. Employees have access to and possess a broad variety of confidential, sensitive and privileged information. To release this information could be harmful to individuals, our business partners and MidState Medical Center itself. All employees must actively protect and safeguard such information at all times. Please refer to the Connecticut Health Systems Information Security Policies, Standards and Guidelines Manual for detailed information on this subject.

 

Standard 3.1 - Patient Information

All of our employees must maintain the confidentiality of patient information. Such information should only be accessed for legitimate business or patient care purposes. Release of such information must only be done in compliance with the policies and guidelines outlined in the MidState Medical Center Information Security Policies, Standards and Guidelines Manual.

 

Standard 3.2 - Personnel

Salary, benefit and other personal information relating to employees must be kept confidential. Information should be accessed only for MidState Medical Center business reasons.

 

Standard 3.3 - Proprietary Information

Information, ideas and intellectual property of MidState Medical Center is important to the organization's success. Employees must protect information pertaining to our competitive position, financial position, business strategies and negotiations. Employees should ensure that they exercise care over such things as patents, trademarks, copyrights and computer software to preserve and protect our value.

 

 

STANDARD 4:

 

CONFLICTS OF INTEREST

 

Our employees must conduct their business activities so as to avoid actual and/or possible conflicts of interest. Employees should fully disclose any actual or potential conflicts to their manager or the Director of Compliance. Employees must never use their positions to profit personally or to assist others to do so at the expense of the corporation.

 

To ensure compliance with these principles, all of our directors, officers and key employees are required to submit a Conflict of Interest Disclosure Statement to MidState Medical Center annually.

 

Standard 4.1 - Conflicts

To be directly involved as an owner, part owner, an employee or someone receiving money from a company doing business with us is considered a conflict of interest. Employees shall not compete directly or indirectly with us in the purchase or sale of goods or services.

 

Standard 4.2 - Gifts

All employees must refuse to accept any gifts, favors or hospitality, which might influence, or appear to influence, their decision making or actions affecting the organization.
Gifts of nominal value may be accepted. Employees are expected to use common sense and good judgment in accepting or rejecting gifts.

 

To the extent possible, appropriately accepted gifts should be shared with co-workers.
If such an individual or company wishes to make a gift of more than slight value, they should be referred to the appropriate business office.

 

Our employees should not solicit gifts, with the exception of gifts solicited from vendors, suppliers, contractors and others, in support of our charitable activities. No gift should be received with the expectation that a supplier or contractor will receive more business from us as a result of the gift.

 

Standard 4.3 - Competitors

Employees must not provide job services to competing companies.

 

STANDARD 5:

 

BUSINESS RELATIONSHIPS

 

All of our business transactions with all third parties must be free from what is unethical or illegal. The following standards are intended to guide our employees in their relationships with suppliers, vendors, contractors, providers, third party payors and government entities. It is our intent that this policy be so broad as to avoid even the appearance of improper business conduct.

 

Standard 5.1 - Contracting

Employees may not use "insider" information for any business activity conducted on behalf of MidState Medical Center. All business relations must be at arm's length.

 

Standard 5.2 - Business Inducements

Our employees must not offer, give, solicit or receive any form of bribe or other improper payment or inducement.

 

Commissions, rebates, discounts and the like are customary and acceptable business practices if they are approved by MidState Medical Center's management, are not illegal and are not unethical. There should be proper documentation for such items. If they are made to others on behalf of MidState Medical Center, they should be made to the business, NOT to individual employees.

 

Standard 5.3 - Supplier Sponsored Training, Seminars, Entertainment

Employees may attend local, supplier sponsored workshops, seminars and training sessions. Supplier sponsored out-of-town seminars should only be accepted with the advanced approval of management. There should be a valid business reason for the trip.

 

The waiver of seminar or conference fees or providing for travel costs where the employee is making a presentation or participating in an information forum is acceptable.

 

Honoraria received as a result of invitation to participate in an educational program will accrue to the employee unless otherwise arranged.

 

Employees may accept supplier or vendor business courtesies such as meals, local transportation and entertainment that are modest in amount and related to a legitimate purpose. In most such situations, a regular business associate of the supplier or vendor should be in attendance with the employee.

 

 

STANDARD 6:

 

PROTECTION OF ASSETS

 

Our employees must always strive to protect and preserve the assets of the corporation through efficient and effective use of resources. They must properly and accurately record the true nature of all financial transactions.

 

Standard 6.1 - Internal Control

All of our employees share responsibility for maintaining and enforcing internal controls set up in their areas. These controls ensure that assets of MidState Medical Center are protected and the financial records are accurate and reliable. Disposition of our assets must be approved by the appropriate management level.

 

Standard 6.2 - Financial Reporting
All of our financial reports, accounting records, expense accounts, time sheets, research reports, and others such documents must accurately and clearly represent the true nature of the underlying transactions. We do not condone improper or fraudulent accounting or financial reporting.

 

Standard 6.3 - Travel and Entertainment

Travel and entertainment expenses should be consistent with the individual's job responsibilities, along with the needs and resources of MidState Medical Center. Employees should have no personal financial gain from business travel and entertainment. Reasonable judgment should be used regarding the appropriateness of expenses. Our travel and entertainment policies must be fully complied with.

 

Standard 6.4 - Personal Use of Corporate Assets

Our assets should not be used for personal purposes, unless approved in advance by management. All of our property must be used in a manner that is in the best interest of the hospital. No employee may receive personal money for use of our assets on company time. No employee shall use our assets for purposes unrelated to their MidState Medical Center work

 

 

STANDARD 7

 

QUALITY OF CARE

 

We are committed to providing high quality of care as defined by our mission and vision and to respect the rights of our patients. Patients are the focus of everything we do and, therefore, we are committed to provide high quality of care and to deliver services and duties in a responsible, reliable, appropriate and cost effective manner. Patient care will be accessible, affordable and appropriate, with the least possible discomfort and inconvenience. We will also abide by all professional and governmental regulatory requirements

 

Standard 7.1 - Patient Dignity

We shall provide for the patient's dignity, comfort and convenience and will treat each patient with consideration, courtesy and respect.

 

Standard 7.2 - Medical Services

We have the duty to provide medical services and products to patients which are safe and which comply with all applicable laws, regulations and professional standards.

 

Standard 7.3 - Access to Care

We shall ensure all patients admitted to our care shall receive service with optimum, cost-effective care, regardless of payor source or level of reimbursement.

 

Standard 7.4 - Duty to Report

We have a duty and affirmative responsibility to never unreasonably ignore any deficiency or error, no matter how small or insignificant. It is essential that all such matters be brought to the attention of those who can properly assess and redress the problem.

 

Standard 7.5 - Honesty and Integrity

We are encouraged to communicate and demonstrate openness, honesty, and integrity through lawful and positive relationships with patients, customers and regulatory agencies.

 

Standard 7.6 - Standards of Care

We shall periodically assess and evaluate medical program goals and objectives to assure maintenance with current standards of practice.

 

Standard 7.7 - Quality of Care for All

We recognize our patients have the right to receive appropriate and high quality care services without discrimination due to their race, creed, gender, national origin, sexual orientation, disability, age, or source of payment.

 

Standard 7.8 - Expected Practices

We shall give employees specific, clear information regarding the expected practices to be followed when caring for, assessing and teaching patients, compounding drugs, transporting drugs, equipment or hazardous wastes, or performing any procedure that may place the patient, employee, or others at risk of infection or harm.

 

Standard 7.9 - Employee Credentialing

We shall use only licensed/credentialed employees to conduct clinical assessments or provide treatment services.

 

Standard 7.10 - Outcomes Measurements

We will measure clinical outcomes and patient expectations of service, leading the community in both quality and value standards. In that same vein, we shall strive in all our endeavors to improve the quality of health care, services and interpersonal relations.

 

Standard 7.11 - Healthcare Evaluation

All patients shall be evaluated by a physician or his/her designee responsible for determining medical necessity of treatment before a treatment plan involving our programs and services is decided.

 

Standard 7.12 - Quality of Services

We shall provide high quality, high value-added treatment services that respond to individual, family and community needs in a safe and healing environment.

 

Standard 7.13 - Environment of Care

We are committed to creating a safe, compassionate treatment environment where patients and their families will be able to understand their individual illnesses and start the recovery process.

 

Standard 7.14 - Informed Consent

We must strive to insure that our patients are always well informed about treatment alternatives and the various risk factors associated with each treatment or no treatment.

 

 

Questions and Answers...

 

 

Q Why have a formal document outlining business conduct?

 

A It's important to clarify our expectations for employee behavior. Much of what constitutes ethical behavior is second nature to individuals. Yet sometimes we find ourselves in situations where we're unsure of what to do or how to act. This Code of Conduct document will assist you in those situations. Most large organizations have such a document to guide their employees.

 

 

Q What is the supervisor's role in administering these standards?

 

A Supervisors are held accountable and responsible for ensuring that their employees understand the Code of Conduct. As a supervisor, you must listen to your employees' issues, find appropriate answers and deal with problems. You are also a role model and must set the ethical examples.

 

 

Q Who's responsible for understanding and complying with the laws and regulations that apply to my work area?

 

A All employees are responsible for complying with the laws and regulations, as well as our policies and procedures that relate to their work areas. Familiarize yourself with this document for expectations regarding your business conduct. If you have questions, ask your supervisor.

 

 

Q What should I do if my supervisor instructs me to do something that I think is wrong, against the law, or against the standards set forth in the Code of Conduct?

 

A Talk to your supervisor again to make sure that you clearly understand what is being asked of you. If, after clarifying the instruction, you believe it is improper, state your concerns to the supervisor and give him or her a chance to rethink what they have requested. If the situation isn't resolved to your satisfaction, please immediately contact the Director of Compliance or the Director of Internal Audit.

 

 

 

The Prevention of Fraud, Waste and Abuse policy was designed to provide employees, contractors and agents of MidState Medical Center, general information regarding MMC's efforts to combat fraud, waste and abuse in the healthcare system. The policy further describes remedies and fines for violations resulting from certain types of fraudulent activities.

 

All vendors, contractors and employees are expected to comply with MidState's policies and code of conduct. Any ethical or legal concerns related to any activity by MidState Medical Center, its employees, vendors or contractors should be reported via our Corporate Compliance Hotline at 1 800 431 5572.

 

Reports may be made anonymously and will remain confidential.

 

 

 

Scope

Patients, and/or the person(s) responsible for a patient's financial obligations, may at times be in a continuing relationship to pay for services received from MidState Medical Center. This policy is established to comply with Federal Trade Commission rules regarding identity theft, as applicable to MidState Medical Center operations.

 

Policy

MidState Medical Center will maintain reasonable policies and procedures to detect and mitigate identity theft related to personal information received or maintained by MidState Medical Center for the purposes of obtaining reimbursement for services.

 

This Program supplements, but does not replace or supersede, any policies, procedures or practices of MidState Medical Center to protect the confidentiality, privacy, security or accuracy of individually identifiable health information or employee's personal information. The privacy and security of employee records and protected health information, including financial records, will continue to be protected in accordance with existing applicable law and regulation as it may be amended from time to time.

 

Definitions

"Red Flags" are those patterns, practices or specific activities that signal possible identity theft. Red Flags include, but are not limited to, the following:

 

1. Suspicious documents, such as
   
   
• Identification cards or documents that appear to have been altered or forged, or contain information that is not consistent with existing records
• The photograph or physical description on identification cards or documents provided to MidState Medical Center is inconsistent with the appearance of (or information known about) the individual.
2. Suspicious personal identifying information, such as social security number in a range that does not correlate with date of birth, or invalid phone number or address that is not resolved with reasonable efforts to obtain accurate information.

 

The list of Red Flags may be updated or supplemented in the form of a departmental procedure from time to time, and as more information becomes available to the health care industry with respect to medical identity theft.

 

 

Procedure:

Detection/Reporting:

1. Staff that suspect that a Red Flag has been implicated in relation to an individual with which MidState Medical Center has a continuing relationship to obtain payment for services shall report such incident to his/her supervisor.
2. If the Red Flag cannot be reconciled after a preliminary review of available records, and review of additional information from medical records, comparison with other government-issued identification cards and/or documents, and after making reasonable attempts to obtain clarification from the patient, family and/or responsible party, the attached form should be completed promptly ("Identity Theft - Report of Suspicious Conduct/Documents") and provided to the Chief Financial Officer (CFO) or authorized designee.
3. Intentional Fraud: Any indication that an identification card, number and/or other eligibility information provided to MidState Medical Center by or on behalf of an individual, in order to obtain coverage under commercial insurance plans, workers' compensation, automobile accident coverage, government programs or other third party payers, is intentionally provided under fraudulent circumstances and/or does not belong to the individual presenting for admission or care and treatment will be reported to the CFO or authorized designee immediately. The attached form ("Identity Theft - Report of Suspicious Conduct/Documents") should be completed and provided to the CFO or authorized designee promptly.
4. Fiscal records related to the incident are retained in order to review the possible identity theft incident(s) until the matter is resolved. Fiscal records include, but are not limited to, the following:
   
   a. Demographic information collected from a patient or responsible person,
   
   b. Any transactions related to payment for services and/or deferred payment plans,
   
   c. Documents related to insurance coverage or eligibility for third party reimbursement
      (Medicare, Medicaid, etc)

Responses

5. As appropriate to the situation and findings upon review, any of the following responses may be made:

 

• Placing a flag or amendment in the patient's medical record and/or patient accounts file that indicates how the incident was resolved,
• Providing notice to insurers/government programs and/or law enforcement agencies of a substantiated incident, subject to patient confidentiality protections,
• Changing methods of security protections, such as passwords and security codes,
• Closing patient accounts that were affected by the incident, and
• Other appropriate responses to mitigate the situation.

 

6. Incidents that meet the definition of criminal identity theft, as defined in state law, will be reported to Legal Affairs/Corporate Compliance Officer, who will notify local law enforcement as necessary. The MidState Medical Center Corporate Health Information Security and Privacy Officer is consulted when such reports are made to ensure that MidState Medical Center policy and applicable law regarding privacy and security of patient's health information is followed.

 

7. Incidents that involve a breach by MidState Medical Center of its policies to protect the security and privacy of patient/resident protected health information which results in unauthorized access or disclosure of patient/resident protected health information are also reported in accordance with the Health Information Security and privacy Incident Reporting policy.

   Updating Program:

8. The MidState Medical Center Identity Theft Prevention Program, and/or related department procedures or guidance, will be updated as needed to reflect changing risks, alerts from law enforcement, industry practices, and changes in methods related to preventing and detecting medical identity theft.

 

 

Informing Employees, Contractors and Agents of Details of the Federal False Claims Act, Protections for Reporting Individuals, Penalties for Violations, and Relevant State Laws.

 

 

Statement of Purpose

The purpose of this policy is to inform employees, contractors and agents of MidState Medical Center of the federal False Claims Act (referenced in this policy as "FCA"), and to provide general information regarding MidState Medical Center's efforts to combat fraud, waste, and abuse in the healthcare system, and to describe the remedies and fines for violations that can result from certain types of fraudulent activities.

 

Reporting Fraud, Waste, or Abuse: All employees, contractors, agents, and volunteers of MidState Medical Center must immediately report to the hospital's compliance officer, any suspicion of fraud, waste, or abuse in connection with the business of MidState Medical Center. MidState Medical Center engages in specific compliance efforts to detect and prevent fraud, waste, and abuse, such as maintaining a corporate compliance hotline to report potential compliance issues; providing annual compliance education; screening all potential employees for sanctions and exclusions, criminal background, drug use and, TB exposure. Sanction and exclusion checks are done on all vendors. All new employees sign an attestation to abide by MidState Medical Center's Code of Conduct. The Code articulates consequences for violation of the Code.

 

If you would like to receive more information on MidState Medical Center's compliance program or policies, or on how to report your concerns, please contact Elizabeth DeSanto RN, JD, Director of Corporate Compliance, at 203 694 8643.

 

 

Detailed Information of the Federal False Claims Act

The federal False Claims Act (FCA) imposes civil penalties on people and companies who knowingly submit a false claim or statement to a federally funded program, or otherwise conspire to defraud the government, in order to receive payment. It also protects people who report suspected fraud.

 

The FCA is not confined to healthcare claims, but extends to any payment requested of the federal government. The FCA applies to billing and claims sent from MidState Medical Center to any government payor program, including Medicare and Medicaid.

 

It is the policy of MidState Medical Center that an employee, contractor, or agent of MidState Medical Center who submits a false claim will be reported to the necessary authorities. Anyone, or any company, that submits a false claim or statement to the government may be fined under the FCA between $5,500 and $11,000 for each such claim submitted, regardless of the size of the false claim, and the person or company could be required to pay an additional fine of three times the value of any charges.

 

Part of the FCA's purpose is to create an environment where employees and others feel safe reporting concerns about fraud. MidState Medical Center fully supports that goal. Any person who lawfully reports information about false claims or suspected false claims that are submitted by others, may not be retaliated against, demoted, suspended, threatened, or harassed by MidState Medical Center for making such a report. The FCA also protects individuals who assist in an investigation, provide testimony, or participate in the government's handling of a false claim.

 

The FCA's provisions are generally enforced by the U.S. Department of Justice. The FCA provides that a person may initiate a formal claim if he or she is the "original source" of the information. This means that the person bringing the claim must have direct and independent knowledge of the alleged fraud. If any funds are recovered, a portion of the funds may be paid to the person who initiated the formal claim, at the discretion of a federal court. This amount, if awarded, generally is between 15% and 30% of the total damage amount.

 

If a person wishes to file a claim regarding fraud or suspected fraud related to a healthcare payment directly with the government, he or she must first present a formal complaint, along with all material evidence relating to the alleged fraud, to the authorities at the U.S. Department of Justice. The authorities have 60 days to investigate, during which time the complaint is kept confidential. Upon completion of the investigation, the government will decide either to pursue the case on its own, or decline to proceed with the case. If the federal government declines the case, the individual may still proceed with the case on his or her own, but without the government's assistance, and at his or her own expense.

 

A private legal action under the FCA must be brought within six years from the date that the false claim was submitted to the government. (A government-initiated claim may be brought up to ten years after the false claim, depending on the circumstances.)

 

 

Detailed Information of the Federal Program Fraud Civil Remedies Act

Persons or companies that commit fraud on the federal government, by false claim or statement, can be assessed monetary penalties in addition to the penalties of the False Claims Act because of a law called the Program Fraud Civil Remedies Act (referenced in this policy as "PFCRA"). Specifically, PFCRA penalties of $5,000 per false claim or statement apply if a person or company submits a claim to the federal government that: the person or company knows or has reason to know is false, fictitious, or fraudulent; includes or is supported by written statements containing false, fictitious, or fraudulent information; includes or is supported by written statements that omit a material fact, which causes the statements to be false, fictitious, or fraudulent, and the person submitting the statement has a duty to include the omitted fact; or is for payment of property or services that are not provided as claimed. The $5,000 penalty also applies if a person or company provides written back-up or materials relating to the claim in which the person or company asserts a material fact that is false, fictitious or fraudulent; or omits a fact that the individual had a duty to include, the omission causes the statement to be false, fictitious, or fraudulent, and the statement contains a certification of accuracy.

 

 

Connecticut State Law

It is a crime in Connecticut to bill Medicaid or the general assistance program fraudulently. All employees, contractors and agents of MidState Medical Center must immediately report suspicion of any criminal activity occurring at MidState Medical Center, including criminal fraud, to the hospital's compliance officer. Anyone who provides services to a state Medicaid beneficiary and seeks or accepts payment for unnecessary or improper services is subject to possible imprisonment and/or criminal fines under state law. Depending upon the amount of the fraudulent services involved, such offenses carry potentially significant penalties, with a maximum of 20 years in prison and a maximum fine of $15,000. Anyone who provides services to a recipient of Connecticut's general assistance program and seeks or accepts payment for unnecessary or improper services is also subject to civil and criminal penalties. Depending upon the amount of the fraudulent services involved, such offenses carry a minimum one-year prison sentence and a maximum of 20 years, as well as a maximum fine of $15,000. Any person who defrauds Connecticut's general assistance program is also excluded from participating in the program for a minimum of one year. Connecticut law protects employees who report suspected violations of state or federal law, including reports of criminal fraud. An employer may not discharge, discipline or otherwise penalize an employee for reporting a violation of the law, or suspected violation, as long as the employee does not know the information being reported is false.

 

 

References: Section 6032 of the Deficit Reduction Act of 2005

31 U.S.C. §§ 3729-3733

31 U.S.C. §§ 3801-3812

Connecticut General Statutes § 31-51m

Connecticut General Statutes § 53a-290 et seq.

Connecticut General Statutes § 17b-127

MidState Medical Center Code of Conduct

MidState Medical Center Employee Hotline for Reporting Fraud: 1-800-431-5572

 

Criminal:

Conn. Gen. Stat. Sec. 53a-290 et seq. (Vendor Fraud)

Conn. Gen. Stat. Sec. 53-440 et. seq. (Health Insurance Fraud)

Conn. Gen. Stat. Sec. 53a-118 et seq. (Larceny)

Conn. Gen. Stat. Sec. 53a-155 (Tampering/Fabricating Evidence)

Conn. Gen. Stat. Sec. 53a-157 (False Statement to Public Servant)

 

Fraud:

Conn. Gen. Stat. Sec. 17b-25a (Vendor Fraud Hotline)

Conn. Gen. Stat. Sec. 17b-99 (Vendor Fraud)

Conn. Gen. Stat. Sec. 17b-102 (Financial Incentive for Reporting Fraud)

Regs. Conn. State Agencies Sec. 17-83k-1 et seq. (Administrative Sanctions)

Regs. Conn. State Agencies Sec. 17b-102-01 et seq. (Financial Incentive for Reporting Fraud and Payment Requirements)

 

Whistle Blower Protections:

Conn. Gen. Stat. Sec. 4-61dd (Whistleblowing)

Conn. Gen. Stat. Sec. 31-51m (Protection for Employee Reporting Fraud)

Conn. Gen. Stat. Sec. 31-51q (Non-Retaliation Liability of Employer)

Regs. Conn. State Agencies Sec. 4-61dd-1 et seq. (Rules of Practice for Contested Case

Proceedings under the Whistleblowers Protection Act)

 

 

 

Scope

To protect the confidentiality of personal information of employees, patients and other clients of MidState Medical Center in accordance with state and federal law.

 

Definition

Personal Information means information capable of being associated with a particular individual through one or more identifiers, including, but not limited to, a Social Security number, a driver's license number, a state identification card number, an account number, a credit or debit card number, and does not include publicly available information that is lawfully made available to the general public from federal, state or local government records or widely distributed media.

 

Policy

It is the policy of MidState Medical Center to protect the confidentiality of Personal Information obtained and used in the course of business from its employees, patients and other clients.

 

1. Use of Personal Information: Personal Information is only used to conduct MidState Medical Center's business in accordance with state and federal law.
2. Storage of and Access to Personal Information:

 

• Storage: All documents containing Personal Information shall be stored in locked or secured areas. All computer applications containing Social Security numbers shall be maintained on secured, authorized-access computer stations only.
• Access: Only persons who have a legitimate business reason will have access to Social Security numbers; such access will be granted through department heads responsible for functions with reporting or transporting of such data responsibilities. Department heads and employees granted such access must take all necessary precautions to ensure the integrity of records that include such numbers when the records are not being used.
3. Destruction of Personal Information: Records that include Personal Information, including Social Security numbers, will be maintained in accordance with federal and state laws. When such documents are released for destruction, the physical records will be destroyed by shredding, and electronic records shall be erased, or the equipment on which such electronic records are stored should be physically destroyed so such records are unreadable.
4. Any individual who is found, after appropriate investigation, to have violated the provisions of this policy will be subject to disciplinary action, up to and including immediate termination.