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.
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
- 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.
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.
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.
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.
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.
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
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.
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
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)
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)