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Episcopal SeniorLife Communities is committed to providing high quality and caring programs and services pursuant to the highest ethical, business, and legal standards, including Federal health care program requirements (e.g., Medicare and Medicaid).
These high standards apply to all ESLC staff, volunteers, partner organizations and business partners associated with ESLC. This includes our resident’s, the community, other healthcare providers, companies with whom we do business (i.e., “contractors”), government entities to whom we report, and the public and private entities from whom reimbursement for services is sought and received.
We expect and require all contractors to be law-abiding, honest, trustworthy, and fair in all business dealings. In short, we do not and will not tolerate any form of unlawful or unethical behavior by anyone associated with ESLC.
Our Compliance Program is designed to help ESLC prevent fraud, waste, and abuse in Federal health care programs. If fraud or abuse is detected, the Program provides a system for investigation, reporting and implementing corrective action. This document includes a Code of Conduct which is designed to assist our contractors in navigating the various compliance obligations of the highly regulated industry in which we provide care.
To the extent that contractors meet the definition of an “affected individual,”1 they are subject to this Compliance and Ethics Program. Failure of an affected individual to meet the Program’s requirements may result in termination of contract or affiliation with the ESLC.
Contractors should adhere to all policies, including ESLC’s Standards of Conduct, to avoid any actions that could reasonably be expected to adversely affect the integrity or reputation of ESLC.
1. “Affected individuals” means all persons who are affected by ESLC’s compliance risk areas. This includes our employees, the Chief Executive Officer, senior administrators, managers, contractors, agents, subcontractors, independent contractors and the Board of Directors. Contractors are subject to the Compliance Program to the extent that it is related to their contracted role and responsibilities within ESLC’s risk areas. All contractors should adhere to all policies, including ESLC’s Standards of Conduct, to avoid any actions that could reasonably be expected to adversely affect the integrity or reputation of ESLC.
Contractors are expected to comply and be familiar with all federal and state law, rules and regulations that govern their work with ESLC. All contractors are also expected to comply with ESLC’s Standards of Conduct, and any applicable compliance standards and policies. Compliance with the Code is a condition of association with ESLC, and violating the Code will result in discipline being imposed, including termination of contract or affiliation.
Lawful Conduct. Contractors should avoid all illegal conduct and not take any action that they believe violates any statute, rule, or regulation.
Reporting Requirements. If contractors become aware of or suspect misconduct or possible violations of ESLC Corporate Compliance Program, it is a requirement they are reported to an ESLC manager or supervisor, a member of senior management or the Corporate Compliance Officer.
ESLC’s Corporate Compliance Officer is Courtney McGinness, Vice President of Marketing and Community Engagement and can be reached at 585.546.8439 x3121. In addition, individuals may submit, in writing, reports or suspected misconduct using any of the suggestion communication boxes located throughout the facility or report suspected misconduct by phone voice message through the Compliance Hotline at 585.546.8439 x3548 (VP of Human Resources).
Questions or concerns may be raised anonymously, via the Compliance Hotline, or suggestion boxes. The identity of callers to the Hotline will be kept confidential, whether requested or not, unless the matter is subject to a disciplinary proceeding, referred to or under investigation by the NY State Medicaid Fraud Control Unit (MFCU), the Office of Medicaid Inspector General (OMIG) or law enforcement or if disclosure is a requirement in connection with a legal proceeding.
ESLC has Standards of Conduct which are listed in the ESLC Employee Handbook. The organization’s Corporate Compliance Program addresses the following:
ESLC maintains a policy of non- retaliation and non-intimidation for good faith participation in the Compliance Program. Good faith participation includes, but is not limited to reporting actual or potential compliance issues via aforementioned communication lines; cooperating or participating in the investigation of compliance issues; assisting with or participation in self-evaluations and audits; assisting with or participation in remedial actions/resolution of compliance issues; reporting instances of retaliation/intimidation; and reporting potential fraud, waste or abuse to appropriate State or Federal entities. Acts of retaliation or intimidation should be immediately reported to the Corporate Compliance Officer or to the Hotline and, if substantiated, the individuals responsible will be disciplined appropriately.
All of ESLC records, documents and reports must be accurate, complete and in compliance with all legal requirements. Claims for services provided must be based on the service actually provided and supported by adequate documentation to justify the claim.
ESLC conducts appropriate background checks on contractors and requires those who assign staff that may be providing services to check applicable federal and state databases prior to assignment and monthly thereafter to ensure contractors employees are not excluded from participating in federal health care programs (e.g., Medicaid). Contractors are required to maintain documentation demonstrating compliance with this condition and immediately disclose to the Corporate Compliance Officer if the contractor or any of its staff becomes excluded or otherwise ineligible. The applicable databases are:
In accordance with the DRA, ESLC has established written policies for all employees and contractors that provide detailed information about the federal False Claims Act, federal administrative remedies for false claims and statements, the New York State false claims provisions, state penalties (both civil and criminal) for false claims and statements, whistleblower protections under such laws, and the role of these laws in preventing and detecting fraud, waste and abuse in federal health care programs (e.g., Medicare and Medicaid).
Contractors who learn confidential information about the residents may not share that information with anyone, including family or friends.
ESLC has developed and distributed written standards of conduct, as well as written policies and procedures that promote our commitment to compliance, address specific areas of potential fraud and abuse, and give guidance to affected individuals about how the compliance program operates and how compliance issues are investigated and resolved. The written policies and procedures are available to all affected individuals in Policy Tech, on ESLC’s website and in ESLC’s employee handbook. A list of current Program policies and procedures is included at the end of this summary. All written standards, policies and procedures are reviewed annually.
ESLC has a designated Corporate Compliance Officer and a Compliance Committee charged with the responsibility for developing, operating, and monitoring the Compliance Program. The Corporate Compliance Officer and the Committee are accountable to and report directly to ESLC’s Board of Directors and Chief Executive Officer.
ESLC has developed and conducts effective education and training programs that cover, among other things, compliance risk areas, expectations, disciplinary standards and the operation of the Compliance Program.
ESLC has established and implemented effective lines of communication, ensuring confidentiality, that are accessible to all affected individuals. This includes an anonymous method for reporting (i.e., the Hotline and comment boxes) and allows for questions regarding compliance issues to be asked and for compliance issues to be reported.
ESLC’s Code of Conduct standards shall be consistently enforced through appropriate disciplinary mechanisms, including discipline of individuals or contractors. Disciplinary standards will be engaged for the following violations:
Violations to ESLC’s Compliance Program threaten our status as an honest and trustworthy provider capable of participating in public health care programs. Furthermore, detected but uncorrected misconduct can seriously endanger the reputation, mission and legal status of ESLC’s programs and services. Consequently, upon reports or reasonable detection of noncompliance, the Corporate Compliance Officer will take steps to determine the scope of the violation and take steps to correct the problem. The disciplinary process explained in the Employee Handbook will be utilized when necessary. This may include a referral to criminal and/or civil enforcement authorities, a corrective action plan, a report to the government, and the submission of over payment as appropriate.
Disciplinary procedures for abuse of ESLC’s Corporate Compliance Program and Standards of Conduct will follow the guidelines under existing Human Resources policies of the organization and may result in immediate contract or relationship termination.
Grievance procedures or opportunities to respond to allegations or evidence of misconduct will follow the guidelines under existing Human Resources policies of ESLC.
Disciplinary measures that are appropriate shall be determined on a case-by-case basis and may involve the advice of legal counsel.
Disciplinary measures and procedures may involve consideration and direction from outside third parties (i.e. governmental agency, law enforcement agency), including fines, reimbursement of funds, criminal prosecution and imprisonment.
The Corporate Compliance Officer will track all reported violations and look for systemic problems. If it is determined that there is credible evidence of misconduct that violates criminal, civil, or administrative law then ESLC will notify the appropriate governmental authority within a reasonable period. This period shall not exceed sixty (60) days from the date of the discovery of credible evidence. The purpose of reporting shall be to demonstrate a good faith effort and a willingness to work with governmental authorities to correct the problem.
ESLC routinely uses audits and/or other risk evaluation techniques to monitor compliance and identify compliance risk areas, such as coding, billing and documentation and payment practices; issues relating to quality of care and medical necessity of services; the credentialing process; compliance with mandatory reporting requirements; governance standards; contractor oversight and other potential compliance risk areas that may arise from complaints, risk assessments, or that are identified by specific compliance protocols or through other means.
ESLC has established and implemented procedures and a system for promptly responding to compliance issues as they are raised, investigating potential compliance problems as identified in the course of self-evaluations and audits, correcting such problems promptly and thoroughly, including reporting of any violations of state or federal law. These steps reduce the potential for recurrence, and ensure ongoing compliance with Federal health care program requirements (e.g., the Medicaid Program).
Intimidation and Retaliation are Prohibited. We expect all affected individuals to comply with this Program, including the reporting of any potential misconduct, illegal conduct or other compliance-related concerns. Retaliation or intimidation in any form against an individual who in good faith reports potential compliance issues or for other good faith participation in the Program is strictly prohibited and is itself a serious violation of the Code of Conduct. Acts of retaliation should be immediately reported to the Corporate Compliance Officer and, if substantiated, will be disciplined appropriately.