Compliance Program

 

Two part’s

of our

Organization’s Compliance

Program

123 Up And Adam, Inc’s

Resolution

On a

Compliance Committee

Board Resolution

123 Up And Adam, Inc is committed to providing high-quality, and cost effective services in compliance with the law. With the help of a dedicated staff, we can make this happen, and earn the trust and respect of client’s we intend to serve. 123 Up And Adam, Inc board of directors, will promote a culture of integrity and honesty we shall adhere to federal, state, and local laws. 

In so doing 123 Up And Adam’s Board of Directors believes that the organization will benefit from what’s called a “Corporate Compliance Program”. The Board’s (Action) on this, is to have the president Manuel Martinez, proceed with the development and implementation of a formal Compliance Program. The development and implementation of 123 Up And Adam’s Compliance Program will be part of the organization’s continuing effort to further the organization’s mission and to improve the quality of our services.

The Department of Health and Human Services, Office of Inspector General, the agency charged with enforcing the Medicaid and Medicare laws, has published a series of compliance program guidelines, these guidelines set forth the components of an effective compliance program and on how to develop and implement these components.

123 Up And Adam, Inc board of directors and management shall dedicate the necessary resources to develop and implement the organization’s Compliance Program Which will adhere to all applicable laws, including the statutes, regulations, and requirements applicable to Medicare and Medicaid, and any other appropriate federal and state healthcare programs.

123 Up And Adam’s Compliance Program shall meet or exceed the components of an effective Compliance Program as identified by the OIG in its compliance program guidelines.These components include:

  • Conducting internal monitoring and auditing
  • Implementing written standards and policies & procedures
  • Designating a compliance officer and committee
  • Conduct appropriate training and education
  • Responding appropriately to detected offenses and developing corrective action
  • Developing open lines of communication and
  • Enforcing disciplinary standards through well publicized guidelines

As the president of 123 Up And Adam, Inc and the only officer at the time of this writing I have gone ahead with the development and implementation of 123 Up And Adam, Inc’s comprehensive compliance program by focusing on which compliance functions have priority, and on practise areas identified as potential “Risk Areas”

Consistent with the OIG’s compliance program guidelines, management will proceed with the development and implementation of the Compliance Program and shall provide periodic progress reports to the Board.

This document among others have been written which will be given to the new board, advising them of 123 Up And Adam’s Compliance Program. This document will be on file which, upon request, can be viewed by consultants, vendors and volunteers advising them of the Compliance Program.

Establishing our Compliance Committee

123 Up And Adam, Inc in conjunction with the organization’s compliance officer will demonstrate its commitment to develop and implementing the organization’s Compliance Program. 

WHEREFORE, THE BOARD RESOLVES THAT:

  1. The Board recognizes the need to designate a Compliance Committee to advise the Compliance Officer and assist in the development and implementation of the Compliance Program. 123 Up And Adam, Inc will therefore proceed with the selection of qualified personnel to staff a Compliance Committee and will support the functions of the Compliance Committee. The Compliance Committee will assist the Compliance Officer in coordinating and overseeing the development and implementation of the Compliance Program as set forth in this resolution and in a manner consistent with the recommendations of the Department of Health and Human Services’ Office of Inspector General, as published in its Compliance Program Guidance.
  2. The Compliance Committee will undertake the compliance activities identified by 123 Up And Adam, Inc in applicable written policies and procedures, including the following:

(a) Identifying Areas of Risk. The Committee will assess the effectiveness of the Compliance Program to determine areas of risk and identify measures that will address those areas of risk. The Committee will also analyze issues affecting the disabled homeless and legal requirements with which we must comply.

(b) Monitoring Audits and Investigations. The Committee will monitor the results of internal and external audits and investigations for the purpose of identifying potential risk areas and will recommend and implement appropriate corrective and preventive action.

(c) Policies and Procedures. The Compliance Committee will work with appropriate personnel to develop standards of conduct and policies and procedures that address areas of risk and that promote compliance with the Compliance Program, all applicable laws (including, as applicable, the laws authorizing and implementing Medicaid, Medicare and other federal and state healthcare programs, and the requirements under Section 330 of the Public Health Service Act) and requirements imposed by private payer health plans.

(d) Implementation. The Compliance Committee will assist the Compliance Officer in developing and monitoring internal systems and controls to ensure compliance with the organization’s standards of conduct and with written policies and procedures.

(e) Developing Strategy. The Committee will also analyze and, as needed, develop new methods for promoting compliance and identifying potential violations and for soliciting, evaluating and responding to complaints and reports of alleged non-compliance.

(f) Resources. The Committee will periodically review the resources assigned to the organization’s compliance efforts to assess our adequacy for maintaining the Compliance Program’s ongoing effectiveness.

Policy

123 Up And Adam, Inc provides an environment in which our staff adhere to a high standard of ethical and legal conduct. The organization requires that staff carry out their duties in an ethical and legal manner. To assure that these standards are adhered to 123 Up And Adam, Inc has established a Compliance Plan. This Plan focuses on compliance with laws pertaining to billing practices. The Plan will seek first to prevent misconduct, but is also designed for early detection of violations that will be addressed in a forthright and remedial fashion.

  1. Goals: 123 Up And Adam’s goals regarding compliance are:

(a) To establish standards of conduct and written policies and procedures for the

staff. 

(b) To provide oversight of the Plan by the Compliance Oversight Committee

consisting of the president or his or her designee, the finance committee, Human Resources.

(c) To provide a Compliance Officer to implement and carry out the Plan.

(d) To assure education, training, and communication about the standards and the

Plan requirements.

(e) To maintain a system for monitoring, auditing, and reporting Plan performance

and compliance.

(f) To maintain and enforce an appropriate disciplinary mechanism for the

consistent enforcement of Plan requirements.

(g) To sustain an appropriate mechanism for implementing corrective action.

  1. Principles: The Plan is founded on principles that assure that the Plan goals will be realized:

(a) Proactivity: High-risk areas will be identified and procedures will be implemented

for compliance. Risk identification will be an ongoing process.

(b) Commitment: The organization is committed to accomplishing the goals and objectives of the Plan.

(c) Education and Communication: 123 Up And Adam, Inc advocates ongoing identification of high-risk activity that creates legal risk and the adoption of procedures designed to minimize such risk.

(d) Self Assessment: Periodic self-assessments will be done by an internal review committee to assure the Plan is a valid and effective program.

  1. Procedure:

(a) 123 Up And Adam, Inc will carry out the Plan in accordance with the goals and principles identified herein.

(b) 123 Up And Adam, Inc will take steps to ensure that pertinent agreements are amended and updated as appropriate to include compliance with the Plan as terms of performance.

(c) 123 Up And Adam, Inc will require the Compliance Officer to periodically report the results of the self-assessment of the Plan, and, depending on the results, will require amendment of the Plan accordingly.

(d) 123 Up And Adam, Inc will monitor the Compliance Officer’s performance to assure that his/her duties remain in conformity with the goals and principles established for the Plan. Based on this review, the Clinic will take appropriate steps to assure that the overall objectives of the Plan are being carried out.

Annual Review of the plan

POLICY:

The Compliance Officer and the Compliance Committee will periodically review the overall effectiveness of the Compliance Plan. In forming recommendations and conclusions about the Plan, the Compliance Officer and the Committee shall consider, the ongoing review and consultant results, trend analysis, improvements in billing practices, increase or decrease questionable practices just to name a few. The Board of Directors has concurrent authority to review the efficacy of the Plan, the individual policies and procedures, and the performance of the Compliance Officer and the Committee, and recommend changes and modifications.

PROCEDURES:

1.1 At least yearly, the Compliance Officer and Committee at one of the regularly scheduled Committee meetings shall review the Plan in its entirety.

1.2 The Plan’s overall success will be evaluated in accordance with the following principles:

(a) Review results;

(b) Trends identified through internal and external reviews;

(c) Effectiveness of training and education in modifying practices;

(d) Enthusiasm of the staff;

(e) Whether policies are current and comport with applicable regulations;

(f) Correlation between Plan and increase or decrease in questionable practices

(g) Correlation between corrective action and reoccurrence.

1.3 Changes designed to improve the Plan arising from yearly maintenance assessment, will be promptly implemented.

Compliance Policy

It is the policy of 123 Up And Adam, Inc to consistently and fully comply with all laws and regulations pertaining to the delivery of and billing for services which apply to the organization on account of its participation in Medicare, Medicaid and other government programs.

  1. INTRODUCTION

123 Up And Adam, Inc Compliance Program is a comprehensive statement of the responsibilities and obligations of all its agents, employees, staff, volunteers and contractors regarding submissions for reimbursement to Medicare, Medicaid, and other government payors and for any care services rendered by the organization and any of its staff professionals. In addition, this Policy is intended to apply to business arrangements between 123 Up And Adam, Inc and physicians, vendors, hospitals and other persons which may be impacted by federal or state laws relating to fraud and abuse, reimbursement and clinical care delivery.

  1. COMPLIANCE STANDARDS/MANUALS

The organization’s manuals and Compliance standards specific to affected areas shall be developed and kept current with applicable laws and regulations.

The compliance standards for each affected area shall contain a statement of compliance for that area and shall define and assign responsibility for the timely and comprehensive updating of both the compliance standards and the compliance manual, necessary training and education, record keeping, and the completion of audit work plans as designated by the Compliance Officer.

The Compliance Plan shall be a resource for our Staff in order that they may perform their responsibilities in compliance with the organization’s Compliance Policy and applicable laws and regulations. The designated manager in each affected area is responsible for ensuring that the compliance standards and manuals as required by this program or as designated by the Compliance Officer are developed and maintained in accordance with this Policy.

  1. Staff, Employee Reporting 

All of 123 Up An Adam’s Staff are required to report their good faith belief of any violation of the Compliance Plan or applicable law. 123 Up And Adam, Inc, will provide such anonymity as possible to Staff who report instances consistent with our obligations to investigate concerns and take necessary corrective action.

There shall be no retaliation in the terms and conditions of employment as a result of such reporting. Staff will report their good faith belief or violations of the Compliance Plan or applicable laws (i) either orally or in writing to their manager, (ii) by calling the Massachusetts Secretary of state at:  http://www.sec.state.ma.us/seccon.htm or http://www.mass.gov/ago/bureaus/hcfc/the-non-profit-organizations-public-charities-division/ 

Employees, Volunteers, Independent Contractors and Officers, working for 123 Up And Adam, Inc  will be collectively referred to as “Staff”.

  1. Report to Board 

The board of directors shall designate a Compliance Officer as the individual within the organization responsible for overall implementation and operation of the Compliance Plan. The responsible individual shall be responsible to ensure that:

(a) Standards and manuals are reviewed and updated as necessary.

(b) Staff and vendor screening mechanisms are in place and are operating Properly.

(c) Staff are receiving adequate education and training and that such education and training is documented.

(d) Audit procedures are implemented in accordance with the our audit policies;

(e) Staff complaints and other concerns regarding compliance are promptly

investigated.

(f) Adequate steps are taken to correct any identified problems and prevent the

reoccurrence of such problems.

The Compliance Officer shall report in writing annually to the Board of Directors on the status of compliance within the organization. This report shall include the results of any recommendations resulting from the audit work plans conducted during the prior year, and any other information requested by the Compliance Committee or the Board.

Compliance Plan Oversight

POLICY:

The Compliance Committee and Compliance Officer will provide the Compliance Plan  oversight. The Compliance Committee and the Compliance Officer are given the authority to discharge their oversight responsibility as hereafter described:

PROCEDURES:

  1. Compliance Committee

(a) Purpose: The purpose of the Compliance Committee is to oversee the implementation and operation of the Compliance Plan. The Compliance Committee will review reports and recommendations of the Compliance Officer regarding Compliance Plan activities, including data regarding compliance generated through audit, monitoring and individual reporting. Based on theses reports, the Compliance Committee will make recommendations to the Board of Directors regarding efficacy of the Compliance Plan. The Compliance Committee will also report to Department Directors regarding the organization’s Staff members’ compliance with the Compliance Plan.

(b) Composition and Chair: The Compliance Committee shall be comprised of key staff; President, Treasurer, Director of Human Resources, and other’s. The president who has the charge of being the Compliance Officer shall be ex officio member of the Compliance Committee. Ex officio members are nonvoting members. The Compliance Officer shall be the chair of the Compliance Committee; the chair shall not vote on any matter, unless his/her vote is needed to break a tie.

(i) Meetings: The Compliance Committee shall meet at least quarterly at predetermined times and dates, and at any time a meeting is needed.

(ii) Record: A summary of the items addressed and actions taken at each

meeting shall be made and retained by the Compliance Officer.

(c) Duties: The duties of the Compliance Committee shall include, but are not limited to:

(i) Overseeing the implementation and operation of the Compliance Plan;

(ii) Receiving and acting upon reports and recommendations from the

Compliance Officer;

(iii) Serving as appellate body for staff members contesting of compliance

reports;

(iv) Evaluating the performance of the Compliance Officer and making

recommendations accordingly;

(v) Reporting actions and making recommendations to the appropriate

Department Head, regarding Staff members performances; and

(vi) Performing other functions that may be reasonably necessary to fulfill the

Compliance Committee’s responsibilities and purpose.

(d) Member Responsibility:

(i) Compliance Committee members are expected to regularly attend the

scheduled and called meetings.

(ii) Any sensitive information regarding individuals, the organization, or information identified as confidential or proprietary learned by the committee member while serving on the Compliance Committee, shall be considered confidential and the Compliance Committee members shall not disclose such information unless otherwise directed by the Board of Directors or CEO.

  1. Compliance Officer

(a) Purpose: The Compliance Officer is responsible for implementation, administration, and oversight of the Compliance Plan. The Compliance Officer is the lead for the Compliance Plan and reports to the Board of Directors. The Compliance Officer is given the authority to carry out his/her duties according to the Compliance Plan Policy.

(b) Duties:

(i) Monitor and oversee the Compliance Plan;

(ii) Becomes 123 Up And Adam, Inc’s authority on the standards of conduct and legal risks associated with billing for professional services.

(iii) Develop policies and procedures for implementation and operation of the

Compliance Plan;

 

(iv) Supervise monitoring, auditing and reporting of activity within the scope of

Compliance Plan;

(v) Investigating possible noncompliance;

(vi) Assist in the development of corrective action plans;

(vii) Serve as ex-officio member of the Compliance Committee;

(viii) Routinely report results of monitoring, auditing, and reporting activity to the

Compliance Committee;

(ix) Provide leadership for the Clinic’s corporate compliance efforts;

(x) Retain the services of attorney’s, accountants, consultants and other

professionals as needed;

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(xi) Ensure, along with the Medical Director, that the HHS-OIG’s list of excluded

individuals and entities and General Services Administration’s list of parties debarred from federal programs have been checked with respect to physicians, billing staff and vendors;

(xii) Maintain a retribution-free system for reporting non-compliance or concerns

about Plan matters; and

(xiii) Encourage awareness among the staff about compliance matters and the

importance of adherence to the Standards of Practice by developing, coordinating and participating in a training program that focus on compliance-related issues;

(c) Specific Authority: The Compliance Officer or his/her designee shall have specific authority to review the billing and billing practices of any Clinic Staff member. The Clinic Staff shall cooperate with the Compliance Officer to allow the Compliance Officer to carry out the Compliance Plan. The Compliance Officer may prohibit billing of services if the Compliance Officer believes that the billing would not comply with applicable law, HIPAA regulations and may require billing to be performed in a specific manner.

  1. Department Head

(a) Role: The Department Heads play an important role in Compliance Plan. The Department Head shall:

(i) Work with the Compliance Officer and the Compliance Committee to assure

compliance with the Compliance Plan in their departments, and otherwise oversee departmental compliance and encourage a culture of compliance throughout their departments;

(ii) Implement corrective disciplinary action as necessary to assure

compliance, as recommended by the Compliance Officer or Compliance Committee;

(iii) Review the departmental policies and procedures, at least annually, to

assure that they comply with the Compliance Plan;

(iv) Apprise staff members of the results of monitoring, auditing, and reporting

activities of the Compliance Plan.

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