Standards of Conduct
VISION AND MISSION STATEMENT
Everyone, regardless of race, religion, color, gender, age, sexual orientation, or disability deserves the same opportunities for dignity and self- respect. We have a moral mandate to do our utmost to serve that in need, achieve self -reliance and help them to take their places as productive members of society. The individuals we serve deserve genuine caring and excellent service. We want not only to develop programs that serve the under-served and hard to serve communities, but to increase public awareness of their needs.
EIHAB has clearly stated mission and purpose approved by the EIHAB’ Board of Directors. EIHAB is committed to comply with all applicable laws and regulations and to detect and prevent unethical, improper, or unlawful behaviors or acts in the delivery and billing of services and prevention and detection of fraud, waste and abuse.
EIHAB Human Services (sometimes referred to as “Agency”) Standards of Conduct is applicable to all Affected Individuals. “Affected Individuals “ defined as all persons who are affected by the provider’s risk areas, including employees, the Chief Executive and other senior administrators, managers, contractors, subcontractors, independent contractors, and governing body and corporate officers.
EIHAB Human Services is an equal employment action employer and is committed to providing a workplace that is free of discrimination of all types from abusive, offensive or harassing behavior. Any employee who feels harassed or discriminated against should report the incident to his or her manager or to the Director of Human Resources.
EIHAB Human Services has an active governing body that is responsible for setting the mission and strategic direction of the organization and oversight of the finances, operation and policies of EIHAB. This document is a formal statement of EIHAB’s commitment to the standards and rules of ethical conduct.
All Affected individuals must abide by EIHAB’ Standards of Conduct which includes abiding by the requirements of Medicaid, and other Federal and State laws. This involves reporting any alleged violations of wrongdoing and assist Management and the Compliance Officer in investigating allegations of wrongdoing.
All Affected individuals should feel comfortable to speak, particularly with respect to ethics concerns that are not addressed by this document or existing policies and procedures, affected.
ETHICS AND BUSINESS CONDUCT
EIHAB commitment is to comply with all laws and regulations applicable and to conduct business with the highest degree of integrity. This applies to all affected individuals we employ or have business relations with.
Because of the nature of our organization, we bound to uphold applicable program, licensing requirements, employee credentials, screening requirements and laws governing consumer protection. EIHAB conducts exclusion screening and background checks to verify that all employees and independent contractors have not been excluded from federal healthcare programs. EIHAB conducts exclusion check searches of the OIG, Office of Inspector General - List of Excluded Individuals/Entities OIG Most Wanted, Office of Inspector General – List of Restricted and Excluded Providers / OMIG, Office of the Medicaid Inspector General- Most Wanted Fugitives SAM, System for Award Management: Excluded Parties SDN, Office Of Foreign Assets Control.
Procedures for Affected Individuals with Honesty:
EIHAB is committed to comply with all applicable laws and regulations. EIHAB established its Corporate Compliance Program, Standards of Conduct, policies and procedures, training and education and auditing and monitoring as an expression of our commitment to uphold ethical and legal behavior.
EIHAB staff should contribute with EIHAB Vision and Mission which includes to be honest and transparent, whether financial or organizational. This involves maintaining and following truthful and accurate practices with service recipients, other providers, supplier, and all others with whom EIHAB does business.
CONFLICT OF INTEREST
This section is designed to help EIHAB identify situations that present potential conflicts of interest. All Affected individuals are responsible to avoid activities, agreements, business or interest, or other situations that that conflict or appear to conflict or interfere with the duty to provide services to the best of his or her ability.
This applies to all Affected individuals when an employee or a family member is in a position to benefit personally, directly, or indirectly, from his or her relationship with the person or entity conducting business with EIHAB.
For the purpose of this section, an immediate family member includes an individual’s spouse, spousal equivalent, children, whether natural or adopted, grandchildren, great-grandchildren, siblings, whether by whole or half-blood, and the spouses of children, grandchildren, and great-grandchildren.
Affected individuals have an obligation to report any potential conflict of which he or she becomes aware involving a family member. To say that one has a conflict of interest doesn’t necessary mean that the individual involved acted or is expected to act inappropriately. However, the appearance of a conflict of interest may be as serious as an actual conflict of interest. When it comes to conflicts of interest, appearance is an important reality. This why disclosing conflicts of interest is important.
Avoiding Conflicts of Interest
There are various types of conflicts of interest can occur because of the nature of relationships versus rules of EIHAB or Federal and State laws:
We must avoid any relationship or activity that might impair, or even appear to impair, our ability to make objective and fair decisions when performing our jobs.
At times, we may be faced with situations where the business actions we take on behalf of EIHAB may conflict with our own personal or family interests because of the course of action that is best for us personally may not also be the best course of action for EIHAB.
We owe a duty to EIHAB to advance its legitimate interests when the opportunity to do so arises.
We must never use EIHAB property or information for personal gain or personally take for ourselves any opportunity that is discovered through our position with EIHAB.
Here are some other ways in which conflicts of interest could arise:
1. Being employed (you or a close family member) by, or acting as a consultant to, a competitor or potential competitor, supplier, or contractor, regardless of the nature of the employment, while you are employed with EIHAB.
2. Hiring or supervising family members or closely related persons.
3. Serving as a board member for an outside commercial company or organization.
4. Owning or having a substantial interest in a competitor, supplier, or contractor.
5. Having a personal interest, financial interest, or potential gain in any EIHAB transaction.
6. Placing company business with a firm owned or controlled by an EIHAB employee or his or her family.
7. Accepting gifts, discounts, favors, or services from a customer/potential customer, competitor, or supplier, unless equally available to all EIHAB employees.
Determining whether a conflict of interest exists is not always easy to do. Employees with a conflict-of-interest question should seek advice from senior management. Before engaging in any activity, transaction or relationship that might give rise to a conflict of interest, employees must seek review from their managers or the Compliance Officer. All conflict will be disclosed and made available for review by Board members.
GIFTS, GRATUITIES, AND BUSINESS COURTESIES
The Standards of Conduct and the following guidelines are intended to help you make appropriate, responsible, and correct decisions in these and all matters.
EIHAB is committed to competing solely on our quality of services provided. We should avoid any actions that create a perception that favorable treatment of outside entities by EIHAB was sought, received or given in exchange for personal business courtesies. Business courtesies include gifts, gratuities, meals, refreshments, entertainment or other benefits from persons or companies with whom EIHAB does or may do business.
We will neither give nor accept business courtesies that constitute, or could reasonably be perceived as constituting, unfair business inducements that would violate law, regulation or polices of EIHAB or consumers, or would cause embarrassment or reflect negatively on EIHAB reputation.
Accepting Business Courtesies
Most business courtesies offered to us in the course of our employment are offered because of our positions at EIHAB. We should not feel any entitlement to accept and keep a business courtesy. Although we may not use our position at EIHAB to obtain business courtesies, and we must never ask for them, we may accept unsolicited business courtesies that promote successful working relationships and good will with the firms that EIHAB maintains or may establish a business relationship with.
Employees who award contracts or who can influence the allocation of business, who create specifications that result in the placement of business or who participate in negotiation of contracts must be particularly careful to avoid actions that create the appearance of favoritism or that may adversely affect the company’s reputation for impartiality and fair dealing. The prudent course is to refuse a courtesy from a supplier when EIHAB is involved in choosing or reconfirming a supplier or under circumstances that would create an impression that offering courtesies is the way to obtain EIHAB business.
Use of EIHAB Resources
Agency resources, including time, material, equipment and information, are provided for business use only. Nonetheless, occasional personal use is permissible as long as it does not affect job performance or cause a disruption to the workplace.
Employees and those who represent EIHAB are trusted to behave responsibly and use good judgment to conserve company resources. Managers are responsible for the resources assigned to their departments and are empowered to resolve issues concerning their proper use.
Generally, we will not use Agency equipment such as computers, copiers and fax machines in the conduct of an outside business or in support of any religious, political or other outside daily activity, except for Agency-requested support to nonprofit organizations. We will not solicit contributions nor distribute non-work related materials during work hours.
In order to protect the interests of EIHAB consumers and our fellow employees, EIHAB reserves the right to monitor or review all data and information contained on an employee’s company-issued computer or electronic device, the use of the Internet. We will not tolerate the use of Agency resources to create, access, store, print, solicit or send any materials that are harassing, threatening, abusive, sexually explicit or otherwise offensive or inappropriate.
Questions about the proper use of company resources should be directed to your manager or the Compliance Officer.
The Organization has developed policies and procedures to assure that the confidentiality of EIHAB Human Services information and information about service recipients is protected and released only with the appropriate authorization or for lawful reasons. All Affected Individuals are required to comply with EIHAB Human Services’ HIPAA Policy. If you have any questions concerning confidential information or the HIPAA Policy, contact your immediate supervisor or the Compliance Officer.
RETENTION AND DESTRUCTION OF RECORDS
EIHAB provides the systematic review, retention and destruction of records received or created by EIHAB’ staff for services delivered. This section discuss and covers all records, regardless of physical form, contain guidelines for how long certain records should be kept and how records should be destroyed.
EIHAB wants to ensure that EIHAB complies with Federal and State laws and regulations, to eliminate accidental or innocent destruction of records and to facilitate EIHAB’ operations by promoting efficiency and freeing up valuable storage space.
The Retention and Destruction of Records applies to all records in any form that contains information about individuals’ services, plans or eligibility for services. Anything that can be represented with words or numbers is a record for purpose of this policy. Documents after the audit review period will be archived. Employees and independent contractors must record all information related to EIHAB Human Services and its operations, its service recipients and financial information fully accurately and honestly.
All corporate records must be true, accurate and complete, and company data must be promptly and accurately entered in our books in accordance with EIHAB and other applicable accounting principles. We must not improperly influence, manipulate or mislead any unauthorized audit, nor interfere with any auditor engaged to perform an internal independent audit of EIHAB books, records, processes or internal controls.
Records will be kept in a secure location and the confidentiality of consumers, employees and business operations and activities will be protected. Records that are no longer needed, are no longer required to be kept or are duplicative of other records maintained will be destroyed on a routine basis using the standard procedures outlined below.
Records relating to a specific incident or report should be retained at least during the period the review or the investigation is ongoing. Otherwise, all records (with the exception of a summary of activities, findings and corrective actions) related to a specific incident that has been resolved should be destroyed on a periodic basis unless otherwise required by applicable state or federal law or the organization is advised to retain the records by corporate counsel.
Records relating to the Compliance Plan including memoranda, meeting minutes and reports will be retained indefinitely in order to maintain a record of Compliance Program activities. These documents can be used by the organization to prove the existence of an active and effective Compliance Program.
Records relating to individual’s program, medical, HIPPA and billing will follow this records retention procedures.
Accurate Public Disclosures
We will make certain that all disclosures made in financial reports and public documents are full, fair, accurate, timely and understandable. This obligation applies to all employees, including all financial executives, with any responsibility for the preparation for such reports, including drafting, reviewing and signing or certifying the information contained therein. No business goal of any kind is ever an excuse for misrepresenting facts or falsifying records.
Employees should inform management or the Compliance Officer if they learn that information in any filing or public communication was untrue or misleading at the time it was made or if subsequent information would affect a similar future filing or public communication.
Each of us is responsible for knowing and adhering to the values and standards set forth in this Code and for raising questions if we are uncertain about company policy. If you are concerned whether the standards are being met or are aware of violations of the Code, we must contact you immediate supervisor or the Compliance Officer. EIHAB takes seriously the standards set forth in the Code, and violations are cause for disciplinary action up to and including termination of employment.
FALSIFICATION OF RECORDS
You must not make any false entries in any of the Organization’s records or in any public record for any reason.
You may not alter any permanent entries in the Organization’s records. Any records to be appropriately altered must reflect the date of the alteration, the name, signature, and title of the person altering the document, and the reason for the alteration, if not apparent.
You may not sign the name of another person to any document.
Signature stamps may not be used.
You may not create or participate in the creation of any records that are intended to mislead or to conceal anything that is improper.
Backdating and predating documents is unacceptable.
PROTECTION OF CONFIDENTIAL INFORMATION
During your employment, contract, or association with the Organization, you may acquire confidential information about EIHAB Human Services, its staff, and service recipients which must be handled in strict confidence and not discussed with outsiders. The protection of confidential business, employee, and service recipient information is very important. Violations may result in fines and penalties, legal action, or criminal charges.
We will not selectively disclose (whether in one-on-one and/or small discussions, meetings, presentations, proposals or otherwise) any material nonpublic information with respect to EIHAB’s operations, plans, financial condition, results of operations or any development plan. We should be particularly vigilant when making presentations or proposals to consumers to ensure that our presentations do not contain material nonpublic information.
CONFIDENTIAL AND PROPRIETARY INFORMATION
Integral to EIHAB business success is our protection of confidential company information, as well as nonpublic information entrusted to us by employees, service recipients and other business partners. Confidential and proprietary information includes such things as pricing and financial data, consumer names/addresses or nonpublic information about other companies, including current or potential supplier and vendors. We will not disclose confidential and nonpublic information without a valid business purpose and proper authorization. Eihab recipients’ confidentiality is to be maintained in accordance with HIPPA Laws in accordance with e Human Resources Manual.
Termination of Employment or Contract
You may not use any confidential information gained from your employment or contract with the Organization for your benefit or another organization’s benefit. You may not take copies of any reports, documents, or any other property belonging to the Organization.
Upon termination of employment or contract with the Organization, you must return all of the Organization’s property including, but not limited to, copies of documents, notes, and other records containing confidential information; computer disks; your ID and keys; and credit cards.
GUIDELINES FOR THE USE OF INFORMATION TECHNOLOGY FOR AFFECTED INDIVIDUALS
These are general guidelines to follow for the protection of IT devices and security of private information.
Follow departmental procedures to safely handle and dispose of protected information.
Employees may be held responsible for any lost, stolen or improperly accessed data if that data was not protected (e.g. password protected and encrypted).
Do not leave devices unattended.
Computers, internet access, email or other office communication systems are intended for business- related purposes only and not for uses that may disruptive, offensive, harassing, or harmful to others.
All Affected Individuals are required to comply with EIHAB’s procedures pertaining electronic devices and materials.
EIHAB’s commitment to integrity begins with complying with laws, rules and regulations where we serve individuals. The compliance Program, these Standards of Conduct, and policies and procedures are developed to provide guidance in in your day-to-day work and activities you perform on behalf of EIHAB. Further, each of us must have an understanding of EIHAB policies, laws, rules and regulations that apply to our specific roles. We are responsible for preventing violations of law and for speaking up if we see possible violations.
EIHAB has put in place procedures and practices to ensure that:
All service documentation, records, and reports are prepared timely, accurately, and honestly;
All documentation supporting claims for service is complete and maintained in accordance with the regulatory requirements and EIHAB’s policies;
Claims are only submitted for services provided by eligible providers;
All claims submitted to outside entitles are accurate and comply with all Federal and State laws and regulations and payer requirements;
All claims are properly documented and accurately coded and identified billing errors are returned to the payer.
It is against the law and EIHAB policies to knowingly or carelessly submit a false claim. Submitting a false claim includes using false records, using wrong code, double billing, or billing, or causing to be billed services that are not provided or fully documented.
GUIDELINES FOR AFFECTED INDIVIDUALS: FAIR DEALING
The Standards of Conduct and the following guidelines are intended to help you make appropriate, responsible, and correct decisions in these and all matters:
Kickbacks and Rebate
Kickbacks and rebates in cash, credit, or other forms are prohibited. They are not only unethical, but also in many cases illegal.
Agreements with Contractors and Vendors
The Organization must ensure that any agreements with contractors and vendors clearly and accurately describe the services to be performed or items to be purchased. Performance standards and the applicable compensation, if any, must be reasonable in amount, not be excessive in terms of industry practice, and must equal the value of the service(s) rendered or items purchased.
FEDERAL AND STATE PROGRAMS
EIHAB Human Services is committed to complying with the laws and regulations that govern the Federal and State programs that it administers. The Compliance Program, these Standards of Conduct, and policies and procedures are developed to provide guidance in your day-to-day work and activities you perform on behalf of the Organization. You must abide by the policies and procedures and the Standards set by the Organization.
EIHAB Human Services’ programs and services are largely funded by Federal and State healthcare programs, including Medicaid and Medicare. EIHAB Human Services is committed to full compliance with all Federal and State healthcare program requirements. EIHAB Human Services must also comply with laws and regulations designed to combat fraud, waste, and abuse and the submission of inaccurate or false claims.
EIHAB Human Services has put in place procedures and practices to ensure that:
All service documentation, records, and reports are prepared timely, accurately, and honestly;
All documentation supporting claims for service is complete and maintained in accordance with regulatory requirements and the Organization’s policies;
All claims submitted to any government or private healthcare program are accurate and comply with all Federal and State laws and regulations and payer requirements;
Claims are only submitted for medically necessary services provided by eligible providers;
All claims are properly documented and accurately coded; and
Billing errors are promptly identified and any payments received in error are promptly returned to the payer.
Employees and independent contractors responsible for the documentation, charging, coding, billing, and accounting of services must comply with all applicable State and Federal regulations and EIHAB Human Services policies and procedures.
It is against the law and EIHAB Human Services’ policies to knowingly or carelessly submit a false claim. Submitting a false claim includes using false records, using the wrong code, double billing, or billing or causing to be billed services that are not provided or fully documented, and billing for services that are not medically necessary.
All Affected Individuals have a responsibility to notify the Compliance Officer promptly if they are charged with a criminal offense related to healthcare or are proposed or found to be subject to exclusion from Federal or State healthcare programs.
There may be times that the Organization is asked to cooperate with an investigation by a Federal or State governmental agency, or to respond to a request for information. A request may be formally addressed to the Organization or to an individual employed by or associated with the Organization. All Affected Individuals must report any requests for information or cooperation with an investigation to the Chief Executive and Compliance Officer immediately.
EIHAB is committed to maintaining a working environment free from all forms of discrimination, including any action that is considered sexual harassment. Therefore, we expect all employees to maintain a high standard of personal and professional behavior.
At EIHAB everyone should feel comfortable to speak his or her mind, particularly with respect to ethics concerns. Managers have a responsibility to create an open and supportive environment where employees feel comfortable raising such questions. We all benefit tremendously when employees exercise their power to prevent mistakes or wrongdoing by asking the right questions at the right times.
EIHAB will investigate all reported instances of questionable or unethical behavior, including allegations of sexual harassment and discrimination or any other unethical behavior. In every instance where improper behavior is found to have occurred, the organization will take appropriate action. We will not tolerate retaliation and/or intimidation against employees who raise genuine ethics concerns in good faith. All Affected individuals are required to support EIHAB’s commitment to a safe and professional work environment and to demonstrate appropriate behavior in the workplace.
EIHAB Human Services is committed to creating a safe and professional workplace where employees and others are treated with respect and without regard to their race, sex, age, religion, national origin, color, marital status, disability, or other protected characteristics. Business integrity, teamwork, trust, and respect are the Organization’s most important values. Unlawful discrimination or harassment of any sort violates these values. All Affected Individuals must exhibit and promote respect, integrity, trust, and teamwork in the workplace and must comply with the Organization’s policies prohibiting discrimination and harassment in all facets of the Organization’s work.
All Affected Individuals are required to support the Organization’s commitment to a safe and professional work environment and to demonstrate appropriate behavior in the workplace.
All Affected Individuals are prohibited from joking about another person’s race, sex, age, religion, national origin, color, marital status, disability, or other protected characteristics.
All employees are prohibited from considering someone’s race, color, religion, sex, national origin, age, disability, or other protected characteristic in making decisions about hiring, placement, assignment of duties, training, promotion, termination, compensation, benefits, and other work terms.
Sexual harassment is prohibited. Sexual harassment includes any form of unwelcome sexual advance, request for sexual favors, or other verbal or physical conduct of a sexual or sex-based nature.
Affected Individuals are responsible for understanding the Organization’s policy prohibiting discrimination and sexual harassment. You should consult with an appropriate supervisor, administrator, or Human Resources if you have questions about your right to a workplace free from unlawful harassment or discrimination or if you have questions about your duty to avoid discrimination.
Be alert to any situation that could violate EIHAB Human Services’ Standards of Conduct, Compliance Program, policies and procedures, guidelines, and/or Federal and State laws and regulations.
Promptly report any questions, issues, compliance concerns, wrongdoing, violations, or suspected violations to your supervisor, another member of Management, a member of the Compliance Committee, or the Compliance Officer.