- Autism & Developmental Services
Autism & Developmental Services
COMPLIANCE PLAN AND CODE OF CONDUCT FOR ACHIEVE BEYOND
Since 1995, Achieve Beyond has taken pride in offering high quality Pediatric Therapy and Autism services to the children and families. As with any vital and vibrant organization, Achieve Beyond cannot be content with the status quo, but rather must focus on the future. To preserve and enhance our well-deserved reputation, everyone associated with Achieve Beyond must share a commitment not only to our clients and our work, but also to compliance with the numerous laws, regulations, and policies that govern our conduct. To assist us in our compliance goals, we have developed the Achieve Beyond Compliance Program which applies to all of our employees, officers, senior administrators, managers, directors, agents and contractors (collectively “Affected Individuals”).
The goal of the Compliance Program is to ensure Achieve Beyond fully complies with the laws, regulations and requirements that apply to the services we provide, including those that pertain to billing, payment, ordered services, medical necessity, quality of care, governance, mandatory reporting, credentialing and contractor oversight (“Compliance Focus Areas”). We strive to achieve this by providing all Affected Individuals with the tools and training they need to perform their jobs compliantly and with the means to bring forward any potential compliance concerns.
The Compliance Program includes a Compliance Plan and Code of Conduct. In that Code, we have briefly summarized the internal and external provisions that govern various legal and ethical requirements we must meet. The Code is expected to serve as a useful guide to assist us and you in identifying and addressing those instances where there may not be compliance with the law or with Achieve Beyond policy. The failure to follow existing law can damage our reputation and threaten our ability to carry out our mission. Unlawful behavior also may result in criminal liability and civil fines and penalties. Individuals who knowingly violate or recklessly disregard this Compliance Plan, the Code of Conduct, the Compliance Policies and Procedures, or the laws, regulations and policies which govern Achieve Beyond are subject to discipline under our progressive disciplinary policy up to and including termination.
We recognize that our ability to achieve compliance with the law depends upon our ability to recognize, avoid, and remedy existing problems. Our compliance, therefore, depends not only upon a choice to “follow the rules” but also our obligation to our mission, our agency, each other, and all those who serve Achieve Beyond in any capacity, to comply with the laws and to bring all issues of potential concern to the attention of the appropriate Program Manager, a Provider Relations Manager or to a Achieve Beyond Compliance Committee member (see “Discharging Your Obligations”). In return, you have our commitment that the issues you raise will be promptly and properly reviewed and that appropriate corrective action will be taken where necessary. Most important, you will not in any way be subject to any adverse consequences for making good faith reports; to the contrary, we view the failure to bring appropriate concerns to our attention to be a serious breach of your obligations that could lead to disciplinary action. In short, we commend and will strongly support those who make the proper choices at Achieve Beyond, and will hold accountable those persons who make inappropriate choices or those who turn a blind eye toward improper conduct. Through our collective efforts we are confident that we can and will enhance our existing reputation for excellence.
We recognize that there may be instances where you learn of practices at Achieve Beyond that may be of concern to you. While there are many different ways for you to address those concerns, we recognize that your choice will likely depend upon your relationship with the particular employees, independent contractor or vendors involved in the conduct at issue; upon your relationship with your supervisors (if you are an employee); or upon your knowledge of the laws, regulations and policies governing the practice that is of concern to you. We wish to assure you that this Compliance Plan as well as the Compliance Committee (see “Compliance Committee and Compliance Officer”, below) exist to help you when you are unable, for any reason, to assure yourself that the conduct in question is in fact appropriate, or if you believe that the problem has not been effectively remedied. In those instances, we fully expect that you will follow the process below to promptly inform the Compliance Committee of the issue. That Committee is composed of senior members of Achieve Beyond administration who are committed to ensuring full compliance with all existing laws, rules, regulations, protocols and policies that govern us.
Achieve Beyond Compliance Committee has been formed to aid in identifying any potential areas of non-compliance through audits, to assist in investigating areas of concern raised by our employees or by others, and to remedy any deficiencies. The Compliance Committee will meet quarterly or more frequently as necessary and reports to the Executive Directors’ Committee at least quarterly.
The Compliance Committee is responsible for:
The Compliance Program and the Compliance Policies and Procedures will be reviewed at least annually to determine whether they are effective, are being followed, and if any updates are required, and will be revised if necessary. The Compliance Committee and Compliance Officer will have access to all documents, records, information, and individuals relevant to carrying out the Compliance Program’s responsibilities and will retain records related to the implementation and operation of the compliance program for a minimum of six (6) years.
The Compliance Committee’s work is intended to be and will be confidential and privileged to the extent allowed under the law. If requested, the Committee also will make all reasonable efforts to protect the identity of the reporting employee or individual. When the Committee completes any necessary investigation or implements any necessary steps to address the problems detected, the Committee will, whenever appropriate, inform the reporting employee or independent contractor of the result of the investigation and of any action taken concerning the issue presented. The Committee will review and, if necessary, modify this Compliance Plan and Code of Conduct annually.
The Compliance Officer reports directly to the owners of Achieve Beyond. The Compliance Officer will chair the Achieve Beyond Compliance Committee. The Compliance Committee members including the Compliance Officer are listed, along with their telephone numbers, in Attachment A to this Compliance Plan document.
All Achieve Beyond employees and independent contractors are strongly encouraged to bring concerns to the attention of the Compliance Officer or any member of the Compliance Committee. Reports may be made in person, in writing, or over the telephone to the individuals listed in Attachment A. Written communications should be marked “CONFIDENTIAL AND PRIVILEGED MATERIAL PREPARED FOR LEGAL COUNSEL.” Although reports may be made anonymously, in order for the Compliance Committee to obtain more information from or respond to the reporting individual, he or she should provide his or her name and work location when the report is made. All reports and communications received are generated for purposes of assisting Achieve Beyond’s attorneys in providing confidential legal advice and will be confidential and privileged to the extent permitted by law. Counsel for Achieve Beyond and the Compliance Committee will review reports and assist in deciding upon an appropriate investigation. Investigations may include, but are not limited to, patient surveys, audit of case files, and interviews. The cooperation of the reporting employee or individual may be sought during any investigation, and such cooperation will be positively noted in the employee’s or individual’s file. Upon conclusion of the investigation, with the advice of legal counsel, the Committee will determine the necessary follow-up action to be taken. Any concerns about the Compliance Officer, the Committee members, or the Committee’s actions or determinations may be brought directly to the owners of Achieve Beyond.
The following Code of Conduct summarizes the conduct we expect from all our employees, officers, senior administrators, managers, directors, agents and independent contractors (collectively, “Affected Individuals”). It highlights certain key areas where the potential for concerns may be significant. This Code will not serve as a substitute for a thorough understanding of your job function, your obligations, and the laws and institutional policies that apply to your job. It will not constitute an excuse to avoid training or in-service presentations in your area. However, it can and should provide useful guidance, make you sensitive to potential problems you may face, and help you to avoid particular pitfalls.
Our agency is subject to many federal, state and local laws, together with various internal policies and protocols. We have attempted to summarize below the general obligations arising in key areas of our operations. The key areas are:
Achieve Beyond is committed to equal opportunity and to the respect for human dignity. Unequal treatment or discrimination based upon gender, color, national origin, age, race, color, creed, religious affiliation or belief, disability, citizenship, immigration status, sexual orientation, gender identity or expression, military status, genetic characteristics, family or marital status, or other non-performance or ability-related grounds is unacceptable. We will hire, promote, retain and contract with individuals based upon their ability to meet bona fide occupational qualifications, and to effectively and efficiently discharge the obligations of their job. Similarly, we do not condone and will not tolerate conduct that demeans or undermines our clients, or that creates or encourages a hostile or oppressive working environment.
Achieve Beyond has developed and maintains various employment-related and independent contract-related policies that are available through the employees’ supervisors or the independent contractors’ provider relations manager. We expect that all employees and independent contractors will be familiar with and will adhere to these policies. Questions or concerns should be directed to the appropriate Program Manager, Provider Relations Manager or Compliance Committee member.
Federal and state laws prohibit certain conduct by, and certain business arrangements for, healthcare and educational providers. These include arrangements where goods, services, or office space are provided for some amount other than fair market value in return for referring a client for services or items. These kickbacks and other related practices are generally grouped under the heading “fraud and abuse.” While there are many practices that are prohibited or restricted, there are also several exceptions or “safe harbors” that apply under specified circumstances. The most common fraud and abuse issues arise in connection with referral practices and in vendor relationships.
Achieve Beyond is not permitted to pay a physician or therapist for a referral of a child to Achieve Beyond and, as a general rule, you must avoid relationships with vendors or other third parties that appear to provide financial incentives for the use of their products or for the referral of clients to them or Achieve Beyond. These incentives, moreover, are not necessarily in the form of cash payments, but may include consulting relationships, leases or other arrangements with vendors for other than fair market value, and gifts. A useful guide is to avoid arrangements that confer personal benefits to you over and above that which ordinarily would be provided for your services. You also must clear with the appropriate Program Manager any proposed arrangement with clinicians, vendors, contractors or suppliers, or any rebate, bonus or volume discount proposals, before these arrangements take effect. Program Managers will discuss these proposed arrangements with the Compliance Officer.
Client referrals to health care entities in which the referring clinician or a relative has an ownership or compensation relationship are also prohibited under statutes commonly known as the “Stark” laws. There are several exceptions to the Stark prohibitions, but the regulations are complex and must be carefully complied with. The appropriate course of action is to raise all issues in this regard with the appropriate Program Manager. Any concerns regarding this area should be immediately brought to the attention of the appropriate Program Manager, Provider Relations manager or Compliance Committee member.
A conflict of interest may arise where an employee stands to benefit personally at the expense of /Achieve Beyond, or where an employee is in a position to put his or her personal interests above those of Achieve Beyond. We believe strongly that all Achieve Beyond employees, and independent contractors during the term of the contract, owe a duty of loyalty to the agency and, therefore, should avoid any actual or apparent conflicts of interest. While conflicts can arise in many different contexts, in general we expect that all employees and, independent contractors during the term of their contract, will put the interests of Achieve Beyond ahead of their personal concerns, and will not seek to benefit themselves at the expense of, or as a result of, their affiliation with Achieve Beyond. We expect all Achieve Beyond employees and independent contractors will become familiar with and obey policies in this area. Suspected violations, including less-than-arms-length relationships and transactions, should be reported immediately to the appropriate Program Manager, Provider Relations Manager or Compliance Committee member immediately.
You should be aware that the receipt or giving of gifts by Achieve Beyond personnel may raise questions about relationships with our clients, vendors, governmental officials, or others who interact with Achieve Beyond. We must always refrain from activities that could possibly be construed as an attempt to improperly influence these relationships. You should not offer or receive a gift in circumstances where it could appear that the purpose of the gift is to improperly influence Achieve Beyond’s relationship with a client, vendor, regulator, or other person or entity.
It is Achieve Beyond’s policy to reimburse its employees for all reasonable expenses, including meals, entertainment, and travel, that are appropriately incurred while conducting Achieve Beyond business. Rarely, therefore, will justification exist for you to permit someone else to pay for such items. We are confident that if you follow Achieve Beyond policy and exercise reasonable judgment and common sense with respect to gifts and gratuities, you will avoid situations that might bring you or Achieve Beyond’s integrity into question. If you have any questions in connection with the receipt or offer of gifts or entertainment, you should consult the applicable Achieve Beyond policy and the appropriate Program Manager. Any concerns regarding violations of policy in this area should be brought to the attention of the appropriate Program Manager, provider relations manager or Compliance Committee member.
Achieve Beyond is not permitted to employ anyone who is not a United States citizen, unless that person has an appropriate visa or other documentation that allows him or her to legally work at our agency. If Achieve Beyond violates federal immigration laws, there could be significant civil or criminal liability. It is the policy of Achieve Beyond to fully comply with the immigration laws and, therefore, no person will be hired without providing Achieve Beyond with appropriate documentation of their citizenship or immigration status. Any concerns regarding immigration issues should be brought to the attention of the appropriate Program Manager, Provider Relations Manager or a Compliance Committee member.
One of our most valuable assets is our body of confidential information. As an agency employee or independent contractor, you are responsible for maintaining and protecting the information used by you in connection with your job duties. For example, you must not record inaccurate information, make inappropriate or unauthorized modifications of information, or destroy or disclose information, except as authorized. Additionally, no employee, independent contractor or former employee may, without the prior written consent of Achieve Beyond, use for their own benefit or disclose to others any confidential information obtained during employment or term of engagement.
Documents containing sensitive data, including information concerning clients, must not be left in public view or in an unsecured location. You also must be careful when you enter, secure, and store computer data. Given the widespread use of computers throughout Achieve Beyond, the potential for a breach of security exists and must be considered at all times. If you observe individuals whom you do not recognize using terminals in your area, immediately report this to the appropriate Program Manager or to security. Any concerns regarding confidential information should be brought to the attention of a Compliance Committee member.
Many of Achieve Beyond’s services are paid for by government funds. While there are established particular billing formats, protocols, and practices with which all employees involved in the billing process must become familiar, there are certain common issues that are important to mention.
Achieve Beyond is prohibited from submitting false claims to obtain payment for the services w