Achieve Beyond (“The Company”) has implemented a Compliance Program (“Program”) to assist the Company in maintaining, and legal counsel in rendering legal advice regarding, compliance with the numerous laws, regulations, and policies that govern the conduct of the Company. It is the goal of Achieve Beyond to maintain an institutional culture that promotes the prevention, detection, and resolution of potential instances of non‑compliance.
As part of the Company’s Program, a Compliance Committee has been created. The Compliance Officer directs the Compliance Committee which has been appointed to aid in identifying any potential areas of non‑compliance, to assist in investigating areas of concern, and to remedy detected areas of non‑compliance. The members of the Compliance Committee and the Compliance Officer are listed in Attachment A of the Plan and Code. A written Compliance Plan (“Plan”) and Code of Conduct (“Code”) have been developed that summarizes various legal requirements that must be adhered to by those that work for and do business with Achieve Beyond. This includes employees, officers, senior administrators, managers, directors, agents and contractors (collectively, “Affected Individuals”). As outlined in the Compliance Plan, the Compliance Program is intended to ensure the Company complies with all of the laws, regulations and requirements that apply to the services it provides, including those that pertain to billing, payment, ordered services, medical necessity, quality of care, governance, mandatory reporting, credentialing and contractor oversight (“Compliance Focus Areas”).
Training for all Employees and Contractors will occur at date of hire or start of contract. Training will be renewed annually thereafter. Training is offered either in person or online thru the Achieve Beyond Website.
At the Compliance Training, all attendees will receive a copy of the Plan and Code. All attendees shall be required to complete a Compliance Plan Verification, which verifies their receipt of and agreement to be bound by and comply with the Plan and the Code.
A Compliance Pre-Test is given prior to the start of the actual training. The training will cover:
Once the training is completed, a Post-Test is given.
All records of attendance, Compliance Plan Verifications and Test results are maintained by the Compliance Officer for a minimum of six years from the date they are completed.
All Employees and Contractors will be provided with periodic compliance-related training addressing the topics described above, either in person or through the Achieve Beyond website. Training will be provided at least annually, and on an on-going basis when appropriate as part of corrective action plans, and in response to changes in policy and procedure, new work responsibilities and new requirements issued by regulatory agencies.
All suspected incidents of non-compliance should be reported to the Compliance Office, a member of the Compliance Committee or the Appropriate Program Manager.
Examples of the types of issues that must be reported include, but is not limited to the items below:
Reports may be made in person, in writing, over the phone or online via the “Consumer Report Form” on the Achieve Beyond website. Written Reports should be labeled “CONFIDENTIAL AND PRIVILEGED MATERIAL PREPARED FOR LEGAL COUNSEL.”
In the report, describe the nature of concern and all parties involved (provider, child/student, parent, office staff). There will be no retaliation or adverse consequences for reporting in good faith. Achieve Beyond wants all staff to report all possible compliance issues.
Reports can be anonymous. An anonymous report can be made by mailing an anonymous letter to:
Achieve Beyond
Attn: Compliance Officer
7000 Austin St, Ste 200
Forest Hills, NY 11375
An anonymous report can also be made by filling out the “Consumer Report Form” online leaving the name, e-mail and phone number fields blank or by calling the Consumer Report Hotline 718-762-7633, ext 300.
The identity of all reporters will be kept confidential.
Once a report is made the Compliance Officer determines the level and manner of investigation, and ensures they are conducted promptly and thoroughly with the assistance of legal counsel where appropriate.
The entire timeline of the investigation is tracked by the Compliance Officer on a “Compliance Issue Report” form. The form will include the date the report was received, the name of the individual making the report (if disclosed), the method of reporting, the nature of the issue, a summary of any investigation conducted, and a summary of action taken. Compliance Issue Report Forms shall be provided to legal counsel as appropriate in order for counsel to provide legal advice to Achieve Beyond.
The investigation may involve parent surveys, audit of notes/reports, interviews of staff, or any other methods deemed necessary by the Compliance Officer. All employees and contractors are expected to participate in the investigation and cooperate in good faith in the resolution of all compliance issues.
The Compliance Officer shall maintain any materials generated as part of an investigation so as to preserve the confidentiality of such materials and safeguard any applicable legal privilege that may attach to the materials and the investigation.
Upon conclusion of an investigation, the Compliance Officer shall make any necessary reports and shall ensure that appropriate remediation and corrective action is undertaken. Possible outcomes of investigations include refund of payment(s), self-disclosure to a health regulatory agency such as the New York State Office of the Medicaid Inspector General, restaff of case(s), Corrective Action Plan (CAP), discipline of Affected Individuals in accordance with the Disciplinary Policy, and report to State, County, City or other governing or licensing body.
Any identified overpayment will be reported and returned within 60 days of when the Company has investigated and quantified it. The Company will use diligence to complete the investigation and quantification process as quickly as possible. Absent extraordinary circumstances, the Company will complete any investigation and quantification within six months of when it receives credible information indicating it has been overpaid.
Documentation of any investigations shall be maintained for a minimum of six years.
Achieve Beyond encourages all contractors and employees to participate in the compliance program with good faith and report all possible incidents of non-compliance. Sanctions may include, without limitation, oral counseling, written warnings, suspension without pay, and/or termination. The Company does not guarantee that one form of action will necessarily proceed another and reserves the right to impose discipline at any level, including immediate termination, depending upon the seriousness of the misconduct. Intentional or reckless behavior will be subject to the most significant sanctions. All employees and contractors are expected to participate in the investigation and resolution of all compliance issues. Employees and contractors will be subject to disciplinary action, up to and including termination, if they:
The disciplinary policy is enforced is fairly and firmly by the Compliance Committee.
Achieve Beyond’s Compliance Committee oversees internal audits and patient surveys to gauge quality, identify overpayments/underpayments, program strengths and weaknesses, and assess risk. The Risk Assessment process is used to develop Achieve Beyond’s annual compliance Work Plan and to identify issues for auditing and monitoring throughout the year.
The manner and scope of each audit and patient survey project are determined by the Compliance Officer with assistance by the Compliance Committee. All audits are organized and tracked in the annual Work Plans and the results of auditing activity is documented in internal audit reports. Generally, audits and patient surveys monitor compliance with programmatic requirements, billing requirements, clinic performance, and customer satisfaction. Work Plans and internal audit reports are reviewed on a regular basis by the Compliance Committee and program managers.
Corrective Action Plans are developed to repair program deficiencies, billing errors, clinical issues and other possible risks. Incidents of non-compliance discovered during audits and risk assessment are investigated per the “Investigations” section of this policy.
On a monthly basis, all employees/contractors of Achieve Beyond are screened thru several Exclusion Lists up to and including:
http://exclusions.oig.hhs.gov/
http://www.omig.ny.gov/data/content/view/72/52/
Any employee/contractor that is an Excluded Party will be terminated immediately. Achieve Beyond will issue appropriate refunds concerning the employee/contractor to the payer.
The Compliance Program is reviewed by the Compliance Committee on a regular basis. The program is continuously revised to accommodate regulatory changes, to evaluate its effectiveness and to increase efficiency in identifying compliance-related issues. As part of this evaluation, the Compliance Committee also assesses whether the Company’s Compliance Plan, Compliance Policies, and Code of Conduct are effective, are being followed by Affected Individuals, and whether any updates are required. The Committee also evaluates whether the Compliance Officer has sufficient time, and the Compliance Program has sufficient staff and resources to carry out the Compliance Program responsibilities effectively.
The Compliance Officer reviews the Compliance Program with the CEO and Executive Director annually. The Compliance Officer highlights strengths and weaknesses for the year and the outlook for the coming year. The CEO and Executive Director offer their insight on how to strengthen and improve the Compliance Plan for the coming year.
Amendments to the Compliance Program are proposed by the Compliance Officer, any member of the Compliance Committee, the CEO or Executive Director. All amendments must be approved by all members of the Compliance Committee.
The Company retains all records pertaining to the operation of the Compliance Program for a minimum of six years from the date the records were created.