DRA NOTICE POLICY

DRA NOTICE POLICY
ACHIEVE BEYOND

Adopted: April 2018
Revised:

Introduction

As a condition of receiving certain payments under Medicaid, Achieve Beyond must comply with Section 6032 of the Deficit Reduction Act of 2005 (“DRA”), which requires Achieve Beyond to ensure that all employees, contractors, and agents receive detailed information regarding federal and state false claims laws and the role of those laws in preventing and detecting fraud, waste, and abuse.

Policy

It is Achieve Beyond’s policy to provide the fraud and abuse education required under the DRA to its employees, contractors, and agents. Specifically, Achieve Beyond will provide all employees, contractors and agents with detailed information about:

  • the federal False Claims Act;
  • the federal administrative remedies associated with the False Claims Act;
  • state laws pertaining to civil or criminal penalties for false claims and statements;
  • whistleblower protections provided under federal and state laws; and
  • the role of federal and state laws in preventing and detecting fraud, waste and abuse.

Procedure

  1. State-Specific DRA Notices

    Each employee, contractor, and agent of Achieve Beyond will receive upon hire a state-specific DRA notice containing a description of Achieve Beyond’s compliance program and a DRA-compliant explanation of the federal and state fraud and abuse laws applicable in the state in which the employee, contractor, or agent will work for Achieve Beyond.

  2. Dissemination to Employees, Agent, and Contractors

    Upon engaging a new employee, contractor, or agent, Achieve Beyond shall provide the new employee, contractor, or agent with the applicable state-specific DRA notice as part of his or her orientation paperwork within 7 days of his or her hire date. All up-to-date state-specific DRA notices can be found at www.achievebeyondusa.com.

  3. Revisions to State-Specific DRA Notices

    Achieve Beyond shall periodically obtain legal review of its state-specific DRA notices and revise them as necessary or appropriate to ensure they remain accurate and up-to-date with respect to changes in law.

Questions

Questions about this policy and/or issues accessing the state-specific DRA notices should be directed to the Compliance Officer, Joseph Matuza, at (718) 762-7633 (x190).

Related Documents

The following documents are incorporated herein by reference.

  1. DRA Notice – NY
  2. DRA Notice – VA
  3. DRA Notice – NJ
  4. DRA Notice – MD
  5. DRA Notice – CT
  6. DRA Notice – CA



To: Achieve Beyond employees and others affiliated with Achieve Beyond

From: Joseph Matuza, Corporate Compliance Officer

Date: August 2016

RE: Compliance Program and Federal Deficit Reduction Act

Achieve Beyond is committed to preventing and detecting fraud, waste and abuse. In support of this commitment, Achieve Beyond has established a Corporate Compliance Program. The purpose of the Corporate Compliance Program is to establish appropriate controls that will help ensure consistent compliance with the federal and State laws which govern our activities, and to detect violations of the law by employees and others affiliated with Achieve Beyond.

Elements of Achieve Beyond’s Corporate Compliance Program include:

  • A Compliance Officer who is responsible for the day-to-day operations of the Corporate Compliance Program.
  • Written standards of conduct, policies and procedures that describes compliance expectations and promote Achieve Beyond’s commitment to compliance for all employees and others affiliated with Achieve Beyond.
  • A Corporate Compliance Committee that operates and monitors the Corporate Compliance Program and initiates the necessary actions to correct any compliance problems.
  • Regular, effective education and training programs for all employees whose job descriptions include activities that are subject to the Corporate Compliance Program.
  • Procedures to encourage employees and others affiliated with Achieve Beyond to openly bring to the Corporate Compliance Committee’s attention any situation that may be a violation of law or the Corporate Compliance Program without fear of threats, intimidation, retaliation or punishment.
  • A system that allows for confidential and anonymous reporting of compliance issues or concerns.
  • A system to respond to allegations of improper or illegal activities and the enforcement of appropriate disciplinary action against employees who have violated the Corporate Compliance policies.
  • Fairly and firmly enforced disciplinary policies that encourage good faith participation in the compliance program, that articulate expectation for reporting compliance issues and assisting in their resolution and that outline sanctions for: a) failing to report suspected problems; b) participating in non-compliant behavior; or c) encouraging, directing, facilitating or permitting non-compliant behavior.
  • Compliance audits and/or other evaluation techniques to monitor compliance and assist in the reduction of potential problem areas.

A goal of the Corporate Compliance Program is to educate appropriate employees with respect to federal and State statutes and regulations with which they must comply. In this regard, the federal Deficit Reduction Act (“DRA”) requires Achieve Beyond to provide all employees, contractors or agents with “detailed information” about:

  • the federal False Claims Act

  • the federal administrative remedies associated with the False Claims Act

  • New York State laws pertaining to civil or criminal penalties for false claims and statements

  • whistleblower protections provided under federal and State laws

  • the role of federal and State laws in preventing and detecting fraud, waste and abuse

This letter provides you with the information required by the DRA.

Federal and New York Statutes
Related to Filing False Claims and Whistleblower Protections

Numerous federal and State laws prohibit health care providers from submitting “false” or “fraudulent” claims to Medicare and Medicaid and other federally-funded health care programs. Presented below is a listing and description of various federal and State statutes related to the filing of false Medicare and Medicaid claims.

Federal Laws

  1. Federal Laws

    1. False Claims Act, 31 U.S.C. 3729-3733.

      The federal False Claims Act imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from Medicare, Medicaid, or other federal health programs. The penalty for filing a false claim is $10,781 - $21,563 per claim and the recoverable damages are between two and three times the value of the amount falsely received. In addition, the false claims filer may have to pay the government’s legal fees.

      The False Claims Act allows private individuals to file lawsuits in federal court, just as if they were federal prosecutors. If the suit eventually concludes with payments back to the government, the person who started the case can recover 25- 30% of the proceeds if the government did not participate in the suit, or 15-25% if the government did participate in the suit.

    2. Administrative Remedies for False Claims, 31 U.S.C. 3801-3812.


      This statute allows for administrative recoveries by federal agencies. If a person submits a claim that the person knows is false, or contains false information, or omits material information, then the agency receiving the claim may impose a penalty of up to $10,781 for each claim. The agency may also recover twice the amount of the claim.

      A violation of this law occurs when a false claim is submitted, not when it is paid. Also, unlike the False Claims Act, the determination of whether a claim is false and the imposition of fines and penalties is made by the administrative agency, not by bringing lawsuits in the federal court system.

New York State Laws

New York false claims laws fall into two categories: administrative and civil laws; and criminal laws. Many of the laws overlap. Some apply to recipient false claims, and some apply to provider false claims.

  1. Administrative and Civil Laws

    1. State Finance Law Article 13, New York False Claims Act. The New York False Claims Act imposes penalties and fines on individuals and entities that knowingly file false or fraudulent claims for payment from Medicaid or other State health programs. The potential penalty for knowingly filing a false claim is (1) $6,000 - $12,000 per claim, (2) payment of between two and three times the State’s damages, (3) payment of between two and three times the damages sustained by any local government, and (4) payment of the State’s legal fees.

      The New York False Claims Act allows private individuals to file lawsuits in State court. If the suit eventually concludes with payments back to the State, the person who started the case can recover a percentage of the proceeds based on whether the State did or did not participate in the suit.

    2. Social Services Laws 145-c. If any person applies for or receives public assistance, including Medicaid, by intentionally making a false or misleading statement or misrepresenting, concealing or withholding facts (or committing an act intended to mislead, misrepresent, conceal, or withhold facts), then the person’s needs shall not be taken in account in determining his or her need or the person’s family’s need, for six months if a first offense, 12 months if a second offense (or once if benefits received are $1,000 - $3,900), 18 months if a third offense (or once if benefits received are over $3,900) and five years for four or more offenses.

    3. Social Services Law 145-b False Statements. It is a violation to knowingly obtain or attempt to obtain payment for items or services furnished under any Social Services program, including Medicaid, by use of a false statement, deliberate concealment or other fraudulent scheme or device.

      The State or the local Social Services district may recover three times the amount incorrectly paid. In addition, the Department of Health may impose a civil penalty of up to $10,000 per violation. If repeat violations occur within five years, a penalty up to $30,000 per violation may be imposed if they involve more serious violations of Medicaid rules, billing for services not rendered or providing excessive services.

  2. Criminal Laws

    1. Social Services Law 145, Penalties. Any person who submits false statements or deliberately conceals material information in order to receive public assistance, including Medicaid, is guilty of a misdemeanor.

    2. Social Services Law 366-b, Penalties for Fraudulent Practices.

      1. Any person who obtains or attempts to obtain, for himself or others, medical assistance by means of a false statement, concealment of material facts, impersonation or other fraudulent means is guilty of a Class A misdemeanor.

      2. Any person who, with intent to defraud, presents for payment any false or fraudulent claim for furnishing services, knowingly submits false information in order to obtain greater Medicaid compensation or knowingly submits false information in order to obtain authorization to provide items or services is guilty of a Class A misdemeanor.

    3. Penal Law Article 155, Larceny. The crime or larceny applies to a person who, with intent to deprive another of his property, obtains, takes or withholds the property by means of trick, embezzlement, false pretense, false promise, including a scheme to defraud, or other similar behavior. It has been applied to Medicaid fraud cases.

      1. Fifth degree petit larceny involves property of any amount. It is a Class A misdemeanor.

      2. Fourth degree grand larceny involves property valued over $1,000. It is a class E felony.

      3. Third degree grand larceny involves property valued over $3,000. It is a class D felony.

      4. Second degree grand larceny involves property valued over $50,000. It is a class C felony.

      5. First degree grand larceny involves property valued over $1 million. It is a class B felony.

    4. Penal Law Article 175, False Written Statements. Four crimes in this Article relate to filing false information or claims that have been applied in Medicaid fraud prosecutions.

      1. 175.05, Falsifying business records in the second degree involves entering false information, omitting material information or altering an enterprise’s business records with the intent to defraud. It is a Class A misdemeanor.

      2. 175.10, Falsifying business records in the first degree includes the elements of the 175.05 offense and includes the intent to commit another crime or conceal its commission. It is a Class E felony.

      3. 175.30, Offering a false instrument for filing in the second degree involves presenting a written instrument (including a claim for payment) to a public office knowing that it contains false information. It is a Class A misdemeanor.

      4. 175.35, Offering a false instrument for filing in the first degree includes the elements of the second degree offense and must include intent to defraud the State or a political subdivision. It is a Class E felony.

    5. Penal Law Article 176, Insurance Fraud. Six crimes in this Article apply to claims for insurance payment, including Medicaid or other health insurance.

      1. Insurance Fraud in the 5th degree involves intentionally filing a health insurance claim knowing that it is false. It is a Class A misdemeanor.

      2. Insurance fraud in the 4th degree is filing a false insurance claim for over $1,000. It is a Class E felony.

      3. nsurance fraud in the 3rd degree is filing a false insurance claim for over $3,000. It is a Class D felony.

      4. Insurance fraud in the 2nd degree is filing a false insurance claim for over $50,000. It is a Class C felony.

      5. Insurance fraud in the 1st degree is filing a false insurance claim for over $1 million. It is a Class B felony.

      6. Aggravated insurance fraud is committing insurance fraud more than once. It is a Class B felony.

    6. Penal Law Article 177, Health Care Fraud. Five crimes apply to claims for health insurance payment, including Medicaid.

      1. Health care fraud in the 5th degree is knowingly filing, with the intent to defraud, a claim for payment that intentionally has false information or omissions. It is a Class A misdemeanor.

      2. Health care fraud in the 4th degree is filing false claims and annually receiving over $3,000 in aggregate. It is a Class E felony.

      3. Health care fraud in the 3rd degree is filing false claims and annually receiving over $10,000 in aggregate. It is a Class D felony.

      4. Health care fraud in the 2nd degree is filing false claims and annually receiving over $50,000 in aggregate. It is a Class C felony.

      5. Health care fraud in the 1st degree is filing false claims and annually receiving over $1 million in aggregate. It is a Class B felony.

Whistleblower Protections

  1. New York Labor Law 740. An employer may not take any retaliatory action against an employee if the employee discloses information about the employer’s policies, practices or activities to a regulatory, law enforcement or other similar agency or public official. Protected disclosures are those that assert that the employer (1) is in violation of a law that creates a substantial and specific danger to the public health and safety; or (2) has committed health care fraud (as defined in Penal Law Article 177). The employee’s disclosure is protected only if the employee first brought up the matter with a supervisor and gave the employer a reasonable opportunity to correct the alleged violation.


    If an employer takes a retaliatory action against the employee, the employee may sue in State court for reinstatement to the same or equivalent position, any lost back wages and benefits and attorneys’ fees. If the employer is a health provider and the court finds that the employer’s retaliatory action was in bad faith, it may impose a civil penalty of $10,000 on the employer.

  2. New York Labor Law 741. A health care employer may not take any retaliatory action against an employee if the employee discloses certain information about the employer’s policies, practices or activities to a regulatory, law enforcement or other similar agency or public official. Protected disclosures are those that assert that, in good faith, the employee believes constitute improper quality of patient care. The employee’s disclosure is protected only if the employee first brought up the matter with a supervisor and gave the employer a reasonable opportunity to correct the alleged violation, unless the danger is imminent to the public or patient and the employee believes in good faith that reporting to a supervisor would not result in corrective action.


    If an employer takes a retaliatory action against the employee, the employee may sue in State court for reinstatement to the same or equivalent position, any lost back wages and benefits and attorneys’ fees. If the employer is a health provider and the court finds that the employer’s retaliatory action was in bad faith, it may impose a civil penalty of $10,000 on the employer.

  3. Federal False Claims Act (31 U.S.C. 3730(h)) and New York False Claims Act (State Finance Law 191). An employee who is “discharged, demoted, suspended, threatened, harassed or in any manner discriminated against” because of the employee’s lawful acts under the federal or New York False Claims Act is entitled to reinstatement, double back pay with interest, special damages, and litigation costs and attorneys’ fees.

If you become aware of any compliance issues or have any questions regarding the information contained in this letter, please contact Joseph Matuza, Achieve Beyond’s Corporate Compliance Officer, at (718) 762-7633 (x 190).




To: Achieve Beyond employees and others affiliated with Achieve Beyond

From: Joseph Matuza, Corporate Compliance Officer

Date: August 2016

RE: Compliance Program and Federal Deficit Reduction Act

Achieve Beyond is committed to preventing and detecting fraud, waste and abuse. In support of this commitment, Achieve Beyond has established a Corporate Compliance Program. The purpose of the Corporate Compliance Program is to establish appropriate controls that will help ensure consistent compliance with the federal and State laws which govern our activities, and to detect violations of the law by employees and others affiliated with Achieve Beyond. Achieve Beyond’s Corporate Compliance Program includes the following elements:

  • A Compliance Officer who is responsible for the day-to-day operations of the Corporate Compliance Program.
  • Written standards of conduct, policies and procedures that describes compliance expectations and promote Achieve Beyond’s commitment to compliance for all employees and others affiliated with Achieve Beyond.
  • A Corporate Compliance Committee that operates and monitors the Corporate Compliance Program and initiates the necessary actions to correct any compliance problems.
  • Regular, effective education and training programs for all employees whose job descriptions include activities that are subject to the Corporate Compliance Program.
  • Procedures to encourage employees and others affiliated with Achieve Beyond to openly bring to the Corporate Compliance Committee’s attention any situation that may be a violation of law or the Corporate Compliance Program without fear of threats, intimidation, retaliation or punishment.
  • A system that allows for confidential and anonymous reporting of compliance issues or concerns.
  • A system to respond to allegations of improper or illegal activities and the enforcement of appropriate disciplinary action against employees who have violated the Corporate Compliance policies.
  • Fairly and firmly enforced disciplinary policies that encourage good faith participation in the compliance program, that articulate expectation for reporting compliance issues and assisting in their resolution and that outline sanctions for: a) failing to report suspected problems; b) participating in non-compliant behavior; or c) encouraging, directing, facilitating or permitting non-compliant behavior.
  • Compliance audits and/or other evaluation techniques to monitor compliance and assist in the reduction of potential problem areas.

A goal of the Corporate Compliance Program is to educate appropriate employees with respect to federal and State statutes and regulations with which they must comply. In this regard, the federal Deficit Reduction Act (“DRA”) requires Achieve Beyond to provide all employees, contractors or agents with “detailed information” about:

  • the federal False Claims Act

  • the federal administrative remedies associated with the False Claims Act

  • Virginia laws pertaining to civil or criminal penalties for false claims and statements

  • whistleblower protections provided under federal and State laws

  • the role of federal and State laws in preventing and detecting fraud, waste and abuse

This letter provides you with the information required by the DRA.

Federal and Virginia Statutes
Related to Filing False Claims and Whistleblower Protections

Numerous federal and State laws prohibit health care providers from submitting “false” or “fraudulent” claims to Medicare and Medicaid and other federally-funded health care programs. Presented below is a listing and description of various federal and State statutes related to the filing of false Medicare and Medicaid claims.

Federal Laws

  1. Federal Laws

    1. False Claims Act, 31 U.S.C. 3729-3733.


      The federal False Claims Act imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from Medicare, Medicaid, or other federal health programs. The penalty for filing a false claim is $10,781 - $21,563 per claim and the recoverable damages are between two and three times the value of the amount falsely received. In addition, the false claims filer may have to pay the government’s legal fees.

      The False Claims Act allows private individuals to file lawsuits in federal court, just as if they were federal prosecutors. If the suit eventually concludes with payments back to the government, the person who started the case can recover 25- 30% of the proceeds if the government did not participate in the suit, or 15-25% if the government did participate in the suit.

    2. Administrative Remedies for False Claims, 31 U.S.C. 3801-3812.


      This statute allows for administrative recoveries by federal agencies. If a person submits a claim that the person knows is false, or contains false information, or omits material information, then the agency receiving the claim may impose a penalty of up to $10,781 for each claim. The agency may also recover twice the amount of the claim.

      A violation of this law occurs when a false claim is submitted, not when it is paid. Also, unlike the False Claims Act, the determination of whether a claim is false and the imposition of fines and penalties is made by the administrative agency, not by bringing lawsuits in the federal court system.

Virginia Commonwealth Law

Virginia Fraud Against Taxpayers Act. The Virginia Fraud Against Taxpayers Act imposes penalties and fines on individuals and entities that knowingly file false or fraudulent claims for payment from Medicaid or other Commonwealth health programs. The potential penalty for knowingly filing a false claim is (1) $5,000 - $10,000 per claim, (2) payment of three times the amount of damages sustained by the Commonwealth, and (3) costs of any civil action to recover penalties and damages.

The Virginia Fraud Against Taxpayers Act allows private individuals to file lawsuits in State court. If the suit eventually concludes with payments back to the State, the person who started the case can recover a percentage of the proceeds based on whether the State did or did not participate in the suit.

Whistleblower Protections

Federal False Claims Act (31 U.S.C. 3730(h)) and Virginia Fraud Against Taxpayers Act. An employee who is “discharged, demoted, suspended, threatened, harassed or in any manner discriminated against” because of the employee’s lawful acts under the federal False Claims Act is entitled to reinstatement, double back pay with interest, special damages, and litigation costs and attorneys’ fees.

If you become aware of any compliance issues or have any questions regarding the information contained in this letter, please contact Joseph Matuza, Achieve Beyond’s Corporate Compliance Officer, at (718) 762-7633 (x 190).




To: Achieve Beyond employees and others affiliated with Achieve Beyond

From: Joseph Matuza, Corporate Compliance Officer

Date: August 2016

RE: Compliance Program and Federal Deficit Reduction Act

Achieve Beyond is committed to preventing and detecting fraud, waste and abuse. In support of this commitment, Achieve Beyond has established a Corporate Compliance Program. The purpose of the Corporate Compliance Program is to establish appropriate controls that will help ensure consistent compliance with the federal and State laws which govern our activities, and to detect violations of the law by employees and others affiliated with Achieve Beyond. Achieve Beyond’s Corporate Compliance Program includes the following elements:

  • A Compliance Officer who is responsible for the day-to-day operations of the Corporate Compliance Program.
  • Written standards of conduct, policies and procedures that describes compliance expectations and promote Achieve Beyond’s commitment to compliance for all employees and others affiliated with Achieve Beyond.
  • A Corporate Compliance Committee that operates and monitors the Corporate Compliance Program and initiates the necessary actions to correct any compliance problems.
  • Regular, effective education and training programs for all employees whose job descriptions include activities that are subject to the Corporate Compliance Program.
  • Procedures to encourage employees and others affiliated with Achieve Beyond to openly bring to the Corporate Compliance Committee’s attention any situation that may be a violation of law or the Corporate Compliance Program without fear of threats, intimidation, retaliation or punishment.
  • A system that allows for confidential and anonymous reporting of compliance issues or concerns.
  • A system to respond to allegations of improper or illegal activities and the enforcement of appropriate disciplinary action against employees who have violated the Corporate Compliance policies.
  • Fairly and firmly enforced disciplinary policies that encourage good faith participation in the compliance program, that articulate expectation for reporting compliance issues and assisting in their resolution and that outline sanctions for: a) failing to report suspected problems; b) participating in non-compliant behavior; or c) encouraging, directing, facilitating or permitting non-compliant behavior.
  • Compliance audits and/or other evaluation techniques to monitor compliance and assist in the reduction of potential problem areas.

A goal of the Corporate Compliance Program is to educate appropriate employees with respect to federal and State statutes and regulations with which they must comply. In this regard, the federal Deficit Reduction Act (“DRA”) requires Achieve Beyond to provide all employees, contractors or agents with “detailed information” about:

  • the federal False Claims Act

  • the federal administrative remedies associated with the False Claims Act

  • California laws pertaining to civil or criminal penalties for false claims and statements

  • whistleblower protections provided under federal and State laws

  • the role of federal and State laws in preventing and detecting fraud, waste and abuse

This letter provides you with the information required by the DRA.

Federal and California Statutes
Related to Filing False Claims and Whistleblower Protections

Numerous federal and State laws prohibit health care providers from submitting “false” or “fraudulent” claims to Medicare and Medicaid and other federally-funded health care programs. Presented below is a listing and description of various federal and State statutes related to the filing of false Medicare and Medicaid claims.

Federal Laws

  1. False Claims Act, 31 U.S.C. 3729-3733.


    The federal False Claims Act imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from Medicare, Medicaid, or other federal health programs. The penalty for filing a false claim is $10,781 - $21,563 per claim and the recoverable damages are between two and three times the value of the amount falsely received. In addition, the false claims filer may have to pay the government’s legal fees.

    The False Claims Act allows private individuals to file lawsuits in federal court, just as if they were federal prosecutors. If the suit eventually concludes with payments back to the government, the person who started the case can recover 25- 30% of the proceeds if the government did not participate in the suit, or 15-25% if the government did participate in the suit.

  2. Administrative Remedies for False Claims, 31 U.S.C. 3801-3812.


    This statute allows for administrative recoveries by federal agencies. If a person submits a claim that the person knows is false, or contains false information, or omits material information, then the agency receiving the claim may impose a penalty of up to $10,781 for each claim. The agency may also recover twice the amount of the claim.

    A violation of this law occurs when a false claim is submitted, not when it is paid. Also, unlike the False Claims Act, the determination of whether a claim is false and the imposition of fines and penalties is made by the administrative agency, not by bringing lawsuits in the federal court system.

California State Laws

  1. California False Claims Act. The California False Claims Act imposes penalties and fines on individuals and entities that knowingly file false or fraudulent claims for payment from Medicaid or other State health programs. The potential penalty for knowingly filing a false claim is (1) $5,500 - $11,000 per claim, (2) payment up to three times the damages sustained by the State or local government, (3) payment of the legal fees of the State or political subdivision.

    The California False Claims Act allows private individuals to file lawsuits in State court. If the suit eventually concludes with payments back to the State, the person who started the case can recover a percentage of the proceeds based on whether the State did or did not participate in the suit.

  2. California Welfare & Institutions Code 14107. This statute establishes grounds for both criminal and civil actions against any person who knowingly defrauds Medi-Cal or other state medical assistance programs by submitting false claims or making false representations. Action may only be brought by State officials as there is no mechanism for private individuals to file qui tam lawsuits. Penalties for a violation of this statute include imprisonment up to five years and/or a fine not exceeding three times the amount or value of the fraud.

  3. California Insurance Code 1871. It is a violation to knowingly submit a false claim for a health care benefit to a private insurer. Actions under this statute may be brought by the district attorney or the Insurance Commissioner of California although a private individual may file a qui tam lawsuit on behalf of the State. The State or district officials may choose to participate in the qui tam lawsuit. If the case is successful, the individual is entitled to a portion of the State’s recovery. Individuals who assist or participate in actions under this statute are protected from workplace retaliation. The potential penalty under this statute is $5,000 - $10,000 and an assessment up to three times the amount of each fraudulent claim. Additionally, there may be a separate criminal prosecution.

Whistleblower Protections

Federal False Claims Act (31 U.S.C. 3730(h)) and California False Claims Act 12650. An employee who is “discharged, demoted, suspended, threatened, harassed or in any manner discriminated against” because of the employee’s lawful acts under the federal and California False Claims Acts is entitled to reinstatement, double back pay with interest, special damages, and litigation costs and attorneys’ fees.

If you become aware of any compliance issues or have any questions regarding the information contained in this letter, please contact Joseph Matuza, Achieve Beyond’s Corporate Compliance Officer, at (718) 762-7633 (x 190).




To: Achieve Beyond employees and others affiliated with Achieve Beyond

From: Joseph Matuza, Corporate Compliance Officer

Date: August 2016

RE: Compliance Program and Federal Deficit Reduction Act

Achieve Beyond is committed to preventing and detecting fraud, waste and abuse. In support of this commitment, Achieve Beyond has established a Corporate Compliance Program. The purpose of the Corporate Compliance Program is to establish appropriate controls that will help ensure consistent compliance with the federal and State laws which govern our activities, and to detect violations of the law by employees and others affiliated with Achieve Beyond. Achieve Beyond’s Corporate Compliance Program includes the following elements:

  • A Compliance Officer who is responsible for the day-to-day operations of the Corporate Compliance Program.
  • Written standards of conduct, policies and procedures that describes compliance expectations and promote Achieve Beyond’s commitment to compliance for all employees and others affiliated with Achieve Beyond.
  • A Corporate Compliance Committee that operates and monitors the Corporate Compliance Program and initiates the necessary actions to correct any compliance problems.
  • Regular, effective education and training programs for all employees whose job descriptions include activities that are subject to the Corporate Compliance Program.
  • Procedures to encourage employees and others affiliated with Achieve Beyond to openly bring to the Corporate Compliance Committee’s attention any situation that may be a violation of law or the Corporate Compliance Program without fear of threats, intimidation, retaliation or punishment.
  • A system that allows for confidential and anonymous reporting of compliance issues or concerns.
  • A system to respond to allegations of improper or illegal activities and the enforcement of appropriate disciplinary action against employees who have violated the Corporate Compliance policies.
  • Fairly and firmly enforced disciplinary policies that encourage good faith participation in the compliance program, that articulate expectation for reporting compliance issues and assisting in their resolution and that outline sanctions for: a) failing to report suspected problems; b) participating in non-compliant behavior; or c) encouraging, directing, facilitating or permitting non-compliant behavior.
  • Compliance audits and/or other evaluation techniques to monitor compliance and assist in the reduction of potential problem areas.

A goal of the Corporate Compliance Program is to educate appropriate employees with respect to federal and State statutes and regulations with which they must comply. In this regard, the federal Deficit Reduction Act (“DRA”) requires Achieve Beyond to provide all employees, contractors or agents with “detailed information” about:

  • the federal False Claims Act

  • the federal administrative remedies associated with the False Claims Act

  • Maryland laws pertaining to civil or criminal penalties for false claims and statements

  • whistleblower protections provided under federal and State laws

  • the role of federal and State laws in preventing and detecting fraud, waste and abuse

This letter provides you with the information required by the DRA.

Federal and Maryland Statutes
Related to Filing False Claims and Whistleblower Protections

Numerous federal and State laws prohibit health care providers from submitting “false” or “fraudulent” claims to Medicare and Medicaid and other federally-funded health care programs. Presented below is a listing and description of various federal and State statutes related to the filing of false Medicare and Medicaid claims.

Federal Laws

  1. False Claims Act, 31 U.S.C. 3729-3733.


    The federal False Claims Act imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from Medicare, Medicaid, or other federal health programs. The penalty for filing a false claim is $10,781 - $21,563 per claim and the recoverable damages are between two and three times the value of the amount falsely received. In addition, the false claims filer may have to pay the government’s legal fees.

    The False Claims Act allows private individuals to file lawsuits in federal court, just as if they were federal prosecutors. If the suit eventually concludes with payments back to the government, the person who started the case can recover 25- 30% of the proceeds if the government did not participate in the suit, or 15-25% if the government did participate in the suit.

  2. Administrative Remedies for False Claims, 31 U.S.C. 3801-3812.


    This statute allows for administrative recoveries by federal agencies. If a person submits a claim that the person knows is false, or contains false information, or omits material information, then the agency receiving the claim may impose a penalty of up to $10,781 for each claim. The agency may also recover twice the amount of the claim.

    A violation of this law occurs when a false claim is submitted, not when it is paid. Also, unlike the False Claims Act, the determination of whether a claim is false and the imposition of fines and penalties is made by the administrative agency, not by bringing lawsuits in the federal court system.

Maryland State Laws

  1. Maryland False Claims Act. The Maryland False Claims Act imposes penalties and fines on individuals and entities that knowingly file false or fraudulent claims for payment from Medicaid or other State health programs. The potential penalty for knowingly filing a false claim is (1) $10,000 per claim, and (2) payment of three times the State’s damages for each false claim.


    The Maryland False Claims Act allows private individuals to file lawsuits in State court and the State must join the suit in order for the suit to proceed. If the suit eventually concludes with payments back to the State, the person who started the case can recover a percentage of the proceeds.

  2. Maryland Medicaid Fraud statute. Individuals who knowingly and willfully defraud or attempt to defraud a State health plan in connection with the delivery of or payment for a health care service or who obtain or attempt to obtain by providing a false statement, record or bill for health care services to the government are guilty of a crime and are subject to penalties including monetary fines, imprisonment and both. Additional sanctions may include suspension or forfeiture of their professional license. Those who violate the Medicaid Fraud statute are also liable to the State for a civil monetary penalty up to three times the State’s damages

Whistleblower Protections

Federal False Claims Act (31 U.S.C. 3730(h)). An employee who is “discharged, demoted, suspended, threatened, harassed or in any manner discriminated against” because of the employee’s lawful acts under the federal False Claims Act is entitled to reinstatement, double back pay with interest, special damages, and litigation costs and attorneys’ fees.

Maryland Whistleblower Law and Maryland Health Care Workers’ Whistleblower Protection Act. An employee who believes he/she is the victim of employer retaliation may seek restitution in the form of: reinstatement to the same or equivalent position; removal of all references to whistleblowing from personnel file; reinstatement with full fringe benefits and seniority rights; compensation of lost wages, benefits and other remuneration; and payment of reasonable costs and attorneys’ fees.

If you become aware of any compliance issues or have any questions regarding the information contained in this letter, please contact Joseph Matuza, Achieve Beyond’s Corporate Compliance Officer, at (718) 762-7633 (x 190).M




To: Achieve Beyond employees and others affiliated with Achieve Beyond

From: Joseph Matuza, Corporate Compliance Officer

Date: August 2016

RE: Compliance Program and Federal Deficit Reduction Act

Achieve Beyond is committed to preventing and detecting fraud, waste and abuse. In support of this commitment, Achieve Beyond has established a Corporate Compliance Program. The purpose of the Corporate Compliance Program is to establish appropriate controls that will help ensure consistent compliance with the federal and State laws which govern our activities, and to detect violations of the law by employees and others affiliated with Achieve Beyond.

Elements of Achieve Beyond’s Corporate Compliance Program include:

  • A Compliance Officer who is responsible for the day-to-day operations of the Corporate Compliance Program.
  • Written standards of conduct, policies and procedures that describes compliance expectations and promote Achieve Beyond’s commitment to compliance for all employees and others affiliated with Achieve Beyond.
  • A Corporate Compliance Committee that operates and monitors the Corporate Compliance Program and initiates the necessary actions to correct any compliance problems.
  • Regular, effective education and training programs for all employees whose job descriptions include activities that are subject to the Corporate Compliance Program.
  • Procedures to encourage employees and others affiliated with Achieve Beyond to openly bring to the Corporate Compliance Committee’s attention any situation that may be a violation of law or the Corporate Compliance Program without fear of threats, intimidation, retaliation or punishment.
  • A system that allows for confidential and anonymous reporting of compliance issues or concerns.
  • A system to respond to allegations of improper or illegal activities and the enforcement of appropriate disciplinary action against employees who have violated the Corporate Compliance policies.
  • Fairly and firmly enforced disciplinary policies that encourage good faith participation in the compliance program, that articulate expectation for reporting compliance issues and assisting in their resolution and that outline sanctions for: a) failing to report suspected problems; b) participating in non-compliant behavior; or c) encouraging, directing, facilitating or permitting non-compliant behavior.
  • Compliance audits and/or other evaluation techniques to monitor compliance and assist in the reduction of potential problem areas.

A goal of the Corporate Compliance Program is to educate appropriate employees with respect to federal and State statutes and regulations with which they must comply. In this regard, the federal Deficit Reduction Act (“DRA”) requires Achieve Beyond to provide all employees, contractors or agents with “detailed information” about:

  • the federal False Claims Act

  • the federal administrative remedies associated with the False Claims Act

  • New York State laws pertaining to civil or criminal penalties for false claims and statements

  • whistleblower protections provided under federal and State laws

  • the role of federal and State laws in preventing and detecting fraud, waste and abuse

This letter provides you with the information required by the DRA.

Federal and Connecticut Statutes
Related to Filing False Claims and Whistleblower Protections

Numerous federal and State laws prohibit health care providers from submitting “false” or “fraudulent” claims to Medicare and Medicaid and other federally-funded health care programs. Presented below is a listing and description of various federal and State statutes related to the filing of false Medicare and Medicaid claims.

Federal Laws

  1. False Claims Act, 31 U.S.C. 3729-3733.


    The federal False Claims Act imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from Medicare, Medicaid, or other federal health programs. The penalty for filing a false claim is $10,781 - $21,563 per claim and the recoverable damages are between two and three times the value of the amount falsely received. In addition, the false claims filer may have to pay the government’s legal fees.

    The False Claims Act allows private individuals to file lawsuits in federal court, just as if they were federal prosecutors. If the suit eventually concludes with payments back to the government, the person who started the case can recover 25- 30% of the proceeds if the government did not participate in the suit, or 15-25% if the government did participate in the suit.

  2. Administrative Remedies for False Claims, 31 U.S.C. 3801-3812.


    This statute allows for administrative recoveries by federal agencies. If a person submits a claim that the person knows is false, or contains false information, or omits material information, then the agency receiving the claim may impose a penalty of up to $10,781 for each claim. The agency may also recover twice the amount of the claim.

    A violation of this law occurs when a false claim is submitted, not when it is paid. Also, unlike the False Claims Act, the determination of whether a claim is false and the imposition of fines and penalties is made by the administrative agency, not by bringing lawsuits in the federal court system.

Connecticut State Laws

It is a crime in Connecticut to fraudulently bill Medicaid or the general assistance program. Anyone who provides services to a Medicaid beneficiary and seeks or accepts payment for unnecessary or improper services is subject to criminal and civil penalties, including possible imprisonment and/or fines, under State law. Depending on the amount of the fraudulent services involved, offenses can carry significant penalties up to and including a 20 year prison sentence and a penalty of up to $15,000. Individuals who defraud the State’s general assistance program will be excluded from participating in the program for at least one year.

Whistleblower Protections

Federal False Claims Act (31 U.S.C. 3730(h)). An employee who is “discharged, demoted, suspended, threatened, harassed or in any manner discriminated against” because of the employee’s lawful acts under the federal False Claims Act is entitled to reinstatement, double back pay with interest, special damages, and litigation costs and attorneys’ fees.

Conn. Gen. Stat. Sec. 4-61dd (Whistleblowing). An employee of a “large State contractor” (e.g., Medicaid) who is disciplined (or a threatened with discipline) as a result of a report of reporting the employer’s corruption, violation of federal or State law or regulations or gross waste of funds can make an administrative complaint to the Chief Human Rights Referee. The Referee may award the employee reinstatement, back pay, reestablishment of employee benefits, reasonable attorneys’ fees and other damages.

Conn. Gen. Stat. Sec. 31-51 (Protection of Employee Who Discloses Employer’s Illegal Activities or Unethical Practices). After going through any required administrative process, any employee who is disciplined for reporting an employer’s violation or suspected violation of any federal, State or local law or regulation or who participates in an investigation a public body may file a court claim. The employee may be entitled to reinstatement, back pay, reestablishment of employee benefits, court costs and attorneys’ fees.

If you become aware of any compliance issues or have any questions regarding the information contained in this letter, please contact Joseph Matuza, Bilinguals Inc’s Corporate Compliance Officer, at (212) 684-0099 (x 190).




To: Achieve Beyond employees and others affiliated with Achieve Beyond

From: Joseph Matuza, Corporate Compliance Officer

Date: August 2016

RE: Compliance Program and Federal Deficit Reduction Act

Achieve Beyond is committed to preventing and detecting fraud, waste and abuse. In support of this commitment, Achieve Beyond has established a Corporate Compliance Program. The purpose of the Corporate Compliance Program is to establish appropriate controls that will help ensure consistent compliance with the federal and State laws which govern our activities, and to detect violations of the law by employees and others affiliated with Achieve Beyond.

Elements of Achieve Beyond’s Corporate Compliance Program include:

  • A Compliance Officer who is responsible for the day-to-day operations of the Corporate Compliance Program.
  • Written standards of conduct, policies and procedures that describes compliance expectations and promote Achieve Beyond’s commitment to compliance for all employees and others affiliated with Achieve Beyond.
  • A Corporate Compliance Committee that operates and monitors the Corporate Compliance Program and initiates the necessary actions to correct any compliance problems.
  • Regular, effective education and training programs for all employees whose job descriptions include activities that are subject to the Corporate Compliance Program.
  • Procedures to encourage employees and others affiliated with Achieve Beyond to openly bring to the Corporate Compliance Committee’s attention any situation that may be a violation of law or the Corporate Compliance Program without fear of threats, intimidation, retaliation or punishment.
  • A system that allows for confidential and anonymous reporting of compliance issues or concerns.
  • A system to respond to allegations of improper or illegal activities and the enforcement of appropriate disciplinary action against employees who have violated the Corporate Compliance policies.
  • Fairly and firmly enforced disciplinary policies that encourage good faith participation in the compliance program, that articulate expectation for reporting compliance issues and assisting in their resolution and that outline sanctions for: a) failing to report suspected problems; b) participating in non-compliant behavior; or c) encouraging, directing, facilitating or permitting non-compliant behavior.
  • Compliance audits and/or other evaluation techniques to monitor compliance and assist in the reduction of potential problem areas.

A goal of the Corporate Compliance Program is to educate appropriate employees with respect to federal and State statutes and regulations with which they must comply. In this regard, the federal Deficit Reduction Act (“DRA”) requires Bilinguals Inc. to provide all employees, contractors or agents with “detailed information” about:

  • the federal False Claims Act

  • the federal administrative remedies associated with the False Claims Act

  • New Jersey laws pertaining to civil or criminal penalties for false claims and statements

  • whistleblower protections provided under federal and State laws

  • the role of federal and State laws in preventing and detecting fraud, waste and abuse

This letter provides you with the information required by the DRA.

Federal and New Jersey Statutes
Related to Filing False Claims and Whistleblower Protections

Numerous federal and State laws prohibit health care providers from submitting “false” or “fraudulent” claims to Medicare and Medicaid and other federally-funded health care programs. Presented below is a listing and description of various federal and State statutes related to the filing of false Medicare and Medicaid claims.

Federal Laws

  1. False Claims Act, 31 U.S.C. 3729-3733.

    The federal False Claims Act imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from Medicare, Medicaid, or other federal health programs. The penalty for filing a false claim is $10,781 - $21,563 per claim and the recoverable damages are between two and three times the value of the amount falsely received. In addition, the false claims filer may have to pay the government’s legal fees.

    The False Claims Act allows private individuals to file lawsuits in federal court, just as if they were federal prosecutors. If the suit eventually concludes with payments back to the government, the person who started the case can recover 25- 30% of the proceeds if the government did not participate in the suit, or 15-25% if the government did participate in the suit.

  2. Administrative Remedies for False Claims, 31 U.S.C. 3801-3812.

    This statute allows for administrative recoveries by federal agencies. If a person submits a claim that the person knows is false, or contains false information, or omits material information, then the agency receiving the claim may impose a penalty of up to $10,781 for each claim. The agency may also recover twice the amount of the claim.

    A violation of this law occurs when a false claim is submitted, not when it is paid. Also, unlike the False Claims Act, the determination of whether a claim is false and the imposition of fines and penalties is made by the administrative agency, not by bringing lawsuits in the federal court system.

New Jersey State Laws

  1. New Jersey False Claims Act. The New Jersey False Claims Act imposes penalties and fines on individuals and entities that knowingly file false or fraudulent claims for payment from Medicaid or other State health programs. The potential penalty for knowingly filing a false claim is (1) $5,500 - $11,000 per claim, and (2) payment of three times the State’s damages for each false claim.

    The New Jersey False Claims Act allows private individuals to file lawsuits in State court. If the suit eventually concludes with payments back to the State, the person who started the case can recover a percentage of the proceeds based on whether the State did or did not participate in the suit.

  2. New Jersey Medical Assistance and Health Services Act. Violations of the New Jersey Medical Assistance and Health Services Act include (1) fraudulent receipt of payments or benefits; (2) false claims statements or omissions, or conversion of benefits or payments; (3) kickbacks, rebates and bribes; and (4) false statements or representations regarding conditions or operations of an institution or facility to qualify for payment. A private individual may bring an action to enforce this statute. The civil penalties for violation of this statute include recovery of overpayments and interest and up to three times the damages and up to $2,000 for each false claim.

  3. New Jersey Health Care Claims Fraud Act. Individuals who knowingly or recklessly provide a false statement, record or bill for health care services to the government are guilty of a crime and are subject to penalties including monetary fines and temporary or permanent suspension or forfeiture of their professional license.

Whistleblower Protections

Federal False Claims Act (31 U.S.C. 3730(h)) and New Jersey False Claims Act. An employee who is “discharged, demoted, suspended, threatened, harassed or in any manner discriminated against” because of the employee’s lawful acts under the federal False Claims Act is entitled to reinstatement, double back pay with interest, special damages, and litigation costs and attorneys’ fees.

New Jersey Conscientious Employee Protection Act. An employee who believes he/she is the victim of employer retaliation may seek restitution in the form of: reinstatement to the same or equivalent position; reinstatement with full fringe benefits and seniority rights; compensation of lost wages, benefits and other remuneration; payment of reasonable costs and attorneys’ fees; and punitive damages. Employers who are found guilty of violating this act may be assessed a civil fine of $1,000 for the first violation and up to $5,000 for each subsequent violation, payable to the State Treasurer.

If you become aware of any compliance issues or have any questions regarding the information contained in this letter, please contact Joseph Matuza, Bilinguals Inc’s Corporate Compliance Officer, at (718) 762-7633 (x 190).