WHEREAS, the Choices Women’s Medical Center and the Comprehensive Women's Medical Care, P.C., (hereinafter referred to as “CWMC”) are owned and operated pursuant to the laws of the State of New York; and
WHEREAS, its purpose is to serve to provide patient care and education in accordance with the mission of the CWMC and
WHEREAS, it is recognized that the workforce, including but not limited to, employees, contractors, medical staff, volunteers, students, and other persons employed or affiliated with the CWMC is responsible for the quality of medical care in the Center and must accept and discharge this responsibility, subject to the ultimate authority of the Chief Executive Officer of Choices Women’s Center and Vice President of Comprehensive Women’s Medical Care, P.C. and that the cooperative efforts the workforce is necessary to fulfill the Center’s obligations to its patients;
THEREFORE, members of the workforce, including but not limited to, employees, contractors, medical staff, volunteers, students, and other persons employed or affiliated with CWMC practicing in this Center hereby organize themselves in conformity with these Polices.
FALSE CLAIMS PREVENTION POLICY
It is Choices Women’s Medical Center policy to consistently and fully comply with all laws and regulations pertaining to the preparation and submission of claims for items or services provided, or rendered, by Choices Women’s Medical Center or one of its Affiliates to Medicaid or other state or federal health programs (“Public Health Programs”).
For Public Health Programs Claims:
1. The State of New York adopted a false claims act NY False Claims Act (State Finance Law, §§187-194) that contains provisions similar to those under the federal False Claims Act. New York also adopted a Medicaid anti-fraud statute making it unlawful for a person to submit false and fraudulent claims to the New York Medicaid program. Violations of the statute are both civil and criminal in nature, punishable by imprisonment or significant monetary penalties. The NY False Claims Act closely tracts the federal False Claims Act. It imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from any state or local government, including health care programs such as Medicaid. The penalty for filing a false claim is $6,000 -$12,000 per claim and the recoverable damages are between two and three times the value of the amount falsely received.
2. Under the 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 $2,000 per violation. If repeat violations occur within 5 years, a penalty up to $7,500 per violation may be imposed if they involve more serious violations of Medicaid rules, billing for services not rendered or providing excessive services.
For Private Plan Claims:
It is Choices Women’s Medical Center policy to consistently and fully comply with The Health Insurance Portability and Accountability Act of 1996, Title II, Preventing Fraud and Abuse and its implementing regulations.
Employees are held accountable for knowing or believing that information contained in a claim submitted on behalf of Choices Women’s Medical Center is accurate. Employees cannot deliberately or carelessly ignore questionable information contained in claims made to a Public Health Program. Consistent with other Choices Women’s Medical Center policy and our Code of Conduct, employees are responsible for reporting concerns related to a Public Health Program claims to supervisors, Choices Women’s Medical Center Compliance Officer or the Compliance Hotline. Choices Women’s Medical Center takes reports of suspected fraud and abuse seriously and conducts periodic audits to detect and prevent false claims. Employees that lawfully and in good faith report false claims are protected from retaliation by Choices Women’s Medical Center policy and federal and state law.
NOTE: This policy also applies to Choices Women’s Medical Center business arrangements with physicians, contractors, vendors, and other agents impacted by federal or state laws relating to Public Health Program claims.
CODE OF ETHICAL CONDUCT
Choices Women’s Medical Center has adopted this Code of Ethical Conduct as a demonstration of our unwavering commitment to honor all laws and regulations that govern the healthcare industry. The elements of this Code of Ethical Conduct include our Vision, Mission, Values, Basic Principles of Conduct, Standards of Service Excellence and Standards of Professional and Business Conduct and are incorporated into Choices Women’s Medical Center Compliance Program. This Code of Ethical Conduct serves to enhance and continually develop a culture that values compliance from the top-down and fosters compliance from the bottom-up throughout Choices Women’s Medical Center and among all workforce members.
This Code of Ethical Conduct is designed to provide overall guidance; however, it is not possible to address every situation. Guidance that is more specific may be provided in Choices Women’s Medical Center Policies and Procedures or in Choices Women’s Medical Center Employee Handbook. If there is no specific policy, this Code of Ethical Conduct becomes the policy. (If a policy and a Code of Ethical Conduct provision conflict, the policy governs.) This Code of Ethical Conduct is a “living document” meaning that it will be updated periodically to respond to changing conditions. Questions regarding this Code of Ethical Conduct, or any issue, should first be raised by an employee to his or her immediate supervisor, then through the chain of authority up to, and including, the Compliance Officer, or the Director of Human Resources at Choices Women’s Medical Center. Alternatively, issues may be reported confidentially and anonymously to the Compliance Officer.
CHOICES stands for Creative Health Organization for Information, Counseling and Educational Services. We at CHOICES WOMEN'S MEDICAL CENTER firmly believe that in matters of pregnancy and childbearing, women and their lives must come first, and women must be the ones to decide. We are committed to helping women make the best decisions for themselves and their loved ones.
CHOICES is committed to Women's Health throughout their reproductive - and post-reproductive - lives.
We emphasize our philosophy of Patient Power, which means being an informed consumer of medical treatment with the knowledge and information that enables each individual to make appropriate decisions about medical care, whether in the area of general health, surgery or birth control.
To create and deliver high quality medical/surgical treatment, physician and other related Gynecological/Prenatal healthcare services to improve the health and well being of the individuals and communities we serve.
STANDARDS OF SERVICE EXCELLENCE
As we meet and exceed the expectations of our community, we lay the foundation of Customer Service through our Standards of Service Excellence. We work diligently and consistently to build a organization-wide culture of service excellence wherein every employee is responsible and accountable for upholding the following Standards of Service Excellence:
We believe in making positive first impressions our first priority.
Apply the ten-foot rule. Initiate interaction with patients, guests or other employees within ten feet of you with a smile and warm hello. Help the facilities be and look their best. Create a sense of trust and respect with everyone, first impressions set the tone.
We believe in treating others as guests.
Apply the golden rule. Treat others as you wish to be treated. Be friendly and outgoing, show an interest in our patients and coworkers; help them feel welcome and important.
We believe in developing service recovery.
Be a problem solver. Take the initiative to find a solution or someone who can. Another important component of service recovery is to acknowledge, apologize and amend. Finally, turn negative into positive experiences.
We believe in communicating effectively.
Listen to understand. Listen with empathy and always communicate on someone’s level. Give your undivided attention and use appropriate words and tone, remember body language is 55% of the message you communicate.
We believe in serving others from a team-centered approach.
Be accountable for team effort and success. Be a mentor to those needing encouragement and direction. Make patient satisfaction a team effort.
We believe in projecting a positive attitude.
Always speak positively. Remember attitude sets the stage for success or failure. Positive attitude, ambition and enthusiasm are contagious.
We believe in making excellence the goal in everything we do.
Never settle for second best; expect the best from yourself and others. Exceed the expectations of others.
CHOICES WOMEN’S MEDICAL CENTER/COMPREHENSIVE WOMEN’S MEDICAL CARE, P.C. (CWMC) COMPLIANCE PROGRAM
Choices Women’s Medical Center and Comprehensive Women’s Medical Care, P.C. (CWMC) Compliance Program is a comprehensive self-governing program designed to proactively minimize the chances that a violation of law or government regulation occurs within CWMC. It is modeled on the eight basic elements proposed by the federal government’s Office of Inspector General (OMIG) for developing effective Compliance Programs, and includes: (1) Policies and Procedures, (2) Compliance Officer, (3) Training and Education, (4) Open Lines of Communication, (5) Enforcing Disciplinary Standards, (6) Risk Management, and (7) Responding to Detected Deficiencies, and (8) Non-Intimidation and Non-Retaliation Policies. The Compliance Officer reports directly to the Chief Executive Officer of Choices Women’s Medical Center and Vice President of Comprehensive Women’s Medical Care, P.C. and the Compliance Advisory Committee and is responsible for the administration of Choices Women’s Medical Center Compliance Program as well as the day-to-day operation of Choices Women’s Medical Center Compliance Program. Choices Women’s Medical Center Compliance Program is responsible for regulatory, privacy, monitoring and auditing issues, and training.
The Compliance Officer also chairs the Compliance Advisory Committee – a complement of multidisciplinary CWMC leaders. This committee has oversight responsibilities to ensure organization-wide compliance with the fundamental elements of CWMC Compliance Program. In general, the committee addresses various compliance related issues and other applicable projects including but not limited to regulatory developments, internal and external audits and legal issues. Most importantly, the committee seeks to ensure that all compliance objectives are advanced according to expectations and properly executed. In furthering organization-wide compliance, the Compliance Advisory Committee determines the scope of issues that warrant further review by the Committee of Departmental Directors and makes recommendations accordingly. The Compliance Officer, on behalf of the Compliance Advisory Committee, presents regular compliance reports to the Chief Executive Officer of Choices Women’s Medical Center and Vice President of Comprehensive Women’s Medical Care, P.C. and the Compliance Advisory Committee. The Compliance Officer also makes reports directly to the Committee of Departmental Directors from time to time. The diagram below provides an overview of the organizational structure of our Compliance Program:
MONITORING AND AUDITING
Choices Women’s Medical Center Compliance Program has a dedicated team that is responsible for internal monitoring and auditing of documentation, coding, and billing patterns across Choices Women’s Medical Center physician offices and facilities. Coding Assurance audits focus on ensuring that all applicable state and federal laws and regulations are being followed; that underpayments and overpayments are identified early; payments are refunded appropriately when needed; and action plans are developed to mitigate against further occurrences. Additionally, each year the Compliance Advisory Committee develops and executes an internal audit plan derived from the federal government’s annual OIG Annual Work Plan, internal issues of concern, and from various other issues within the healthcare industry. This audit plan is also utilized as an internal risk assessment tool.
TRAINING AND EDUCATION
CWMC Compliance Program provides initial orientation and continuing compliance education for all new and existing employees. In addition, all employees are required to complete annual compliance training. The Compliance Program utilizes in-person training. In-person training includes lunch and learns, attending staff meetings, and periodic rounding throughout Choices Women’s Medical Center. In addition, the Compliance Advisory Committee provides education and training when needed throughout Choices Women’s Medical Center. Education is also provided from outside healthcare consultants when applicable.
PERSONAL OBLIGATION TO REPORT
Choices Women’s Medical Center believes each of its employees has an individual responsibility and duty to report their good faith belief of any violation of this Code of Conduct, Choices Women’s Medical Center policies or applicable law to his or her immediate supervisor, Choices Women’s Medical Center Compliance Program, or the Compliance Hotline and encourages each employee to do so.
MECHANISM FOR REPORTING - COMPLIANCE HOTLINE
Choices Women’s Medical Center operates a Compliance Hotline that reports may be made anonymously to the Compliance Hotline at (718) 349-9100 ext. 409 or if calling internally just dial extension x409. You can send an email to firstname.lastname@example.org that is available for anyone either inside or outside of our organization that may have a compliance concern available 24/7. It is Choices Women’s Medical Center policy to not discriminate or retaliate against employees who report, based on a good faith belief that Choices Women’s Medical Center is not operating in accordance with applicable federal and state laws and regulations.
Choices Women’s Medical Center initiates corrective action and appropriate discipline when internal investigations reveal violations of this Code of Conduct, Choices Women’s Medical Center policies, and federal or state laws, rules, and regulations. Corrective Actions include, without limitation, refunding improper payments, notifying regulatory agencies, correcting the source of errors, and implementing monitoring processes to prevent future violations.
Employee actions which violate Choices Women’s Medical Center Employee Conduct Policy or Employee Handbook can result in counseling reports or dismissal. Please refer to that policy for examples of improper employee conduct.
Choices Women’s Medical Center Code of Conduct is shared with all employees from inception of employment and is repeated with annual compliance training, which is incorporated into the employee’s annual review and must be completed by all employees. Each employee must acknowledge in writing that he/she received a copy of this Code of Conduct, understands it, and commits to honor it. This acknowledgement is maintained in the employee’s personnel file in the Human Resources Department.
Choices Women’s Medical Center provides a copy of this Code of Conduct to Vendors and Contractors as a condition of conducting business. Like Choices Women’s Medical Center employees, Vendors, and Contractors must acknowledge in writing that they received a copy the Code of Conduct, understand it, and commit to honor it. This acknowledgement is maintained on file in the Purchasing Department.
STANDARDS OF PROFESSIONAL AND BUSINESS CONDUCT
Please refer to Choices Women’s Medical Center policies and procedures for additional details regarding each Standard.
Patients and Communities served:
Choices Women’s Medical Center is committed to providing quality health care in a manner that is appropriate, medically necessary and efficient without discrimination due to age, disability, race, color, religion, national origin or ability to pay. Choices Women’s Medical Center strives to provide considerate and respectful care with recognition of patient’s dignity and right to privacy.
Choices Women’s Medical Center employees, Medical Staff Members, and Allied Health Professionals are properly credentialed, experienced and licensed to meet the needs of Choices Women’s Medical Center patient population. To the extent possible, the patient (or the patient’s representative) is involved in decisions regarding care delivered.
Generally, the patient’s health care provider or designee will inform patients about the therapeutic alternatives and risks associated with the care the patient seeks and obtain the informed consent of the patient or patient representative. To the extent possible, information will be provided in a language that the patient can understand.
Coding, Billing, and Accounting for Patient Services, Medical Necessity, and Covered Benefits
Choices Women’s Medical Center provides patients with services or items that are medically reasonable, necessary, and appropriate. Choices Women’s Medical Center submits claims for payment to all payers, including government, private insurance and individuals, for the services and items provided. Choices Women’s Medical Center personnel who are responsible for providing services, documenting, coding, billing, and accounting for patient care services work hard to ensure accuracy in the foregoing activities, compliance with all applicable state, federal, and payer regulations that apply due to Choices Women’s Medical Center participation in Medicare, Medicaid, and other state and federal government programs (“public health programs”), Choices Women’s Medical Center policies and procedures pertinent to these activities and the Compliance Program. Choices Women’s Medical Center prepares and submits cost reports and associated documentation according to all applicable regulations and contracts.
Choices Women’s Medical Center understands that patients expect to know the identity and qualifications of all Choices Women’s Medical Center employees, Medical Staff Members and Allied Health Professionals who provide services to them and to receive information regarding policies, procedures, and charges. All such personnel are required to wear identification badges which identify their name, title, affiliation with Choices Women’s Medical Center and photograph. Choices Women’s Medical Center instructs its employees to answer all questions from patients promptly and courteously or to refer the patient to an appropriate source.
Choices Women’s Medical Center provides an emergency medical screening examination and necessary stabilization of patients and treats pregnant women in labor regardless of the patient’s ability to pay or insurance status. Provided the Choices Women’s Medical Center facility has the capacity and capability, anyone with an emergency medical condition is treated. Patients with emergency medical conditions are only transferred upon the patient’s request or if the patient’s medical needs cannot be met at the Choices Women’s Medical Center facility and appropriate care is available elsewhere.
FREEDOM OF CHOICE
When referring patients to providers of designated health services, such as Deliveries and prenatal transfers for emergency services or care at Elmhurst Hospital, medical equipment suppliers, or other medical professionals, Choices Women's Medical Center respects and honors a patient's right to choose his or her own providers. Choices Women’s Medical Center also respects and honors, to the extent legally permitted a patient’s right to refuse treatment.
PERSONAL AND CONFIDENTIAL PATIENT INFORMATION
Choices Women’s Medical Center makes all efforts to protect personal and confidential or privileged information about Choices Women’s Medical Center patients. Choices Women’s Medical Center abides by federal privacy and security regulations, including HIPAA, and applicable state laws. Our Notice of Privacy Practices informs patients about how we treat their health information. Choices Women’s Medical Center employees are trained about privacy and security regulations as these regulations apply to their duties. Confidential patient information is disclosed only on a “need to know” basis.
Adherence to Antitrust Laws
Choices Women’s Medical Center avoids engaging in anti-competitive behavior or agreements that restrain trade.
CONFLICTS OF INTEREST
Choices Women’s Medical Center requires its employees to conduct their clinical activities and personal business in such a manner as to avoid potential or actual conflicts of interest.
CREATION AND RETENTION OF RECORDS
Choices Women’s Medical Center retains ownership of all patient records it creates. Choices Women’s Medical Center works hard to ensure that patient records are accurately prepared, securely maintained and retained as prescribed by law and Choices Women’s Medical Center policy. Accurate records are required for Choices Women’s Medical Center to retain applicable licensure and accreditation.
GOVERNMENT REQUESTS FOR INFORMATION, SUBPOENAS AND SEARCH WARRANTS
Choices Women’s Medical Center cooperates with appropriately authorized governmental (federal, state and local) investigations and audits. If an investigator wishes to speak to a Choices Women’s Medical Center employee, the employee has the right to consult with the Compliance Officer and if needed CWMC outside legal counsel or a personal attorney. Consulting with an attorney does not mean the employee is unwilling to cooperate.
MARKETING AND EXTERNAL RELATIONS
Choices Women’s Medical Center adheres to fair business practices and fairly, accurately, and honestly represents itself and the products and services of the Center. Refusing Gifts and Tips and Preventing Improper Referrals, Kickbacks, and Influences on Clinical Decisions.
Choices Women’s Medical Center does not permit its employees to accept nor offer, for themselves or for the Center, gifts, tips, personal gratuities or anything of value from/to patients, vendors, or others, in exchange for referrals of business or the referral of patients. Choices Women’s Medical Center honors Federal regulations that prohibit referral of a patient to an entity in which a physician has a financial interest, and that prohibits Choices Women’s Medical Center to accept payment or other similar benefit in exchange for referrals of patients covered by Medicare or Medicaid.