A code of conduct is simply one piece of an overall compliance plan.
It puts forth a number of core concepts that should be incorporated
into the compliance plan. Often, a surgery center will have a difficult
time administering and starting to put together a comprehensive
compliance plan.
A code of conduct is simply one piece of an overall compliance plan. It puts forth a number of core concepts that should be incorporated into the compliance plan. Often, a surgery center will have a difficult time administering and starting to put together a comprehensive compliance plan. This is not an excuse for not having a compliance plan. However, even in these surgery centers, it can be very easy for a surgery center to develop a code of compliance that serves as standard rules by which the surgery center operates. This can become the mantra and the cornerstone of a culture of compliance that every surgery center should have. These items set forth below are the introduction to the pieces of a compliance plan that a surgery center should have. We hope that you find this helpful.
The Center strives to provide quality health care services to the community. The Center's values and goals include the achievement of excellence in the treatment of the patients and the compliance with all laws applicable to the Center's operations. The operation of the Center in compliance with all laws shall take precedence at all times over any interest in generating profits. All references herein to "owners" of the Center shall include both direct and indirect owners. The Center, in its business and clinical operations, will strive to abide by the following principles:
1. The Center, each owner, and each employee shall use best efforts to protect the confidential information of patients and families of patients.
2. The Center, each owner, and each employee will abide by all policies applicable to such person's positions with the Center, as well as all state and federal laws and conditions of participation in health care reimbursement programs.
3. The Center, the owners, and the employees will not encourage or participate, directly or indirectly, in activities such as theft, bribery, kick backs, misappropriation, false statements, submission of false claims, discrimination, boycotts, price fixing, or violations of environmental or work place safety laws.
4. The Center, the owners, and the employees will not make any payment, or offer to make any payment, whether in cash or in kind, to any physician, patient, hospital, facility, or other party in order to induce the referral of patients or other items or services to the Center.
5. The Center shall not enter into relationships with any person or entity that may refer business to the Center unless such arrangements involve compensation for fair market value and the arrangements are fully compliant with all laws. No such arrangement shall take into account the volume or value of referrals by such person.
6. The Center will only bill for services in a manner that is legally appropriate. Owners and employees who are involved with billing functions will not submit any claims for amounts other than in accordance with the Center's policies. In the event that any owner or employee discovers any intentional or unintentional improper billing practices (including the submission of any false claim), such person shall immediately report it to the appropriate Center personnel.
7. Owners and employees who refer patients for services to the Center will only refer patients for services or procedures that are medically necessary or cosmetic in nature. Services that are neither medically necessary nor cosmetic in nature shall not be performed at the Center.
8. The Center, each owner, and each employee shall treat all patients (including Medicare, Medicaid, and indigent patients) in a non-discriminatory manner in accordance with Center policies regarding acceptance of patients.
9. The Center shall not offer shares in exchange for referrals. Shares in the Center may only be sold at fair market value, and the sale of more or less shares depending on the referrals generated by such person is strictly prohibited.
10. All distributions of Center earnings shall be based on the number of shares held by the owners and shall in no way be based on the volume or value of referrals to the Center.
11. Each owner shall notify patients of his or her financial interest in the Center if he or she refers such patients to the Center.
12. Each owner and employee shall treat all patients, Center personnel, and other members of the community with dignity, respect and compassion.
13. The Center, each owner, and each employee will maintain a safe working environment, will fulfill all duties in a safe manner, and will notify the proper Center personnel immediately of any hazard, injury, equipment problem, or other potential safety issue.
14. If an owner or employee becomes aware that any Center staff or owner or other person providing services to the Center has engaged in any of the behavior prohibited above, such person must notify the appropriate Center personnel.
15. The Center and each owner will strive to maintain compliance with the ambulatory surgery center Safe Harbor to the Federal Anti-Kickback Statute, and, except to the extent of efforts to comply with the one third tests of the ambulatory surgery center Safe Harbor, the Center, the owners, and the employees will not pressure any person or entity to refer patients or cases to the Center. In furtherance of such, the following principles shall be followed:
The Center strives to provide quality health care services to the community. The Center's values and goals include the achievement of excellence in the treatment of the patients and the compliance with all laws applicable to the Center's operations. The operation of the Center in compliance with all laws shall take precedence at all times over any interest in generating profits. All references herein to "owners" of the Center shall include both direct and indirect owners. The Center, in its business and clinical operations, will strive to abide by the following principles:
1. The Center, each owner, and each employee shall use best efforts to protect the confidential information of patients and families of patients.
2. The Center, each owner, and each employee will abide by all policies applicable to such person's positions with the Center, as well as all state and federal laws and conditions of participation in health care reimbursement programs.
3. The Center, the owners, and the employees will not encourage or participate, directly or indirectly, in activities such as theft, bribery, kick backs, misappropriation, false statements, submission of false claims, discrimination, boycotts, price fixing, or violations of environmental or work place safety laws.
4. The Center, the owners, and the employees will not make any payment, or offer to make any payment, whether in cash or in kind, to any physician, patient, hospital, facility, or other party in order to induce the referral of patients or other items or services to the Center.
5. The Center shall not enter into relationships with any person or entity that may refer business to the Center unless such arrangements involve compensation for fair market value and the arrangements are fully compliant with all laws. No such arrangement shall take into account the volume or value of referrals by such person.
6. The Center will only bill for services in a manner that is legally appropriate. Owners and employees who are involved with billing functions will not submit any claims for amounts other than in accordance with the Center's policies. In the event that any owner or employee discovers any intentional or unintentional improper billing practices (including the submission of any false claim), such person shall immediately report it to the appropriate Center personnel.
7. Owners and employees who refer patients for services to the Center will only refer patients for services or procedures that are medically necessary or cosmetic in nature. Services that are neither medically necessary nor cosmetic in nature shall not be performed at the Center.
8. The Center, each owner, and each employee shall treat all patients (including Medicare, Medicaid, and indigent patients) in a non-discriminatory manner in accordance with Center policies regarding acceptance of patients.
9. The Center shall not offer shares in exchange for referrals. Shares in the Center may only be sold at fair market value, and the sale of more or less shares depending on the referrals generated by such person is strictly prohibited.
10. All distributions of Center earnings shall be based on the number of shares held by the owners and shall in no way be based on the volume or value of referrals to the Center.
11. Each owner shall notify patients of his or her financial interest in the Center if he or she refers such patients to the Center.
12. Each owner and employee shall treat all patients, Center personnel, and other members of the community with dignity, respect and compassion.
13. The Center, each owner, and each employee will maintain a safe working environment, will fulfill all duties in a safe manner, and will notify the proper Center personnel immediately of any hazard, injury, equipment problem, or other potential safety issue.
14. If an owner or employee becomes aware that any Center staff or owner or other person providing services to the Center has engaged in any of the behavior prohibited above, such person must notify the appropriate Center personnel.
15. The Center and each owner will strive to maintain compliance with the ambulatory surgery center Safe Harbor to the Federal Anti-Kickback Statute, and, except to the extent of efforts to comply with the one third tests of the ambulatory surgery center Safe Harbor, the Center, the owners, and the employees will not pressure any person or entity to refer patients or cases to the Center. In furtherance of such, the following principles shall be followed:
A. Any services provided to the Center by owners or other persons or entities will be provided pursuant to a written contractual arrangement directly with the Center or an affiliate. Any such contract, whether it is directly between the Center and physician owner or other person or entity, a subcontract with an affiliate, or otherwise, will be negotiated and entered into by all parties at arm's-length.
B. Any services by owners to the Center shall be legitimately needed services and shall be clearly enumerated in the contract. All such services shall also be necessary to the maintaining or improving the quality and/or efficiency of the Center's operations.
C. No physician owner or other person or entity will receive any compensation or remuneration, either directly or indirectly, from the Center, or any affiliate of the Center, that is related to the volume or value, or potential volume or value, of such physician's or other person's or entity's referrals of patients to the Center (i.e. based on such physician or other person or entity's referrals).
D. Neither the Center nor any affiliate of the Center will provide any incentive to owners to refer patients to the Center and the Center will not withhold any compensation from any owners who do not refer patients to the Center.
E. No owner, except as specifically required under the ASC Safe Harbors, shall be required to perform services to the Center and all contracts pursuant to which owners provide services to the Center should clearly state the same.
F. No physician owner shall condition referrals to another physician or otherwise require another physician to perform cases referred by such first physician at the Center.
G. No physician shall be admitted as an owner or allowed to become or remain an owner based on his or her ability to generate referrals for other physicians.