Corporate Compliance for Vendors/Contractors

Corporate Compliance for Vendors/Contractors

St. Elizabeth Physicians (STEP), a Catholic Healthcare organization dedicated to the vision of St. Francis of Assisi and the tradition of the Roman Catholic Church to extend the healing ministry of Jesus Christ to God’s people, demonstrates its commitment to fostering an ethical and moral environment by developing and maintaining a Corporate Compliance Program which promotes sound ethical practices and moral behavior and attempts to minimize instances of improper conduct by individuals throughout STEP.

As a vendor/contractor of STEP, we would like to alert you to some pertinent compliance issues that pertain to our vendors/contractors.

Code of Conduct Statement – The Corporate Compliance Code of Conduct Statement provides guidance to all of STEP, officers, leadership associates, managers, supervisors, associates, contractors, volunteers, students and others who assist in carrying out daily activities within appropriate ethical and legal standards. As a vendor/contractor of STEP, we expect you to abide by this Code of Conduct as well.
Policy: Code of Conduct STEHCC0130

Deficit Reduction Act – On January 1, 2007, the Deficit Reduction Act went into effect. Its purpose is to drastically reduce the national deficit. One way the Deficit Reduction Act seeks to reduce the deficit is through increased emphasis on detecting and preventing fraud, waste and abuse within the states’ Medicaid programs. In order to increase awareness of the laws regarding false claims under the Medicaid program, Section 6032 of the Deficit Reduction Act requires entities that receive or pay annual Medicaid payments of $5 million or more, such as STEP, to establish new written policies for all their employees, and the employees of their contractors and agents, which provide: detailed information regarding the federal False Claims Act; the administrative remedies for false claims and statements; any state law with civil or criminal penalties for false claims or statements; and the whistleblower protections under such laws.

As a vendor/contractor, we are informing you that STE has developed such a policy. Highlights from the policy are provided below. In addition, please familiarize your employees with the policy. If you or any of your employees have questions regarding STEP’s policy regarding False Claims or any other compliance issues, please feel free to contact the Compliance Officer at 743-2463.
Policy: DRA/FCA STEHCC0125

The Federal False Claims Act
      Civil False Claims Act; 31 U.S.C. §§ 3729 – 3733
The False Claims Act (FCA) is a federal law which imposes civil liability on organizations and individuals for knowingly submitting to the federal government a false or fraudulent claim for payment. It applies to all federal programs, from military procurement contracts to welfare benefits to health care benefits.

The False Claims Act prohibits, among other things:
• Knowingly presenting or causing to be presented to the federal government a false or fraudulent claim for payment or approval;
• Knowingly making or using, or causing to be made or used, a false record or statement in order to have a false or fraudulent claim paid or approved by the government;
• Conspiring to defraud the government by getting a false or fraudulent claim allowed or paid; and
• Knowingly making or using, or causing to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the government.

A person or entity found liable under the Civil False Claims Act is subject to a civil money penalty of between $5,500 and $11,000 plus three times the amount of damages that the government sustained because of the illegal act. In health care cases, the amount of damages sustained is the amount paid for each false claim that is filed.
Policy: DRA/FCA STEHCC0125

The Program Fraud Civil Remedies Act of 1986
      31 U.S.C. §§ 3801 – 3812
The Program Fraud Civil Remedies Act of 1986 (PFCRA) authorizes federal agencies such as the Department of Health and Human Services (“HHS”) to investigate and assess penalties for the submission of false claims to the agency. The conduct prohibited by the PFCRA is similar to that prohibited by the False Claims Act.

A violation of this section of the PFCRA is punishable by a $5,000 civil penalty for each wrongfully filed claim, plus an assessment of twice the amount of any unlawful claim that has been paid.

Louisiana Healthcare Claims Fraud Act
      The Louisiana State false claims law titled, ACT NO. 1373, S.B. No. 1559 “Medical Assistance Programs Integrity Law – Claims Review and Administrative Sanctions; Civil Actions: “Qui Tam” Actions.” The Act intends for the Secretary of the Department of Health and Hospitals, the Attorney General, and private citizens of Louisiana to be agents of the state with ability, authority and resources to pursue civil monetary penalties, liquidated damages, or other remedies to protect the integrity of Federal medical assistance programs from fraud, misrepresentation and abuse.

Protection for Whistleblowers
The FCA permits a person with knowledge of fraud against the United States Government to file a lawsuit on behalf of the government against the business that committed the fraud, known as a qui tam action or whistleblower.

Anyone initiating a qui tam case may not be discriminated or retaliated against in any manner by their employer. The employee is authorized under the FCA to initiate court proceedings to make themselves whole for any job related losses resulted from any such discrimination or retaliation.