If you have a patient care or safety concern that has not been addressed by hospital staff, we encourage you to notify administration at 931-243-3581. If your concern is not resolved by administration you may contact Joint Commission at 1-800-994-6610 or visit their website at www.jointcommission.org
General Description
Purpose:
To establish written guidelines to satisfy the requirements of Section 6032 of the Deficit Reduction Act of 2005 by identifying certain federal and state laws relating to liability for false claims and statements; protections against reprisal or retaliation for those who report wrongdoing; and Cumberland River Hospital’s policies and procedures to detect and prevent occurrences of potential fraud and abuse.
Scope:
All Departments, Entities, and Employees including but not limited to, the hospital, home health agency, psychiatric care, physician practices, and any other affiliated agencies owned or managed by Cumberland River Hospital.
Policy:
It is the policy of Cumberland River Hospital to obey all federal and state laws, to implement and enforce procedures to detect and prevent fraud, waste and abuse regarding payments to Cumberland River Hospital from federal or state healthcare programs, and to provide protections for those who report actual or suspected wrongdoing.
This Policy shall be available to all current Board Members, contractors and agents of Cumberland River Hospital through posting to the Cumberland River Internet and through other means. Information on its subject will be included in the employee handbook.
Explanation of Laws
Set forth below are summaries of certain statutes that provide liability for false claims and statements. These summaries are not intended to identify all applicable laws but rather to outline some of the major statutory provisions as required by the Deficit Reduction Act of 2005.
FEDERAL FALSE CLAIMS ACT
Federal False Claims Act (31 U.S.C. §§ 3729 – 3733)
The Federal False Claims Act (FCA) imposes civil liability on any person or entity who:
• Knowingly files a false or fraudulent claim for payments to Medicare, Medicaid or other federally funded health care program:
• Knowingly uses a false record or statement to obtain payment on a false or fraudulent claim from Medicare, Medicaid or other federally funded health care program; or
• Conspires to defraud Medicare, Medicaid or other federally funded health care program by attempting to have a false or fraudulent claim paid.
“Knowingly” means:
• actual knowledge that the information on the claim is false;
• acting in deliberate ignorance of whether the claim is true or false; or
• acting in reckless disregard of whether the claim is true or false.
A person or entity found liable under the Federal False Claims Act is subject to a civil money penalty of between $5,000 and $10,000 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.
Any person may bring a qui tam action under the Federal False Claims Act in the name of the United States in federal court. The case is initiated by filing the complaint; the complaint remains under seal for at least 60 days, and will not be served on the defendant. During this time, the government investigates the complaint and gathers additional evidence as necessary to determine if it wishes to pursue the case. If the government decides not to pursue the case, the person who filed the action has the right to continue with the case on his or her own.
If the government proceeds with the case, the person who filed the action can receive a percentage of any monetary recovery, depending upon the contribution of that person to the prosecution of the case.
Anti-discrimination
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 loses resulted from any such discrimination or retaliation.
Program Fraud Civil Remedies Act (31 U.S.C. §§ 3801 – 3812)
The Program Fraud and Civil Remedies Act (PFCRA) creates administrative remedies for making false claims and false statements. These penalties are separate from and in addition to any liability that may be imposed under the Federal False Claims Act.
The PFCRA imposes liability on people or entities who file a claim that they know or have reason to know:
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.
In addition, a person or entity violates the PFCRA if they submit a written statement which they know or should know:
Anti-Retaliation “Whistleblower” Protections; Individuals within Cumberland River Hospital who observe activities or behavior that may violate the law are encouraged by the Cumberland River Hospital Code of Conduct to bring information regarding such situations to the attention of hospital management so that any violations can be corrected. Individuals who report their observations either to management or to governmental agencies are provided protections under certain laws. Employees are further protected by CRH’s standards as described in the Restoration Healthcare Corporate Compliance Program.
The Civil False Claims Act states that an employee who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment because of lawful actions taken in furtherance of a qui tam action is entitled to recover damages. The employee also can be awarded litigation costs and reasonable attorneys’ fees.
Role of False Claims Laws: The False Claims Laws described herein are intended to control waste, fraud and abuse in federal and state health care programs by giving appropriate governmental agencies the authority to seek out, investigate and prosecute violations in three available forums – criminal, civil and administrative.
Cumberland River Hospital Policies and Procedures for Detecting and Preventing Fraud: Cumberland River Hospital is committed to detecting and preventing fraud, waste, and abuse. Regular education, monitoring, audits and investigations occur throughout the organization in compliance with the policies, procedures, and Cumberland River Compliance Plan.
Those wishing to report suspected abuse or fraud may do so in the following manners:
Kevin Adcock Ext 186
REFERENCES:
Cumberland River Hospital Corporate Compliance Program: MHS-Admin-01-1006 42 U.S.C. § 1320a-7b; 42 U.S.C. §1001.952(a)-(a); 42 U.S.C. §1395 nn; 66 Fed. Reg. 856, 961-962 (January 4, 2001); 69 Fed. Reg. 16054 (March 26, 2004)
10/01/2007
Pursuant to the Non-Smoker Protection Act, Tennessee Code Annotated 39-17-1801-1710, smoking is prohibited in enclosed areas of Company property, including but not limited to, cafeterias, employee lounges, hallways, meeting rooms, offices, restrooms, and Company vehicles (unless solely occupied by the operator). Smoking may take place only in designated unenclosed areas. Any violation of this provision may result in disciplinary action, up to and including termination.