ComForCare

Code of Conduct; Fraud; False Claims

The Company has adopted a formal Code of Conduct to provide standards for all ComForCare employees to follow in the conduct of their jobs for the Company, to establish financial integrity throughout the Company, and to assure compliance with laws and regulations applicable to the operations of the Company.  All employees are required to follow this Code of Conduct.

Medicare/Medicaid Fraud and Abuse: All employees are reminded that, with a few narrow exceptions, it is a federal crime to knowingly and willingly offer or receive any kind of remuneration, in cash or in kind, direct or indirect, overt or covert, one purpose of which is to induce referrals of Medicare or Medicaid clients or the purchasing, leasing, ordering, or arranging of any good, facility, service, or item paid for by Medicare or Medicaid or any other federal health program. It is also a crime to knowingly submit documentation for client services that are false or fraudulent. The Company relies on honest and accurate employee documentation to bill federal, state and private insurance programs. Examples of fraud include, without limitation: documenting for services that were never performed; documenting for the same thing twice; documenting medical services not ordered by the client’s doctor; and having the client or another person clock an employee in or out of their client assignment (e.g., falsifying time records).  All employees are prohibited from committing fraud and abuse when documenting or billing for client services. Any employee who violates these prohibitions will be subject to applicable legal consequences and disciplinary action up to and including immediate discharge.

Federal and State False Claims Laws:  It is a violation of federal and state laws to knowingly submit false or fraudulent claims for payment to the United States or to the state of Indiana.  It is also a crime to knowingly make or use a false statement to get a claim paid or approved.  False claims are prohibited by a number of state and federal laws, including the federal False Claims Act and the Indiana False Claims Act.  

Both the Federal and Indiana False Claims Acts, and other statutes, provide very severe civil monetary penalties for submitting false claims.  Submitting false claims can also lead to being excluded from participation in Medicare, Medicaid and other state or federal healthcare programs.  In addition to these civil penalties, parties submitting false claims may be subject to criminal prosecution under state and/or federal law.

The applicable federal laws are set forth in 31 U.S.C. §§ 3729 – 3732 and 31 U.S.C. § 38. Indiana’s False Claims Act is set forth at I.C. §§ 5-11-5.5-2 to 5-11-5.5-9.  Both the federal and state False Claims Acts include “whistleblower” provisions.  These provisions provide protection for employees who investigate or report an allegedly false claim.  They also protect employees who provide testimony or otherwise assist in a false claim prosecution.  

The protections afforded to whistleblowers include prohibiting terminating, suspending, harassing or otherwise discriminating against an employee who cooperates with or participates in a false claims investigation.  Under both the Federal and Indiana False Claims Acts, an employee with independent knowledge of a false claim may file suit on behalf of the government to enforce the state or federal act.

Code of Conduct - Ethical Considerations and Legal Integrity:  All employees shall perform their assigned duties with honesty, integrity and fairness, in an ethical manner, and in accordance with all laws and regulations applicable to the business of the Company and to the employee’s professional license or job title accreditation.  All employees shall fulfill their professional commitments in good faith and provide their services with objectivity and respect for the independence and unique needs and values of their clients. Employees shall inform the public and colleagues of services only bu use of factual and appropriate information. Employees shall not discriminate against any client on any basis prohibited by law and shall avoid biases in any kind of professional evaluation. Employees shall assume responsibility and accountability for their personal and professional competence when providing services to clients. All professional, licensed and accredited employees shall adhere to acceptable standards for their professional practice. Employees shall maintain the confidentiality of client information in accordance with all applicable laws and policies.

Conduct Standard - Fraud and Abuse:  Each employee shall have knowledge and act in accordance with the prohibitions against fraud and abuse in the provision of services to the clients of the Company, including without limitation thorough assessment and evaluation of a patient’s medically necessary needs and services, timely and accurate reporting/documentation of services, actual and precise time and expense reporting, immediate reporting of any suspected or real fraudulent documentation of services or offer of a bribe, kickback, or disguised payment for service or illegal referrals from other providers or vendors.

Conduct Standard - Conflicts of Interests:  Each employee shall perform his or her job duties free of conflict arising from regard for his or her personal gain, profit or advantage, including but not limited to receipt of gifts or gratuities from clients, clients’ family members, or vendors, self-dealing which conflicts with the interests of the Company, or professional or personal interests which place the Company at risk of non-compliance with all applicable laws and regulations for the operations of its business.  The Company’s Conflicts of Interest – Outside Employment – Copyright Ownership policy in the Employee Handbook is also incorporated into this Conduct Standard in full by this reference.

Conduct Standard - Business Ethics: Each employee shall use candor and honesty in the conduct of his or her job duties and shall transact all business with vendors, contractors and other third parties free from offers or solicitations of gifts, favors, illegal inducement for services or referrals, or other indirect benefits whether such benefits are directed to the Company or the employee. No employee may offer or accept discounts or deviations from customary charges or payments without pre-authorization from management. Gifts or gratuities from clients may only be accepted in accordance with the Agency’s policy or procedure for receipt of such items. The Company and employees shall not advertise or market services in a misleading manner or engage in uninvited solicitation of potential clients who are vulnerable to undue influence, manipulation or coercion. The Company and employees shall provide sufficient objective information to enable a client or client’s representative to make informed decisions. The Company and employees shall timely notify appropriate parties of any unprofessional conduct that may jeopardize a client’s safety or influence the client or client’s representative in any decision-making process.

Conduct Standard - Protection of the Company’s Assets:  Each employee shall preserve and protect the Company’s assets and property by making prudent, efficient use of the Agency’s resources and property and accurately reporting costs and expenditures charged to the Company. Each employee shall refrain from using the Company’s assets for personal use or without proper authorization by management.  Travel and entertainment expenses shall be consistent with the employee’s job responsibility and, where applicable, properly authorized by management.

Conduct Standard - Reporting of Illegal Conduct:  Employees must report any direct or indirect act which may place the Company at risk of fraud or abuse or of the rules for participation in, or reimbursement by, the Medicare or Medicaid program, another publicly funded or third-party payor, or a private pay arrangement.  The act may be real, suspected or which otherwise raises concern.  As circumstances permit, all reports will remain confidential and anonymous and will be investigated by the Company’s Owner or designee.  No employee will receive retribution or discipline in retaliation for reporting any such incident or act.   

Conduct Standard - Reporting Quality Concerns:  Employees must report any incident or complaint concerning the quality or quantity of services provided by the Company.  Complaints from clients must be submitted to the Company Administrator or Owner as well as all other complaints or incidents.

Conduct Standard - Reporting Violations of this Code of Conduct: Employees must advise the Company’s management of any activity not otherwise addressed in these Code Standards which is true and believed to violate the Code. Reports of violations should be submitted to the Company Administrator or Owner.

Code Standard - False Reporting: To the extent possible, all reports made pursuant to this Code must be legitimate and true in fact as to the actual incidents. Reports of incidents or concerns submitted pursuant to this False Reporting standard or otherwise made to the Company which are false or are made for reasons of personal animosity or gain shall result in disciplinary action up to and including discharge.  

Code Standard - Anti-Retaliation:  Employees may report noncompliance with this Code of Conduct in person or anonymously (as circumstances permit) in the safety suggestion box in the Company office. The Company prohibits retaliation against any individual who reports noncompliance with this Code of Conduct policy, files a suit or testifies, assists, or participates in any enforcement proceeding or hearing.  Any employee who believes he or she has been retaliated against in violation of this Standard should report the incident to the employee’s Supervisor, Company Administrator or Owner as soon as reasonably possible.

Consequences for Noncompliance with the Code of Conduct:  Reported noncompliance will be promptly investigated; systemic or personnel problems will be identified; appropriate corrective and/or disciplinary actions, up to and including discharge, will be taken; and results of such actions will be continuously monitored.  

By signing below, I certify that I have read and understand this Code of Conduct and agree to abide by its Standards.

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Employee’s Printed Name Position

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