Corporate Compliance Procedure -- Billing & Claims Submission

SUBJECT:     Reporting of Potential Compliance Violations

DIRECTIVE:

This procedure is established for reporting, investigating and resolving potential violations of the law at Van Buren Community Mental Health Authority.  

PROCEDURES:

1. Reporting of Potential Violations:  Van Buren Community Mental Health personnel suspecting or discovering a potential violation or receiving a report of a violation from another party have an affirmative duty to report such violation in writing, in person, or by telephone to a supervisor, the CEO, the Corporate Compliance Officer, or anonymously, through Van Buren Community Mental Health Authority’s compliance hotline.
   1. Substantive requirements that may give rise to a violation are described in Van Buren Community Mental Health Authority’s Corporate Compliance Plan.
   2. Van Buren Community Mental Health Authority personnel reporting a violation should discuss the situation only with supervisors, the CEO, or the Corporate Compliance Officer in order to maintain the confidentiality of the effected parties.
2. Reports to a Supervisor:  If a supervisor receives a report of a potential violation, the supervisor will notify the Corporate Compliance office with in twenty-four (24) hours.  The supervisor should not document or discuss the situation with other parties.
3. Reports to the Compliance Hotline:  If the compliance hotline receives a report of a potential violation, the person monitoring the compliance hotline will document its discussion by completing a Confidential Corporate Compliance Report.  The Report will be provided to the Corporate Compliance Officer within twenty-four (24) hours of receiving notification of a potential violation.
4. Reports to the Corporate Compliance Officer:  As soon as the Corporate Compliance Officer is notified, he/she will prepare a Confidential Corporate Compliance Report if one has not been completed.  Within seven (7) working days of receiving the notification the Corporate Compliance Officer will conduct an initial investigation based on the report and coordinate with legal counsel if necessary.  The reporting party, supervisor (if applicable), and others involved or interviewed, will be instructed to discuss the matter only with the Corporate Compliance Officer, Van Buren Community Mental Health’s legal counsel and members of the Corporate Compliance Committee, as requested, in order to maintain the confidentiality of all effected parties.
5. Assessment of Reported Violations:  The Corporate Compliance Officer (potentially in consultation with legal counsel) will make an initial determination as to whether the situation documented in the Confidential Corporate Compliance Report represents a serious or a potentially serious violation.  Serious violations are those that could result in significant civil liability, criminal prosecution, exclusion from Medicare or Medicaid programs or other major sanctions.  Overpayment situations involving federal or state programs are generally deemed serious in nature.
6. Violations Deemed Non-Serious in Nature:  If a potential violation is determined not to be potentially serious, any further investigation or necessary action will be coordinated by the Corporate Compliance Officer
   1. Upon investigation, the Corporate Compliance Officer may determine that a Corrective Action Plan is necessary.  Specific steps in the Corrective Action Plan may involve recommending and enforcing appropriate disciplinary action against employees who have violated internal compliance policy/procedure, applicable statues, regulations or requirements of federal, state or private plans.  Other steps recommended under a Corrective Action Plan may include revising a policy and/or procedure, recommending additional education and training for an identified risk and/or other action deemed necessary by the Corporate Compliance Officer.
   2. If the Corporate Compliance Officer determines, upon investigation, that no action is necessary, he/she will indicate in the Confidential Corporate Compliance Report the manner in which the matter was resolved and place the report in a confidential file.
7. Violations Deemed Serious in Nature:  If a violation is deemed serious or potentially serious, the Corporate Compliance Officer must notify the Chief Operating Office and/or Chief Executive Officer and, Corporate Compliance Committee immediately. At any time after a report is filed, or during the investigation, the Corporate Compliance Officer can recommend to the Chief Executive Officer the removal of an employee by means of transfer or suspension until the matter is resolved.  The Corporate Compliance Officer will notify the Chief Operating Officer and Human Resource Manager immediately of such action.  If the violation has occurred by a contract provider, the Corporate Compliance Officer will recommend to the Chief Executive Officer and/or the Chief Operating Office appropriate action up to and including termination of the contract.  The Corporate Compliance Officer will give the Chief Operating Officer and/or the Chief Executive Officer notice of the recommendation and action taken against a contract provider.
   1. The Corporate Compliance Officer will engage legal counsel as necessary. The Corporate Compliance Officer will consider whether it is necessary and appropriate to retain an outside consultant to perform an audit.  In the event an outside audit is deemed necessary, legal counsel will engage the auditor in order to keep the investigation under the attorney-client privilege, to the extent possible.  The Corporate Compliance Officer will provide the terms of engagement including maximum cost, to the Chief Operating Officer and/or Chief Executive Officer. The Corporate Compliance Officer may notify the governing Board as appropriate.  If deemed appropriate and necessary the Corporate Compliance Officer may go directly to the Board Chairperson. 
   2. The Corporate Compliance Officer with the assistance of legal counsel (if counsel is retained) will perform a risk assessment and develop an action plan for investigating the violation.  Factors to be considered in assessing risk and developing an action plan include the following:  the nature and scope of the potential violation, the length of time the situation has existed, additional resources necessary to complete the investigation, and an estimate of the potential financial impact on Van Buren Community Mental Health Authority.
   3. At the conclusion of the investigation or self-audit, the Corporate Compliance Officer will discuss with legal counsel whether a voluntary self-disclosure obligation exists.  If such an obligation is deemed to exist, legal counsel in consultation with the Corporate Compliance Officer, Chief Operating Officer and/or Chief Executive Officer, will determine the nature and content of the disclosure.
   4. Based on the findings of the investigation, a detailed Corrective Action Plan will be developed.  The Corrective Action Plan will include issues identification, a description of findings, recommendations, identification of those responsible for follow-up and a target date for completion.  Investigations involving identified systemic problems may involve the development of procedures. The Corporate Compliance Officer will approve all Corrective Action Plans for serious violations.
8. Compliance Monitoring:  Van Buren Community Mental Health Authority will use audits and other evaluative techniques to monitor its compliance efforts and assist in the reduction of identified problem areas.
1. The Corporate Compliance Officer will provide periodic statistical reports to the Corporate Compliance Committee on the number of violations received from Van Buren Community Mental Health Authority personnel, the number of confirmed and the number requiring a Corrective Action Plan.
2. The Corporate Compliance Officer will be responsible for monitoring the implementation and effectiveness of all Corrective Action Plans and for providing summary reports with such information to the Corporate Compliance Committee, Chief Operating Officer and Chief Executive Officer.