CNSCares, any subdivision of CNSCares, as well as any entity related to CNSCares in any way, has developed a Corporate Code of Conduct to provide those individuals associated with its administration, including all Personnel, with guidance on requirements for conduct related to employment or engagement by the Company.
This Corporate Code of Conduct will describe important parts of the Corporate Compliance Program, including (but not limited to) critical areas such as confidentiality, patient rights, and specific areas of potential fraud, waste and abuse. This Corporate Code of Conduct applies to all Company Personnel, who shall comply with all applicable Federal and State laws, regulations, and Company policies, whether specifically addressed in the Corporate Code of Conduct or not.
B. CODE OF CONDUCT STANDARDS: The following principles, procedures, and laws govern the behavior of Company Personnel at CNSCares:
1. REPORTING: In all instances, it is important that Company Personnel promptly report in good-faith any perceived violation of applicable laws, regulations, or governmental requirements to the appropriate supervisor, Chief Compliance Officer (or her designee), or to the confidential hotline that is available twenty-four (24) hours a day. Any Personnel outside of the CNSCares compliance department who receives a report of potential misconduct is required to escalate those concerns to the compliance team. CNSCares will not retaliate or discriminate against any Company Personnel in response to a good-faith reporting of a suspected, perceived or actual violation.
2. EDUCATION AND TRAINING: CNSCares has developed an effective compliance training and education program and provides compliance training during new hire orientation and on an ongoing basis. Compliance training, as described further in this Corporate Code of Conduct, is mandatory for all current and future employees and other applicable Company Personnel.
3. QUALITY PATIENT CARE AND PROFESSIONALISM: The overall behavior of Company Personnel is guided by the principles set forth herein and any related applicable governing documents and policies. Underlying this policy is the principle that all patients, Company Personnel, physicians, and visitors deserve to be treated with dignity, respect, and courtesy. All treatment decisions must be based solely on medical necessity and be in the best interest of the patient.
Company Personnel are expected to act in a professional manner at all times and in all interactions with patients and with others interacting with our Company. Professionalism includes being empathetic and compassionate, being accountable, being respectful, and maintaining appropriate boundaries with patients. Company Personnel must utilize Company assets wisely to protect against loss, theft, and misappropriation and must not misappropriate or engage in the unauthorized use of Company or patient property or funds.
4. INVESTIGATIONS AND SANCTIONS: Allegations and reports of any suspected violations will be evaluated and investigated as necessary. Sanctions will be imposed for violations of this Corporate Code of Conduct, any CNSCares policy, or any governing law, statute or regulation. Violations of Company policies or this Corporate Code of Conduct may subject an individual to disciplinary action, up to and including termination of employment with CNSCares. Additionally, any such individual may also be subject to criminal and/or civil penalties as applicable.
CNSCares will reasonably cooperate with all appropriate government or third-party inquiries and audits. It is the Company’s intent to respond to inquiries in a complete, timely, and properly coordinated manner so that the rights of those involved are protected. If any CNSCares employee receives an investigative demand, subpoena, or search warrant involving the Company, it should be immediately brought to the Chief Compliance Officer, or her designee, or any member of the Company’s Senior Leadership Team.
Any overpayments identified during routine monitoring, internal audits, or investigations and confirmed by the Company’s Chief Financial Officer or any other member of the Senior Leadership Team shall be refunded in accordance with applicable regulations, any instructions from the payor, or in accordance with the instructions provided to the Company by the Chief Compliance Officer or outside counsel. Any CNSCares employee who identifies a potential overpayment should report it to the Company’s Chief Financial Officer or Chief Compliance Officer as soon as the issue is suspected or known.
5. BILLING: All Company Personnel involved in any aspect of billing should ensure that all codes used are accurate and appropriate for the items or services provided. Company Personnel involved in any aspect of billing are also responsible for remaining informed of changes in the coding and reimbursement policies of federal and state agencies and private sector companies. Company Personnel should timely submit accurate and complete information to any such agency, corporation or firm. Federal and state health care programs and third-party payors must only be billed for approved, medically necessary and appropriate services.
6. GIFTS, GRATUITIES AND BUSINESS COURTESIES: Company Personnel shall not seek or accept personal gains (such as Gifts and Gratuities, meals, transportation and entertainment), directly or indirectly, from anyone soliciting business from, or doing business with, the Company, or from any person or entity in competition with the Company, except actions protected by the National Labor Relations Act. If any Company Personnel member receives an offer of gifts or gratuities that the Company Personnel member believes is intended to influence a business decision, the offer should be declined and reported to the Chief Compliance Officer, or her designee, immediately.
Company Personnel are expected to deal with advisors, suppliers or Independent Contractors who best serve the needs of Company as to price, quality, and service and are expected to pay Fair Market Value for materials and services provided. It is the policy of CNSCares to permit, in accordance with applicable laws and Company policies, limited items of Nominal Value and Business Courtesies as part of its approved marketing-related activities. It is the policy of CNSCares that any items, whether Gifts, Gratuities or Business Courtesies, are not provided to influence any patient or potential patient’s decision to choose the Company as their in-home service provider or in an effort to induce or rewards referrals to CNSCares.
CNSCares will track the provision of Gifts to current patients utilizing a Nominal Gift log to ensure compliance with the annual limit of $75. The log should include, at minimum, the patient name, date, item type, and amount paid for the item.
7. LICENSING: CNSCares is committed to compliance with all state and federal regulations regarding the licensing of those physicians and other health care providers who are Company Personnel. No Company Personnel member may offer to assist or assist anyone in circumventing the licensing requirements set forth by the Federal Government, any state licensing board or regulatory agency. Each Company Personnel member is responsible for maintaining a valid professional license as required by his or her position. Licensed or certified employees are required to immediately notify the Company of any adverse action against their license or certification.
8. CONFLICTS OF INTEREST: A Conflict of Interest exists whenever an individual’s interests appear to, or in fact, interfere or conflict in any way with the interests of the Company. Any business, financial or other relationship with suppliers, vendors, customers, or competitors that might impair or appear to impair, the exercise of judgment solely for the benefit of the Company is prohibited unless specifically reviewed and approved in writing by the Chief Compliance Officer, or her designee.
Company employees shall disclose any potential Conflicts of Interest at time of hire and immediately notify the Chief Compliance Officer, or her designee, whenever a potential or actual Conflict of Interest arises during the course of employment. Additionally, the Company will comply with any federal, state and local government guidelines related to any specific restrictions and rules on Conflicts of Interest.
Transactions or other commercial relationships between the Company and any company or firm in which any Company Personnel member has an ownership interest can give rise to an actual or perceived Conflict of Interest. Gifts to a Company Personnel member by a supplier, vendor, customer or competitor of the Company shall be reported to the Chief Compliance Officer, or her designee.
9. LOBBYING AND POLITICAL CONTRIBUTIONS AND ACTIVITIES: CNSCares encourages its employees to participate actively in civic affairs and the political process. However, federal laws and the statutes of most states prohibit the Company from contributing to political candidates or political parties. Employees may participate in partisan political activities only in their individual capacities, and at their own expense. All Company Personnel are prohibited from using Company funds to support, either directly or indirectly, any political candidate or political parties inside or outside the United States.
CNSCares is committed to abiding by the laws and regulations relating to the lobbying of federal, state and local officials on its behalf. This encompasses reporting or certification requirements including, for example, the disclosures required by any state in which the Company operates. For this reason, lobbying activities and related expenditures should be pre-approved by the Company’s Chief Compliance Officer, or her designee, and the Senior Leadership Team.
10. ANTI-CORRUPTION: CNSCares will not tolerate bribery, kickbacks, or corruption of any kind, directly or through third-parties. Company Personnel are not permitted to give or offer anything of value (including Gifts, Gratuities, and Business Courtesies) to anyone to improperly obtain or retain a business advantage. Similarly, Company Personnel may not solicit or accept such improper items or payments.
Company Personnel shall not be permitted to pay or receive bribes. Company Personnel must conduct their activities in full compliance with Company policies, the laws of the United States and all applicable anti-corruption laws/anti-kickback laws and regulations, including the United States Foreign Corrupt Practices Act. Certain Business Courtesies, including entertainment, travel and lodging, provided to non-employees or other non-Company Personnel (for example, to patients, health care professionals, government officials, etc.) should be pre-approved by the Chief Compliance Officer, or her designee.
11. MEDIA AND PUBLIC RELATIONS: Information disseminated about the Company must be accurate, truthful and transparent. For this reason, the Chief Compliance Officer, or her designee, is responsible for the Company’s internal and external communications, including communication with spokespersons in both routine and crisis situations. Company Personnel are prohibited from making statements on behalf of the Company unless expressly authorized by the Chief Compliance Officer, or her designee, or a member of the Senior Leadership Team.
12. CONFIDENTIAL INFORMATION PROTECTION: CNSCares is committed to maintaining the confidentiality of patient, Personnel, and proprietary business information in accordance with applicable legal and ethical standards and internal policies. Company Personnel must not access, use, or disclose any patient or confidential proprietary business information of the Company or any third-party, except to the extent necessary to perform professional job duties.
13. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) POLICY: The Company has a comprehensive HIPAA Policy to help maintain awareness of and compliance with all applicable data security laws and HIPAA’s privacy, security, and breach notification rules. The HIPAA Policy includes important procedures for reporting perceived HIPAA issues and for establishing and implementing HIPAA training. All Company Personnel should review, understand, and comply with the HIPAA Policy that is found in Company’s Policy Manual.
14. RECORD RETENTION: Records shall be kept in accordance with the Company’s record retention policies and practices, as well as any applicable state and federal laws. This includes practices regarding retention periods of all hard copy and electronically maintained records, including contracts, books, documents, and financial records related to the provision of services to health plan enrollees of third-party private, federal and state plans.
The alteration, destruction, or falsification of corporate documents or records may constitute a criminal act. Destroying or altering documents with the intent to obstruct a pending or anticipated official government proceeding is a criminal act and could result in large fines and incarceration.
15. NO DISCRIMINATION OR HARASSMENT: Discrimination against any person because of sex, race, color, national origin, religion, age, gender, sexual orientation, disability or for any other legally protected category is strictly prohibited. Harassment based on any of these characteristics may be a form of discrimination and will not be tolerated.
16. FRAUD, WASTE, AND ABUSE COMPLIANCE POLICY STATEMENT: CNSCares has a comprehensive Fraud, Waste and Abuse Compliance Plan (the “FWA Plan”) to help maintain awareness of and compliance with all applicable laws, regulations, and governmental guidelines. The FWA Plan designates a Chief Compliance Officer and includes important procedures for reporting perceived compliance issues and for establishing and implementing audits, monitoring and compliance training. All Company Personnel should review, understand, and comply with the FWA Plan that is found in the Company’s Policy Manual.
17. SUMMARY OF APPLICABLE LAWS: Compliance with this Corporate Code of Conduct requires knowledge of and adherence to federal and state laws, regulations, and governmental guidelines that apply to CNSCares. The list below highlights and summarizes many important laws but is not comprehensive. Every Company Personnel member is responsible for ensuring that he or she understands the laws, regulations, and governmental guidelines that apply to his or her professional duties and role(s) within the Company. The following laws may be applicable in certain situations:
a. The Patient Self-Determination Act: The Patient Self-Determination Act (“PSDA”) encourages patients to make choices and decisions about the types and extent of medical care that they want to accept or to refuse, should they become unable to make those decisions due to illness. The PSDA requires all health care entities to which it applies and, which receive federal health care reimbursement to recognize the living will and power of attorney for health care as advance directives. Under the PSDA, health care entities must ask patients or their guardians whether they have advance directives and must provide them with educational materials about their rights under state law.
b. The False Claims Act: The False Claims Act (“FCA”) is a federal law that holds anyone who conducts business with the federal government responsible for dealing with the government honestly and in conformity with regulations. The FCA prohibits and imposes liability upon any person who (1) knowingly presents, or causes to be presented to the federal government, a “false or fraudulent claim” for payment or approval; (2) knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the federal government; (3) conspires to defraud the federal government by getting a false or fraudulent claim allowed or paid; (4) knowingly makes, uses, or causes 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 federal government; or (5) performs one of the other fraudulent acts listed in the FCA.
Any person who violates the FCA may be liable to the United States government for a civil monetary penalty of not less than $5,000 and not more than $100,000 for each violation, plus three times the amount of damages that the government sustains because of the act of that person. The Attorney General may bring a civil action against a person who has violated the FCA. A private person, generally called a “qui tam relator,” may also bring a civil action against a person whom they believe has violated the FCA. It is against the law for a company to retaliate against, discharge, demote, suspend, threaten, or harass a qui tam relator. Further information regarding the FCA may be found in the FWA Plan.
c. The Administrative Remedies for False Claims and Statements: The Administrative Remedies for False Claims and Statements allows the federal government to impose administrative civil penalties on individuals who have made false or fraudulent statements to the government. Under this law, any person who presents a claim that the person knows or has reason to know (1) is false, fictitious, or fraudulent; (2) includes or is supported by any written statement that asserts a material fact that is false, fictitious, or fraudulent; (3) includes or is supported by any written statement that omits a material fact, is false, fictitious, or fraudulent as a result of such omission and is a statement in which the person has a duty to include such material fact; or (4) is for payment for the provision of property or services that the person has not provided as claimed, shall be subject to a civil penalty of not more than five thousand dollars ($5,000) for each claim plus an assessment of up to twice the amount of each false or fraudulent claim, in addition to other remedies prescribed by law.
d. Anti-Kickback Statute: The federal Anti-Kickback Statute prohibits anyone from knowingly and willfully soliciting or receiving payments, in cash or in kind, in return for referring patients for services that are payable by federal health care programs. It also prohibits anyone from knowingly and willfully soliciting or receiving payments, in cash or in kind, in return for purchasing, leasing, ordering, or arranging for or recommending any good, service, or item that is payable by federal health care programs. The government can impose monetary sanctions against any person or entity that submits a false claim to the government that violates this statute. A violation of the Anti-Kickback Statute will also create liability under the federal False Claims Act. Further information regarding the federal Anti-Kickback Statute may be found in the FWA Plan.
e. HIPAA: The U.S. Department of Health and Human Services issued the Privacy Rule, the Security Rule, and the Breach Notification Rule to implement the requirements of HIPAA. The HIPAA Privacy Rule provides confidentiality protections for personal health information held by covered entities, such as CNSCares, and gives patients an array of rights with respect to that information. The Privacy Rule permits the disclosure of personal health information that is needed for patient care or for other important purposes, and the Security Rule specifies a series of administrative, physical, and technical safeguards to assure the confidentiality, integrity, and availability of electronic protected health information. The Breach Notification Rule requires covered entities to notify affected individuals, and in some cases, the media of a breach of unsecured PHI without unreasonable delay and no later than sixty (60) days following discovery of the breach.
18. ENVIRONMENTAL, HEALTH, AND SAFETY: CNSCares strives to protect the environment and the health and safety of Company Personnel through compliance with applicable health, safety, and environmental laws and regulations. Each Company Personnel member is also expected to comply with the Company’s policies, programs, standards, and procedures, and report accidents, injuries, and unsafe equipment, practices, or conditions.
To ensure that the Company complies with environmental laws and regulations, all Company Personnel should understand how job duties may impact the environment, adhere to all requirements for the proper handling of hazardous materials, and immediately notify supervisors, a member of the Senior Leadership Team, or the Chief Compliance Officer, or her designee, of any situation regarding the discharge of a hazardous substance, improper disposal of medical waste, or any situation which may be potentially damaging to the environment. See also CNSCares policy PP-162, Environmental, Social and Governance Policy.
19. RELATED POLICIES: Compliance with the Corporate Code of Conduct requires knowledge of and adherence to the manuals, policies, and procedures that apply to Company Personnel. CNSCares’s policies and procedures provide further and specific guidance for Company Personnel conduct. In addition, the Company is a nationwide company and shall take appropriate steps to ensure the Company is complying with all applicable state and federal laws.
D. Procedure When a Concern is Raised:
1. CNSCares employees who observe, or are subjected to, inappropriate conduct by another employee shall promptly notify their supervisor about the incident, or if the behavior of the employee’s supervisor is at issue, the employee shall notify the CNSCares Human Resources Department.
2. If a supervisor receives notification of inappropriate conduct by an employee, the supervisor is responsible for promptly notifying the CNSCares Human Resources Department. The Human Resource Department shall notify the Senior Leadership Team, or their designee, about such conduct as appropriate.
3. The employee who reported the incident shall be asked to document the incident in writing and shall include the following:
a. Date and time of incident.
b. Factual description of the questionable behavior.
c. Name of any patient or family member, or other employee who may have been involved in or witnessed the incident.
d. Circumstances which may have precipitated the incident.
e. Names of other witnesses to the incident.
f. Consequences, if any, of the behavior as it relates to patient care, Personnel, or CNSCares operations.
g. Any action taken to intervene in or remedy the incident.
h. Name and signature, of the reporting individual, if appropriate.
4. The supervisor shall forward the report to the CNSCares Human Resource Department, which shall review the report and investigate the incident as appropriate. The Human Resources Department investigation may include meeting with the employee who prepared the report and/or any witnesses to the incident.
5. If the CNSCares Human Resources Department determines an incident is likely to have occurred, the CNSCares Human Resources Department shall notify the alleged offender that a complaint has been received and ask that employee to provide additional information.
6. The identity of an employee reporting a complaint of inappropriate conduct shall be safeguarded, unless the employee reporting the incident agrees in advance that it is appropriate to disclose their identity.
7. The alleged offender shall be advised that any retaliation against the employee reporting a concern, whether the reporting employee’s identity is disclosed or not, is grounds for immediate disciplinary action, up to and including termination.
8. If the CNSCares Human Resource Department determines the allegation(s) are substantiated then the HR representative will meet with the supervisor/manager to determine corrective action for the offender.
9. If the CNSCares Human Resource Department determines the allegation(s) are unsubstantiated then the HR representative will meet with the supervisor/manager to continue to monitor the situation and the investigation will be closed.
