Page 17
numbers associated with the matter disclosed. Information will also include the federal health care programs affected (including Medicare Advantage and Part D Programs) affected government contractors (such as carriers and intermediaries) and other third-party payers. 5. The reasons why FHCP believes that a violation of Federal criminal, civil or administrative law may have occurred. Compliance Plan 7 - 2 Revised December 12, 2018 C. A certification by the authorized representative on behalf of FHCP stating that, to the best of the individual’s knowledge, the submission contains truthful information and is based on a good faith effort to bring the matter to the Government’s attention for the purpose of resolving any potential liabilities to the Government. D. SUBSTANTIVE INFORMATION: As part of its participation in the disclosure process, FHCP will conduct an internal investigation and a self-assessment, and then report its findings to CMS (and/or MEDIC) and OIG. The internal review will occur after the initial disclosure of the matter. Compliance Plan 8 - 1 Revised December 12, 2018 DISCIPLINARY GUIDELINES I. Introduction In order for FHCP’s Compliance Plan to be effective, it is imperative that all employees understand the consequences of conduct inconsistent with FHCP’s administrative and departmental Policies & Procedures or the laws, rules and regulations that govern FHCP’s operations. The Office of the Inspector General within the U.S. Department of Health and Human Services provides the following guidance on enforcement and discipline: "It is vital to publish and disseminate the range of disciplinary standards for improper conduct and to educate officers and other staff regarding these standards. The consequences of noncompliance should be consistently applied and enforced, in order for the disciplinary policy to have the required deterrent effect. All levels of employees should be subject to the same disciplinary action for the commission of similar offenses. The commitment to compliance applies to all personnel levels within the organization. The OIG believes that corporate officers, managers, supervisors, medical staff and other health care professionals should be held accountable for failing to comply with, or for the foreseeable failure of their subordinates to adhere to, the applicable standards, laws, and procedures." Accordingly, FHCP has developed the following Disciplinary Policy to communicate to employees the response that FHCP will take upon substantiating non-compliant behavior. It should be noted that these guidelines are not intended to address behavior inconsistent with FHCP’s Human Resources policies. Guidelines addressing behavior inconsistent with FHCP’s Human Resources policies may be found in FHCP’s Employee Handbook. II. Disciplinary Policy It is the policy of FHCP to foster an environment wherein employees conduct themselves in accordance with the organizations administrative and departmental policies and procedures as well as the laws, rules, and regulations that govern the organization’s operations. While FHCP can strive to minimize the occurrence of non-compliant behavior, FHCP recognizes that such occurrences are unavoidable. To ensure that allegations of non-compliant behavior are addressed in an appropriate, consistent and timely manner, the following process will be followed: Compliance Plan 8 - 2 Revised December 12, 2018 A. Reporting It is the responsibility of all employees to become familiar with the laws, rules, regulations and the administrative and departmental policies & procedures that govern FHCP’s operations and to report conduct inconsistent with these standards. If inappropriate conduct by a full-time, part-time, or temporary FHCP employee or an agency employee is observed or detected, the individual witnessing or detecting the behavior shall immediately report the act(s) as described in Section 4 – Communications of this Plan. B. Allegation Report When an allegation of inappropriate conduct is brought forth, all relevant facts should be included. This should contain, at a minimum, the following: • The date, time and location of the conduct. • The name of the individual alleged to have committed the violation. • A description of the alleged act(s) that resulted in the violation. • A description of the standard that was allegedly violated. • The name of the individual that witnessed the act(s). • Any evidence brought forward by the individual witnessing the alleged misconduct. This information shall be forwarded to the Compliance Officer within 2 business days. C. Investigation Once the Compliance Officer has received the information, an investigation shall commence to substantiate/refute the claim. The Compliance Officer shall enlist the assistance of any necessary resources to promptly and thoroughly assess the validity of the allegation. The results of all investigations shall be documented and maintained by the Compliance Officer. In the event that it is determined that it would be inappropriate for the Compliance Officer to conduct the investigation; the Compliance Committee shall identify an alternate individual to manage the investigation. D. Offense Classification Guidelines All substantiated occurrences of conduct inconsistent with the standards that govern FHCP’s operations shall be classified into one of four levels of offenses. The Administrator of the division where the employee is assigned and FHCP’s Compliance Officer shall jointly determine the offense classification. Offenses shall be classified as follows: Compliance Plan 8 - 3 Revised December 12, 2018 III. Offense Classification Guidelines Description of Offense Examples Discipline Level I Violation of a FHCP Policy/Procedure or a regulatory standard that does not compromise the safety of FHCP's members, patients or staff but may cause a minimal disruption to the workplace. • Distributing member communications to Medicare members without a CMS approval number. • Not logging off the computer system when leaving the workstation. Verbal Counseling and/or Supplementary Training Level II Violation of a FHCP Policy/Procedure or a regulatory standard that does not compromise the safety of FHCP's members, patients or staff but may cause a substantial disruption to the workplace. • Unauthorized access of the electronic protected health information of a relative who is a minor. • Leaving protected health information unattended in a non-secured area. Written Counseling and/or Supplementary Training Level III Violation of a FHCP Policy/Procedure or a regulatory standard that poses significant risk but does not result in harm to an individual, FHCP, or another entity. • Intentional unauthorized access of a member’s protected health information. • Sharing passwords. Letter of Warning, Suspension Without Pay 1 day, Supplementary Training, and/or Demotion Level IV Violation of a FHCP Policy/Procedure or a regulatory standard that causes physical, financial, reputational, or other harm to an individual, FHCP, or another entity. • Intentional unallowable disclosure of member protected health information. • Refusing to cooperate with an internal or external investigation. Suspension Without Pay More Than 1 day or Termination E. Determination of Sanctions: FHCP’s Compliance Officer and Human Resources Director shall jointly determine the level of discipline levied upon the offending individual. Prior instances of regulatory misconduct may result in increased disciplinary measures. In the event that the individual has been