Corporate Health Corporate Compliance Program
- Palmetto Health is strongly committed to efficiently providing high-quality care to our patients while adhering to the highest ethical, professional and legal standards.
- Our corporate complaince program continues to ensure that we comply with all applicable state and federal laws, rules, and regulations.
- The entire Palmetto Health workforce is required to participate in the compliance program by being introduced to the program during New Employee Orientation, completing a yearly on-line Annual Training, and reporting known or suspected misconduct or actions.
- The goal of the Corporate Compliance Program is to help Palmetto Health workforce members comply with the increasingly complex rules and regulations governing the healthcare industry by providing uniform policies and procedures as well as aid in the identification and correction of any actual or perceived violation.
- The Corporate Compliance Code of Conduct outlines our commitment to adherence to high ethical and professional standards. Palmetto Health workforce will not engage in Anti-Trust or False Claims Activity such as price-fixing, billing for services not performed, or inappropriate referral arrangements.
- Acknowledgement of the Code of Conduct must be signed by all workforce members.
- The Corporate Compliance policies are located on Palmetto Health's intranet (myPal) or by contacting the Corporate Compliance Depfartment.
Fraud, Waste, Abuse
CMS defines "fraud" as the "the intentional deception (dishonesty) or misrepresentation that an individual knows to be false and makes, knowing that the deception could result in an unauthorized benefit to him or another person." Waste is the use or expending carelessly or needlessly. CMS also defines "abuse" as "incidents or practices by providers that are inconsistent with sound medical practice and may result in unnecessary costs, improper payment, or the payment services that either fail to meet professionally recognized standards of care or are medically unnecessary".
- Knowingly billing for service not provided; billing without a valid physician order,
- Billing the wrong code and receiving higher reimbursement,
- Admitting as inpatient when discharge from recovery or Place in Observation would have been more appropriate,
- Inappropriate hospital and physician arrangements under Stark Law,
- Potential anti-kickback violations by knowingly offering, paying, soliciting or receiving any remuneration in return for referring a person for any item or service
- Under the Federal False Claims Act, penalities for violations can be up to three times the value of the claim plus $5,500 to $11,000 in fines per claim.
- Palmetto Health in its role as a health care provider and as a self-funded employee health plan may use and disclose protected health information (PHI) for treatment, payment and health care operations (TPO) in accordance with applicable state and federal law.
- Palmetto Health will inform patients and employee health plan beneficiaries of their rights through the provision of a Notice of Privacy Practices. Individuals may exercise these rights through the processess outlined in the specific Palmetto Health policies and procedures addressing each of these rights.
- Please do not assume it is all right to discuss a patient's health information in front of guests or family members. This action could lead to a HIPAA complaint being lodged. Palmetto Health recommends asking the patient if it is okay to speak in front of others or asking the guest or visitor to setp out of the patient's room.
- Patient has a right to restrict uses and disclosures such as diagnosis to other family members. If a patient tells you that he/she does not want a person made aware of his/her health information, please share this with the hospital staff as well.
- Physicians, like hospitals, are covered entities as defined by HIPAA. The HIPAA Rules must be followed by all covered entities as appropriate.
- Palmetto Health is committed to informing patients about the benefits, risks, and alternatives of medical procedures.
- The process provides the patient an explanation of the proposed treatment or procedure which provides the patient with information to make his/her decision to undergo or forego the treatment.
- The explanation should include a description of the procedure, the patient's diagnosis, the procedure's risk, the potential benefits, treatment alternatives, the patient's prognosis if he or she declines treatment, whether other practitioners will be involved, and a discussion of the role of residents (if present).
- Informed consent must be obtained, and the informed consent form must be placed in the patient's medical record, prior to surgery, except in the case of emergency surgery.
Medicare Inpatient Only List
- Identifies procedures that are typically provided only in an inpatient setting.
- Medicare will only reimburse the service if performed in the inpatient status. Patients are financially responsible if not provided as an inpatient.
- Procedures on the list are due to the nature of the procedure and the need for at least 24 hours of postoperative recovery time or montoring before the patient can be safely discharged.
- Published yearly by CMS with quarterly updates.
OCHA (Organized Health Care Arrangement)
- The HIPAA Rule allows for an option called an OHCA, an arrangement between Palmetto Health, its medical staff, practitioners and non-practitioners.
- The OHCA benefits physicians and their practices because they will not have to give thier patients a Notice of Privacy Practices or have them sign an acknowledgement when interacting with them at Palmetto Health.
- Our joint Notice of Privacy Practices satisfies this requirement.
- Physicians who agree to participate in Palmetto Health OCHA also agree to our policies and privacy notice and will be required to sign a document indicating their agreement to be part of the OCHA or notice that they opt not to participate.
Patient Records Documentation
- Documentation must support patient's condition to demonstrate medical necessity.
- Documentation must be legible.
- Valid physician orders must be dated, timed and signed.
- Orders must be specific with diagnosis and must include language such as Admit to Inpatient or Place in Observation Status if appropriate.
- Rubber stamp signatures are no longer accepted.
- All medical record entries must be dated, timed and authenticated.
Physician Depositions and Subpoenas
- A "deposition" is an official proceeding authorized by law requiring an individual to give testimony and be cross-examined under oath outside of court. It takes place before an official reporter and in the presence of attorneys representing the parties in litigation.
- A "subpoena" is a legal document issued under the power of the court by the attorney representing a litigant. A subpoena demands the delivery of documents and records or commands a witness' presence with or without documents and records. A subpoena cannot be ignored. A physician must honor a subpoena if the subpoena is served on him personally or through his authorized representative. Physicians should seek legal counsel when responding to the subpoena.
- The time and place of the deposition should be set by the attorney through mutual agreement with the physician. If the subpoena is for court, then the physician should make arrangements to be on telephone standby.
- A physician who has been properly subpoenaed is required to appear wherever the notice of the deposition/trial specifics as to the time and place. Failure to attend a deposition/trial may subject the physician to contempt of court. Timely notice of changes in the deposition/trial time, date or location or the cancellation of a deposition/trial should be given to all involved.
- If the time for deopsition/trial cannot be set by the attorney through mutual agreement, the physician's attendance can be required by subpoena. If the physician, for reasons beyond his control, cannot comply with the requirements of the subpoena, then the physician should do the following:
- Call the Palmetto Health Legal Department when subpoenas to appear or provide depositions are received by physicians in regard to Palmetto Health patients.
- Call the attorney who issued the subpoena, explain the difficulties the subpoena creates and secure the attorney's agreement to continue or cancel the deposition. It is unlikely that a trial will be postponed.
- A physician or a party has the right to object to the issuing of the subpoena. If no objection is raised, then the records must be produced.
- Additional questions can be directed to the Palmetto Health Legal Department at 803-296-3140.
Policies to Note
- Code of Conduct
- Emergency Care/EMTALA
- Detecting & Preventing Fraud, Waste & Abuse
- HIPAA Privacy Policies
- HIPAA Security Policies
- Lewis Blackman Patient Safety Act
- Medical Record Information Release
Contact Corporate Compliance at: Corporate Compliance Hotline (can be anonymous), 1-888-398-2633.
Hotline Website: www.palmettohealth.silentwhistle.com
Corporate Compliance Direct Line: 803-296-5044