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 Department.
Accessing Medical Records
- Physicians must have a patient/doctor relationship to access medical records. If no patient/doctor relationship, the physician must have patient's written authorization to review the medical record.
- Even when consulting with an attending physician, you must have documentation of the consulting lreationship on the patient's chart.
- Also, you must go through proper channels to get access to your own records by completing an authorization form from the Health Information Management department. See Accessing Protected Health Information and Confidentiality policies.
- Palmetto Health conducts quarterly HIPAA audits to review access to medical records.
- Workforce members or their family shall not accept or request, coerce or in any way solicit vendors, potential vendors or others to privide business courtesies, gifts or charitable contributions to Palmetto Health, its for-profit or not-for-profit subsidiaries or for personal use.
- Meals, entertainment and routine marketing materials are often provided during in-services, at educational conferences and in other situations. These items, or nominal value, are permissible to accept. Frequency should be a consideration when evaluating these situations.
- Should a routine marketing item be significant value, it should not be accepted.
- Training and educational opportunities, including meals or other refreshments, are permissible as long as the education is directly relevant to the department's job duties and thr training is directly related to products or services beneficial to Palmetto Health.
- Workforce members may not accept industry-sponsored training and educational opportunities that include paid reistration, travel and/or accommodations. This includes traveling with a company representative in his/her vehicle or other mode of transportation
Conflicts of Interest
- Workforce members shall disclose any situation where a potential conflict of interest might arise via the Conflict of Interest form.
- Workforce members will not use their position, or any knowledge gained from it in such a way that a conflict of interest, the appearance of impropriety or personal gain might arise between the interests of the system, the interests of the system, the interests of the workforce member or volunteer, members of the workforce member's or volunteer's immediate family, individuals with whom the workforce member or volunteer is associated, and/or businesses with which the workforce member or volunteer is associated. Outside employment is included in this definition.
- Any disclosed potential or actual conflict of interest must be reviewed by a vice president, corporate officer, compliance officer, management representative or his/her designee.
- If a potential conflict is reported, the form must be sent to Corporate Compliance for review. These forms will be sent to Human Resources and included in the workforce member's personnel file.
- Failure to comply with this PGR may result in disciplinary action up to and including discharge.
- The Conflict of Interest Discharge Statement will become a permanent part of the workforce member's personnel file and will be maintained in the appropriate area. The form is located on MyPal on the Forms link under Corporate Compliance.
- Palmetto Health is committed to providing appropriate medical care to all individuals who arrive at any Palmetto Health Emergency Department.
- All individuals who have an emergency medical condition as defined by policy will be triaged, medically screened and treated regardless of their ability to pay in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).
- Triage, medical screening and/or emergency treatment are not to be delayed in order to inquire about method of payment or to validate insurance.
- In addition, Palmetto Health is committed to ensuring that individuals will be transferred from one of Palmetto Health's emergency departments to another facility only in accordance with federal and/or state law.
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 expend carelessly or needlessly. CMS also defines "abuse" as "incidents or practices of 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 thier rights through the provision of a Notice of Privacy Practices. Individuals may exercise these rights through the processess outlines in the specific Palmetto Health policies and procedures addressing each of these rights.
- Please do not assume it is alright 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 thers 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.
Lewis Blackman Patient Safety Act
- This act is monitored by DHEC under SC State Law, Title 44, Chapter 7, Article 27.
- Hospital staff and physicians must clearly identify themselves and their job title.
- Palmetto Health must provide documentation to all patients detailing who will be involved in their care and how they can contact their physician any point in their treatment.
- Physicians have a resposibility to respond promptly when a patient/family asks to speak with his/her physician.
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 then sign an acknowledgement when interacting with then 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 see 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 standy.
- 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. Faliure to attend a deposition/trial may subject the physician to contempt of court. Timely notice of changes in the deposition/trial time, date orlocation 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 rasied, then the records must be produced.
- Additional questions can be directed to the Palmetto Health Legal Department at 803-296-3140.
Policies to Note
- Business Courtesies & Gifts
- 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
- Potential Conflicts of Interest
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