BAY-ARENAC BEHAVIORAL HEALTH AUTHORITY POLICIES AND PROCEDURES MANUAL

Transcription

1 Page: 1 of 5 Policy Bay Arenac Behavioral Health Authority (BABHA) is fully committed to carrying out its services consistent with its Mission, Vision, Values and Strategic Plan, to include abiding by all federal regulations, specifically the Deficit Reduction Act (DRA). Purpose This policy and procedure is established to provide a mechanism for providing detailed information regarding the Federal False Claims Act (FCA) to all BABHA employees and contracted providers. Education Applies to All BABHA Staff Selected BABHA Staff, as follows: All Contracted Providers: Policy Only Policy and Procedure Selected Contracted Providers, as follows: Policy Only Policy and Procedure Other: Definitions Anti-retaliation: Section of the FCA that contains a provision that prohibits the discharge or harassment of a whistleblower who makes FCA-protected disclosures or files a qui tam suit. This section also permits the whistleblower to file wrongful discharge suit for double back pay and damages. The anti-retaliation provision was modeled after other whistleblower laws and operates under the basic principles and underlying unemployment discrimination cases. False Claims Act (FCA): A Federal Act that established liability when any person or entity improperly receives from or avoids payment to the Federal government (tax fraud excluded).

2 Page: 2 of 5 In summary, the Act prohibits: 1. Knowingly presenting, or causing to be presented to the Government a false claim for payment. 2. Knowingly making, using or causing to be made or used, a false record or statement to get a false claim paid or approved by the Government. 3. Conspiring to defraud the Government by getting a false claim allowed or paid. 4. Falsely certifying the type or amount of property to be used by the Government. 5. Certifying receipt of property on a document without completely knowing that the information is true. 6. Knowingly buying government property from an unauthorized officer of the Government. 7. Knowingly making, using, or causing to be made or used a false record to avoid, or decrease an obligation to pay or transmit property to the Government. Federal Sentencing Guidelines: guidelines for sentencing criminals, approved by the United States Sentencing Commission, to determine the extent of the penalty. Michigan Health Care False Claims Act: law that provides criminal remedies for filing false claims against Medicaid. Qui tam : who sues on behalf of the king as well as for himself is a provision of the Federal Civil FCA that allows a private citizen to file a suit in the name of the U.S. Government charging fraud by government contractors and other entities that receive or use government funds and share in any money recovered. Whistleblowers : those private citizens or individuals who file suit on behalf of the Government to recover damages incurred by the Federal Government as a result of contractor fraud or other false claims (entitled to a significant portion of the proceeds should the suit prevail). Procedure I. Education Process

3 Page: 3 of 5 1. All employees of BABHA will be provided with: Educational materials regarding the Federal FCA, federal administrative remedies for false claims and statements, and state laws pertaining to civil or criminal penalties for false claims, whistleblower protections under such laws, and examples of false claims Methods that BABHA has for detecting and preventing fraud, waste and abuse (e.g., auditing and monitoring) A copy of BABHA s policy on non-retaliation/non-retribution An excerpt for the employee s handbook that describes the laws, highlights the right of the employees to be protected, and a summary of the process for detecting and preventing fraud, waste and abuse A signature page for acknowledgement of receipt, with a name of BABHA personnel to contact for question or concerns or for more educational materials 2. All contracted providers of BABHA will be provided with: Educational materials regarding the Federal FCA, federal administrative remedies for false claims and statements, and state laws pertaining to civil or criminal penalties for false claims, whistleblower protections under such laws and examples of false claims 3. Education for BABHA employees will be provided at the time of new employee orientation and annually during the Staff Development Day process, as appropriate. II. Process for Detecting and Preventing Fraud, Waste and Abuse 1. As outlined in the Corporate Compliance Plan (XII: Self Review and Auditing System and XIII: Data Monitoring), BABHA will: Perform self-reviews, utilizing existing review mechanisms If appropriate, secure services of an external audit firm to complete reviews

4 Page: 4 of 5 If appropriate, complete a computer analysis of data to identify trends, sudden changes or shifts in numbers, exceptions or aberrations related to the billing or services provided (should alert personnel of potential problems) Perform an annual environmental scan to determine risk areas Review the OIG Workplan for areas to be reviewed or monitored Approve a monitor tool that encompasses risk/concern areas for BABHA that include responsibility and reporting times to the Corporate Compliance Committee III: Employee Handbook The employee handbook will describe the employee s rights to be protected as a Whistleblower and will refer to the Corporate Compliance Plan regarding the process of detecting fraud, waste and abuse. Attachments N/A Related Forms N/A Related Materials BABHA Policy and Procedure, C13-S02-T02 Non-Retaliation/Non-Retribution Hand out from the Taxpayers Against Fraud (TAF) discussing what the False Claims Act is, why it is important, Whistleblower provisions, who the law applies to and types of fraud prosecuted under the FCA

5 Page: 5 of 5 References/Legal Authority False Claims Act, 31 U.S.C Deficit Reduction Act of 2005, PL (Section 6032) Submission Form Approving Body/Committee/Supervisor: M. Bartlett J. Pinter Author/Reviewer: M. Bartlett M. Wolber Approval/Review Date: 8/20/ /25/13 Result: Deletion New No Changes Replacement Revision List reason for deletion/replacement/revision here. If replacement, list policy to be replaced. Reviewed and format updated Reviewed and updated to current practices added new emp. orientation to trg.