Code of Conduct
Wexner Heritage Village’s associates and agents shall strive to deliver exceptional health, housing and supportive services that are necessary to attain or maintain the client’s highest physical, emotional, spiritual and social well-being.
- Wexner Heritage Village associates shall respect a client’s dignity and will treat the client with consideration, courtesy and respect.
- It is everyone’s job to maintain Wexner Heritage Village’s integrity and reputation.
- Wexner Heritage Village associates and agents will provide clients appropriate treatment and services based upon a comprehensive assessment and plan of care that address their clinical conditions.
- Wexner Heritage Village will assure its associates and agents have sufficient education, licenses, background experiences, training and supervision to render service to its clients.
- No deficiency or error should be ignored or covered up. A problem should be brought to the attention of those who can properly assess and resolve the problem.
- No claims for payment or reimbursement of any kind that are false, fraudulent, inaccurate or fictitious may be submitted. No falsification of medical, time or other records that are used for the basis of submitting claims will be tolerated. No goods or services shall be accepted related to the attempt to influence business relationships.
- Wexner Heritage Village will bill only for the services that are medically indicated, ordered by the client’s physician, actually rendered and which are fully documented in the client’s medical records. If the services must be coded, only billing codes that accurately describe the services provided will be used.
- Wexner Heritage Village associates and agents shall respect and protect the confidentiality of client records and other personal information.
- Associates and agents shall promptly report all suspected violations of the Code of Conduct, compliance policies, operational policies, laws or regulations.
WHV Confidential Compliance Hotline:
Notice of Privacy Practices: This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Understanding Your Health Information
Each time you visit a hospital, physician or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as:
- Basis for planning your care and treatment.
- Means of communication among the many health professionals who contribute to your care.
- A legal document describing the care you received.
- Means by which you or a third-party payer can verify that services billed were actually provided
- A tool in educating health professionals.
- A source of data for medical research.
- A source of information for public health officials charged with improving the health of the nation.
- A source of data for facility planning and marketing.
- A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
Rights & Responsibilities
Understanding what is in your record and how your health information is used helps you to:
- Ensure its accuracy.
- Better understand who, what, when, where and how of health information.
- Make more informed decisions when authorizing disclosure to others.
Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522.
- Obtain a paper copy of the notice of information practices upon request.
- Inspect and copy your health record as provided for in 45 CFR 164.524.
- Amend your health record as provided in 45 CFR 164.526.
- Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528.
- Request communications of your health information by alternative means or at alternative locations.
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
This organization is required to:
- Maintain the privacy of your health information.
- Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
- Abide by the terms of this notice.
- Notify you if we are unable to agree to a requested restriction.
- Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We reserve the right to change our privacy practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will post an updated copy in the lobby at the Welcome Center and on our website. A copy will also be provided to you at your request. We will not use or disclose your health information without your authorization, except as described in this notice.
For More Information or to Report a Problem
If you have questions and/or would like additional information, you may contact our HIPAA Privacy Officer at 614-559-0247. If you believe your privacy rights have been violated, you may file a complaint with our Compliance Officer on our confidential hotline at 614-559-0316 or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
Examples of Disclosures for Treatment, Payment and Health Operations
We will use your health information for treatment. For example: Information obtained by a nurse, physician or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to the treatment. We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you’re discharged from this facility. We will use your health information for payment. For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.
We will use your health information for regular health operations. For example: Members of the medical staff, the risk or quality improvement manager or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
Other Uses or Disclosures
There are some services provided in our organization through contacts with business associates. Examples include laboratory services, pharmacy services, ambulance services and radiology services. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Unless you notify us that you object, we will use your name and location in the facility for directory purposes. This information may be provided to all people who ask for you by name.
To maintain your spiritual well-being, we may notify your religious congregation of your admittance to the facility. You have the right to refuse such notification.
We may use or disclose information to notify or assist in notifying a family member, personal representative or another person responsible for your care, your location and general condition.
Communication with Family
Health professionals, using their best judgment, may disclose to a family member or relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.
We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
We may disclose health information to funeral directors consistent with applicable law to carry out their duties.
Unless you notify us that you object, we may contact you and your family to provide information about other health-related services that may be of interest to you. We may approach you to participate, with your permission, in marketing materials. No health information will be used without your permission.
Unless you notify us that you object, we may contact you and your family, using limited health information such as your name and address, as part of a fundraising effort. No health information will be used without your permission.
Food and Drug Administration (FDA)
We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs or replacement.
We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
As required by law, we may disclose your health information to public health or legal authorities charged with preventing/ controlling disease, injury, abuse, neglect or disability. Law Enforcement We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena or court order.
Health Oversight Agencies
We may use or disclose your health information to a health oversight agency that is authorized by law to conduct health oversight activities. The oversight activities may include audits, investigations, inspections or licensure, and certification surveys. These activities are necessary for the government to monitor the persons or organizations that provide healthcare to individuals and to ensure compliance with applicable state and federal laws and regulations.
Health information may be disclosed in the event of emergency situations; protected health information may be released as follows: (1) The treatment of patients; (2) To identify, locate and notify family members and certain others (i.e. The American Red Cross) of the patient’s condition, location or death; (3) To prevent/lessen threats to health or safety.
Vendor Code of Conduct and Compliance Expectations
Wexner Heritage Village (the “Company”) is committed to providing high quality care services, and to providing those services in a highly ethical manner. Our high standards apply to our relationships with our agency staff/vendors (“Vendors”) and the Company requires our Vendors to act in compliance with all applicable state and federal laws and regulations, Company compliance policy, and in a manner that avoids even the appearance of impropriety. The Company does not and will not tolerate any form of unlawful or unethical behavior by our Vendors. To ensure that these expectations are met, the Company has developed and implemented a compliance and ethics program, which includes a Code of Conduct. Please direct any questions about this document or Company’s policies to the Company’s Compliance Officer.
Code of Conduct
Wexner Heritage Village’s employees, vendors and other individuals associated with the company shall strive to deliver exceptional health, housing and supportive services that are necessary to attain or maintain the resident’s highest physical, emotional, spiritual and social well-being.
- Vendors shall respect a resident’s dignity and will treat the resident with consideration, courtesy and respect.
- It is everyone’s job to maintain Company’s integrity and reputation.
- Vendors will provide appropriate treatment and services based upon a comprehensive assessment and plan of care that address each resident’s clinical conditions.
- Vendors will assure its personnel have sufficient education, licenses, background experiences, training, and supervision to render service to its residents.
- No deficiency or error can be ignored or covered up. A problem must be brought to the attention of those who can properly assess and resolve the problem.
- No claims for payment or reimbursement of any kind that are false, fraudulent, inaccurate or fictitious may be submitted. No falsification of medical, time or other records that are used for the basis of submitting claims will be tolerated.
- Company will bill only for the services that are medically appropriate, ordered by the resident’s physician, actually rendered and which are fully documented in the resident’s medical records. If the services must be coded, only billing codes that accurately describe the services provided will be used.
- Vendors shall respect and protect the confidentiality of resident records and other personal information.
- Vendors shall promptly report all suspected violations of the Code of Conduct, compliance policies, operational policies, laws or regulations to the Compliance Officer.
- No goods or services shall be given, solicited, offered, or accepted related to the attempt to influence business relationships. Vendors are prohibited from providing gifts or other items or services of value for free or at a discount to residents which are likely to influence their decision to receive items or services from Company or to influence them to continue to receive such items or services from Company.
Reporting Potential Violations
The Company’s commitment to ethical and legal business practices cannot succeed without open lines of communication between the Compliance Officer and Vendors. The Compliance Hotline is 614-559-0316. Such reports may be made anonymously, however all individuals making reports are encouraged to provide as much information as possible, including name, in order to facilitate investigation of all allegations. The identity of all individuals making reports to the Compliance Officer will be held in strict confidence, but depending on the circumstances, the identity of the reporter may become known or have to be revealed.
Confidential Compliance Hotline:
Fraud, Waste and Abuse
As required by 42 U.S.C 1396a(a)(68) and Ohio Revised Code 5162.15, Company must provide the following detailed information to all employees, agents and contractors of Company about federal and state False Claims Acts and laws pertaining to civil and criminal penalties for false claims and statements, and whistleblower protections under such laws, and Company’s policies and procedures to detect and prevent fraud, waste, and abuse.
A. Federal False Claims Act
The federal False Claims Act, 31 USC 3729-3733, among other things, applies to the submission of claims for payment under any federal program, including claims submitted by health care providers for payment by Medicare, Medicaid, and other federal health care programs. The False Claims Act provides the federal government a civil remedy for fraudulent claims.
The False Claims Act prohibits, among other things:
- Knowingly presenting or causing to be presented to the federal government a false or fraudulent claim for payment or approval;
- Knowingly making or using, or causing to be made or used, a false record or statement in order to have a false or fraudulent claim paid or approved by the government;
- Conspiring to defraud the government by getting a false or fraudulent claim allowed or paid; and
- Knowingly making or using, or causing 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 government.
“Knowingly” means acting with actual knowledge or with reckless disregard or deliberate indifference to the truth or falsity of information. Examples of false claims include falsifying medical records submitted, billing for services not rendered or goods not provided, duplicating billing to obtain double compensation, and billing certifying or prescribing medically unnecessary services.
The United States Attorney General may bring civil actions against individuals and entities for violations of the False Claims Act. As with most other civil actions, the government must establish its case by preponderance of the evidence rather than by meeting the higher burden that applies in criminal cases. Penalties under the False Claims Act include three times the amount of any overpayment, and civil monetary penalties ranging from $5,500 to $11,000 per claim (for violations prior to November 2, 2015), $10,781 – $21,563 per claim (for violations between November 2, 2015 – February 2, 2017), $10,957 – $21,916 per claim (for violations that occurred between February 3, 2017 – January 28, 2018), and $11,181 – $22,363 (for violations on or after January 29, 2018) and annual inflation adjustments to the penalty range thereafter, plus attorney fees. The False Claims Act allows private individuals to bring “whistleblower” actions on behalf of the federal government for violations of the Act. The government may decide to intervene and take over the whistleblower action, or decline to intervene and allow the whistleblower to pursue the action. The False Claims Act protects whistleblowers by imposing penalties, including two times back pay, interest and attorneys’ fees, upon individuals and entities that retaliate against whistleblowers.
B. Program Fraud Civil Remedies Act of 1986
The Program Fraud Civil Remedies Act of 1986 (PFCRA), 31 USC Chapter 38, authorizes federal agencies such as the Department of Health and Human Services (“HHS”) to investigate and assess penalties for the submission of false claims or statements to the agency. The conduct prohibited by the PFCRA is similar to that prohibited by the False Claims Act. A person may be liable under the PFCRA for making, presenting, or submitting, or causing to be made, presented, or submitted, a claim or statement that the person knows or has reason to know:
a. Is false, fictitious, or fraudulent;
b. Includes or is supported by any written statement which asserts a material fact which is false, fictitious, or fraudulent;
c. 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 making, presenting, or submitting such statement has a duty to include such material fact; or
d. Is for payment for the provision of property or services, which the person has not provided as claimed.
The government agency may assess twice the amount of its damages and a civil penalty of up to $11,282 (2020) for each false or fictitious claim. The United States Attorney General has exclusive authority to enforce such assessments and penalties in federal court.
C. Ohio Laws
There also may be liability under Ohio laws for false or fraudulent claims with respect to the Medicaid program expenditures, including:
a. Medicaid Fraud, Ohio Revised Code Sec. 2913.40
The Medicaid Fraud Act imposes criminal penalties for among other things:
- Knowingly making or causing to be made a false or misleading statement or representation for use in obtaining Medicaid reimbursement.
- Doing either of the following with the purpose to commit fraud or knowingly facilitating a fraud:
- charging, soliciting, accepting or receiving any amount in addition to the amount of reimbursement due from Medicaid and any authorized deductibles or co-payments;
- soliciting, offering or receiving any remuneration other than authorized deductibles and co-payments, in cash or in kind, including kickbacks or rebates, in connection with the furnishing of goods or services for which payment may be made under the Medicaid program.
- Knowingly altering, destroying concealing or removing any records necessary to support a Medicaid claim or cost report.
b. Medicaid Eligibility Fraud, Ohio Revised Code Sec. 2913.401
The Medicaid Eligibility Fraud Act imposes criminal penalties on persons for knowingly making false or misleading statements, concealing an interest in property, or failing to disclose a transfer of property for purposes of determining eligibility to receive Medicaid benefits.
c. Falsification, Ohio Revised Code Sec. 2921.13
Ohio criminal law prohibits persons from knowingly making false statements or swearing or affirming the truth of a false statement for the purpose of securing payment of benefits administered by a governmental agency or paid out of a public treasury, for the purpose of securing a provider agreement with the government, or in connection with any report that is required or authorized by law, such as the Medicaid cost report.
d. Offenses by Medicaid Providers, Ohio Revised Code Sec. 5111.03
The Medicaid Provider Offenses Statute prohibits Medicaid providers from acting “by deception” to obtain or receive or attempt to obtain or receive payments to which the provider is not entitled, or to falsify any report or document relating to Medicaid. “Deception” includes acting with reckless disregard or deliberate ignorance of the truth or falsity of information or withholding information. Penalties for 15900201v1 violation of the Medicaid Provider Offenses Statute include interest on excess payments, three times the amount of excess payments, civil penalties of $5,000 to $10,000 per claim, recovery of the costs of enforcement, and termination of the Medicaid provider agreement. The Ohio Attorney General may enforce the provisions of this statute in state court.
e. Any other state law pertaining to civil or criminal penalties for false claims and statements with respect to the Medicaid program, including any law that prohibits:
- Knowingly presenting, or causing to be presented, a false or fraudulent claim for payment or approval to the Medicaid program;
- Knowingly making, using, or causing to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the Medicaid program;
- Conspiring to defraud the Medicaid program by getting a false or fraudulent claim allowed or paid;
- Knowingly making, using, or causing 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 Medicaid program.
D. Protection for “Whistleblowers”
It is the policy of Company to detect and prevent any activity that may violate the False Claims Act, the Program Fraud Civil Remedies Act of 1986 or the State Medicaid Fraud Laws cited in this policy. If any vendor of Company has knowledge or information that any such activity may have taken place, such Vendor should contact the Compliance Officer or call the Compliance Hotline at 614-559-0316 Information may be reported to the Hotline anonymously. In addition, federal and state law and Company policy prohibit any retaliation or retribution against persons who report suspected violations of these laws to law enforcement officials or who file “whistleblower” lawsuits on behalf of the government. Anyone who believes that he or she has been subject to any such retribution or retaliation should also report this to the Compliance Officer or the Hotline.
E. Fraud, Waste and Abuse Prevention and Detection
Company has developed, as part of its Compliance Program, detailed written policies for the prevention and detection of fraud, waste, and abuse in government and commercial health care programs, and for the role of employees, contractors and agents in preventing and detecting fraud, waste and abuse in such programs. If any employee, contractor, or agent has any questions regarding such policies and procedures, the employee should contact the Compliance Officer at 614-559-0314.