I. 目的及范围
本政策的目的是告知员工, 承包商, and 代理s of Dartmouth-Hitchcock (D-H) of the provisions of the federal and state (New Hampshire) false claims acts (FCAs), 包括他们举报违反联邦和州法律的权利. 本政策还包括关于D-H在打击欺诈方面所做努力的一般信息, 浪费 和滥用 and to describe the remedies and fines for violations that can result from certain types of fraudulent activities.
II. 政策
报告欺诈、浪费和滥用
所有员工, 承包商, D-H的代理人必须立即向公司合规官报告任何欺诈嫌疑, 浪费, 或滥用与D-H的业务有关的资料. D-H从事具体的合规工作，以发现和防止欺诈, 浪费, 和滥用, 例如公司合规计划.
有关D-H公司合规计划和具体合规政策的更多信息, 或者如何报告任何问题, 请与合规及审计服务部联络，电邮 603-650-3480 或者访问网站. The organization has contracted with a third-party vendor that maintains a 24/7 helpline and can be reached at 1-844-733-0094.
联邦虚假申报法的详细信息
The federal FCA imposes civil (and in some cases criminal) penalties on people and entities who knowingly submit a false claim, or act in deliberate ignorance of the claim's truth or falsity or act in reckless disregard of its truth or falsity or conspire to defraud the government by getting a false 或欺诈 claim paid. 不需要明确的欺诈意图.
The FCA includes an important provision that allows private citizens to initiate a lawsuit on behalf of the federal government and request the government to join in the suit. 作为回报，该公民可以分享任何赔偿或和解的百分比. 这种类型的诉讼被称为集体诉讼和个人诉讼, 或关系词, 是一个“告密者”, 谁提出所谓不当行为的证据. The purpose of this qui tam provision is to give an incentive for whistleblowers to come forward to help the government discover and avoid paying fraudulent claims as well as prosecute those who submit false claims by awarding whistleblowers a percentage of the recovery.
胜诉在诉讼中胜诉, 关联方必须是向联邦政府报告的信息的“原始来源”. 具体地说, the relator must have direct and independent knowledge of the false claims activities and voluntarily provide this information to the government. 如果披露的事情已经是联邦调查的对象, 或者医疗保健提供者或供应商以前曾向联邦机构披露过该问题, 关联方可能被禁止根据FCA获得追偿.
A private legal action under the FCA must be brought within six (6) years from the date that the false claim was submitted to the government. 视情况而定, 政府提出的索赔可在虚假索赔后10年内提出.
FCA并不局限于医疗保健索赔, 但也适用于联邦政府的任何付款要求. FCA适用于从D-H发送到任何政府付款人计划的账单和索赔, 包括医疗保险和医疗补助.
这是D-H的政策，员工, 卫生署的承办商或代理如明知呈报虚假资料，将会向有关当局举报. 根据FCA, anyone or any entity that submits a false claim or statement to the government may be fined a civil penalty between $5,500美元和11美元,每提出一项索赔, 不管虚假索赔的大小, and the person or entity could be required to pay three times the amount of the damages that the government sustains. 除了, 政府可以将违规者排除在医疗保险之外, 医疗补助计划, 以及其他联邦医疗保健项目.
潜在的虚假声明的例子包括, but are not limited to: (a) billing of items or services that were never rendered by the health care provider; (b) billing for services that are medically unnecessary; (c) upcoding (practice of billing for Medicare/医疗补助计划 using a billing code providing a higher payment rate than the billing code intended to be used for the service or item furnished to the patient); (d) billing separately for services that should be bundled; (e) billing separately for outpatient services that were provided within 72 hours (before or after) an inpatient stay; (f) billing for a discharge in lieu of a transfer.
保护举报人-联邦法律
联邦FCA保护被解雇的雇员, 降级, 暂停, 骚扰, 或因其参与或协助而受到雇主的任何形式的歧视.g.(如证言、调查开始)在虚假索赔诉讼中.
该法案赋予雇员获得救济以“使其完整”的权利。, 包括重新声明，如果没有歧视，他们本来会有同样的资历地位, 拖欠工资的两倍, 欠薪利息, 以及因歧视而遭受的特殊损害赔偿 包括诉讼费用和合理的律师费.
联邦程序欺诈民事救济法案的详细信息
对联邦政府进行欺诈的个人或实体, 通过虚假的声明或陈述, can be assessed money penalties in addition to the penalties of the FCA under the Program Fraud Civil Remedies Act (PFCRA). PFCRA罚款5美元,000 per false claim or statement apply if an individual or entity submits a claim to the federal government that: the individual or entity knows or has reason to know is false, 虚构的, 或欺诈; includes or is supported by written statements containing false, 虚构的, 或欺诈 information; includes or is supported by written statements that omit a material fact, 是什么导致这些陈述是错误的, 虚构的, 或欺诈 and the individual submitting the statement has a duty to include the omitted fact; or is for payment of property or services that are not provided as claimed.
的5美元,000 penalty also applies if a person or company provides written back-up or materials relating to the claim in which the individual or entity asserts a material fact that is false, 虚构的 或欺诈; or omits a fact that the individual had a duty to include, 遗漏导致陈述是假的, 虚构的, 或欺诈, 声明中包含了准确性的证明.
新罕布什尔州法律NH RSA 167:61-a等.
新罕布什尔州有自己的FCA，与联邦FCA非常相似. 根据NH法规，任何人不得故意做出, 出现的:出现或引起的, 任何虚假或欺诈性索赔支付任何商品或服务, 或确定医疗补助或其他国家援助计划下的任何权利或福利. 这种行为对国家的责任是不少于5美元的民事罚款,000元，不超过10元,000, 加上该州因该人的行为而承受的损害赔偿金额的三倍.
该法规将索赔定义为任何请求或要求, 无论是根据合同还是其他方式, 付给军官的钱或财产, 员工, 代理, 或其他国家代表或承包商, 受让人, 或者其他人, 如果国家提供请求或要求的任何部分的金钱或财产, 或者州政府是否会赔偿承包商, 受让人, 或其他被请求或要求的金钱或财产的任何部分的接受者.
The statute defines "knowingly" as intentionally making or causing to be made any false 或欺诈 statement, 或故意提供或导致提供或呈现, 全部地或部分地, 任何欺诈记录, 文档, 向任何州官员或执法人员提供数据或工具, in connection with any audit or investigation involving any claim for payment or rate of payment for any good or service under 医疗补助计划 or other similar state program.
An action for false claims under the NH statute must be brought within six (6) years from the date that the violation occurred or within three (3) years after the date when facts material to the right of action are known or reasonably should have been known by the official within the office of the attorney general charged with responsibility to act in the circumstances, 但无论如何不得超过违法行为发生之日起10年, 以最后发生的为准.
新罕布什尔州——《十大正规博彩网站评级正规博彩平台》(RSA 275-E)
D-H 员工s should be aware that they may notify the government themselves if they believe D-H does not respond appropriately when given notification of a potential violation. D-H is prohibited from taking any adverse actions whatsoever against the 员工 should said person notify the government directly. 举报违法行为的员工可以得到保护, 参与政府调查或听证会, 或者拒绝执行非法指令.
Any 员工 who lawfully reports information about false claims or suspected false claims that are submitted by others, 或者参与调查, 听力, 或由任何政府机构或任何法院进行的调查, or refuses to execute a directive that violates any law or rule that adopted by the State of NH or political subdivision of the United States cannot be discharged, 威胁, 或者受到歧视.
如果发生这种情况, 该员工有权以相同的资历复职, 拖欠工资金额的两倍, 欠薪的利息, 以及因歧视而遭受的特殊损害赔偿, 包括诉讼费用和合理的律师费.
3. 定义
- Dartmouth-Hitchcock: 所有十大正规博彩网站评级正规博彩平台-希区柯克诊所和玛丽·希区柯克纪念医院的设施.
- 员工: 十大正规博彩网站评级正规博彩平台-希区柯克的所有员工, 包括但不限于医生, 护士, 支持人员, 和管理员.
- 承包商或代理: 包括任何承包商, 分包商, 代理, 或者其他的人, 代表实体, 提供, 或以其他方式授权提供医疗补助项目或服务, 执行计费或编码功能, 或参与监测某一实体提供的保健服务. [注:“承包商”或“代理”的定义引用自12月13日的, 2006年医疗保险和医疗补助中心(CMS)给州医疗补助主任的信. 2007年1月，CMS确认计费和编码供应商被视为承包商, but that copying and shredding service providers or manufacturers who are not directly paid by 医疗补助计划 are not considered 承包商.]