Emerson Nutritional Compliance Plan

Emerson Nutritional Compliance Plan

 I. STATEMENT OF PURPOSE
II. CODE
A. Refrain from Misrepresentations
B. Submit Accurate Billings and Financial Reports
C. Ensure Proper Use of the Company Assets
D. Ensure Facility Certification
E. Obtain Licensure
F. Prevent Unfair Trade Practices
G. Prevent Unlawful Referrals and Kickbacks
H. Prevent Inappropriate Gifts and Entertainment
I. Prevent Theft
J. Commit to Fairness
K. Avoid Conflicts of Interest
L. Comply with Labor and Employment Laws
M. Comply with Immigration Requirements
N. Comply with Environmental Health and Safety Requirements
O. Ensure Proper Control of Medications
P. Ensure Appropriate Use of Emerson Nutritional Information
1. Safeguarding the Privacy of our Patients
2. Confidentiality of Emerson Nutritional Information
3. Records Retention/Destruction
4. Government Investigations

III. COMPLIANCE WITH THE CODE

 

A. Compliance Officer
B. Questions Regarding the Code
C. Reporting of Suspected Violations
D. Investigation of Suspected Violations
E. Discipline for Violations
F. Acknowledgment and Certification of Compliance

I. STATEMENT OF PURPOSE

 

This Compliance Program was created to define the scope of conduct expected of officers, employees
and agents of Emerson Nutritional . This Compliance Program is not intended to be all-inclusive.
Emerson Nutritional relies on each individual’s sense of fairness, honesty and integrity to meet the
challenges he or she may face in providing quality health care.
With this Compliance Program, Emerson Nutritional intends to promote compliance with the legal
duties imposed upon it as a health care entity, to foster and assure ethical conduct, and to provide
guidance to officers, employees and agents for their conduct. This Compliance Program has been
developed to assist them in complying with all policies and procedures, including the Compliance
Program, and applicable federal, state and local laws and regulations, including Medicare and Medicaid
requirements. In addition, the Compliance Program has been designed to comply with the OIG’s
Compliance Program Guidance, which is based on the Federal Sentencing Guidelines.

II. CODE OF CONDUCT

 

Emerson Nutritional ’s activities involve many transactions each day. Emerson Nutritional therefore
must have strict rules to guard against fraud or dishonesty and guidelines for addressing possible
problems that may arise. If you detect or suspect any improper activities on the part of any employee
or agent of Emerson Nutritional or any person with whom Emerson Nutritional deals, you must report
this information immediately so that the appropriate investigation is initiated. Withholding knowledge
of improper activities is a violation of the Code. If evidence of a violation of this Code is established,
any involved Emerson Nutritional representative may be subject to disciplinary action up to and
including dismissal. Any such evidence will be reviewed by the Compliance Officer.
Emerson Nutritional Representatives activities are to be conducted in a manner to protect the
integrity of clinical decision making, regardless of how Emerson Nutritional compensates or shares
financial risk with its leaders, managers, clinical staff and licensed practitioners.
Emerson Nutritional representatives are expected to:

A. Refrain from Misrepresentations

 

Honesty based on clear communications is the cornerstone of ethical disclosure of information.
Emerson Nutritional representatives shall be honest and make no misrepresentation or dishonest
statements in conducting Emerson Nutritional business. Emerson Nutritional representatives must
report and record all information accurately and honestly whether n marketing materials, patient
records, requests for payment, time sheets, financial reports or otherwise. Marketing materials will
accurately reflect accreditation, licensure and services available.

B. Submit Accurate Billings and Financial Reports Company Billing Activities

Emerson Nutritional billing activities are to be performed in a manner consistent with Medicare,
Medicaid and other third party payors’ regulations and requirements. Emerson Nutritional will
comply with all pertinent Medicare regulations in its billing practices. It is the continuing goal of all
Emerson Nutritional representatives participating in billing to comply with all established legal
and regulatory mandates.

C. Ensure Proper Use of Emerson Nutritional Assets

 

All managers must utilize appropriate internal accounting controls over all areas of their
responsibility to ensure the safeguarding of Emerson Nutritional ’s assets and the accuracy of
financial records and reports. These established accounting practices and procedures must be
followed to assure the complete and accurate recording of all transactions.
All records must be fully and accurately completed and maintained consistent with proper
business practices. The creation of fully accurate and complete records is a duty of each
representative of Emerson Nutritional . Outside payments must be made only with a draft or check or through other properly
documented sources. No payment on behalf of Emerson Nutritional should be approved or made without adequate supporting documentation. All accounts must be disclosed and recorded. Proper authorization must be obtained before
opening a new account. Every payment must be recorded to Emerson Nutritional ’s books promptly, accurately and through normal financial reporting channels.

D. Ensure Facility Certification

 

Emerson Nutritional representatives must not make false statements with respect to the
conditions or operation of Emerson Nutritional for participation in the Medicare or Medicaid
Program. Emerson Nutritional representatives must not make false statements with respect to
information regarding ownership and control of Emerson Nutritional .

E. Obtain Licensure

 

Emerson Nutritional is licensed by various regulatory and accreditation bodies. Each Emerson
Nutritional representative is expected to be familiar with the regulations governing his or her area,
to stay abreast of new developments and to alert his or her supervisor to possible noncompliance.
Questions regarding regulatory requirements should be referred to Emerson Nutritional Director.

F. Prevent Unfair Trade Practices

 

Emerson Nutritional will comply with all laws pertaining to restraint of trade and unfair
competition. Such laws generally forbid any kind of understanding or agreement, whether written
or verbal, between competitors to fix or control fees for services or to engage in any other
conduct that results in restraint of competition.
The following conduct is prohibited:

Attempts to unlawfully monopolize the provision of medical services;

Fixing or unlawfully controlling fees or prices, including setting unreasonably low fees or 
prices to drive or keep competitors out of the market;

Telling a supplier that the decision to purchase goods or services is dependent upon the
supplier’s seeking medical services at Emerson Nutritional ; or engaging in any other antitrust
arrangements.
Unlawfully reducing or eliminating competition over price, terms of business or services
offered;
Unlawfully refusing to deal with, or to boycott, suppliers, third party payors or other providers;
Conducting discussions, conversations or other communications with competitors about the
division of either patients, geographic areas or services, the circumstances under which
business will be conducted with suppliers, insurance companies, patients or customers
(including boycotts); or marketing efforts;
Discussing with competitors the future business plans of Emerson Nutritional or those of any
competitors;
Discussing with competitors such information as pricing, reimbursement or salary levels.

G. Prevent Unlawful Referrals and Kickbacks

 

Both federal and state laws specifically prohibit any form of kickback, bribe or rebate made
directly or indirectly, overtly or covertly, in cash or in kind to induce the purchase,
recommendation to purchase or referral of any kind of health care goods, services or items paid
for by Medicare or the Medicaid program. The term “kickback” as defined in these statutes means
the giving of remuneration, which is interpreted under the law as anything of value. Federal and
state “anti-referral” laws impose substantial penalties relative to billing for services referred by
the physicians or other health care practitioners who have a contractual or business relationship
with Emerson Nutritional .
Emerson Nutritional must scrupulously avoid being either the offeror or the recipient of an
improper inducement. Care must be taken in structuring relationships with persons not employed
by Emerson Nutritional so as not to create a situation where Emerson Nutritional appears to be
offering an improper inducement to those who may be in a position to refer or influence the
referral of patients to Emerson Nutritional .
As a provider of patient care, Emerson Nutritional also should not receive any improper
inducement from its vendors to influence it in making decisions regarding the use of particular
products or the referral or recommendation of patients to other providers of goods and services
paid for by Medicare or Medicaid.

No Emerson Nutritional representative shall make a referral for a designated health service to an
entity in which he or she (or an immediate family member) has a financial relationship. Emerson
Nutritional representatives must become familiar with these laws and assure that all activities are
conducted in such a manner that no question may arise as to whether any of these laws have
been violated. Any question concerning these statutes or any business arrangement subject to
anti-kickback or anti-referral laws should be directed to Emerson Nutritional Director.

H. Prevent Inappropriate Gifts and Entertainment 

Giving or accepting gifts and entertainment can sometimes be construed as an attempt to
influence the other party. No personal gifts can be offered or received if the action could raise a
reasonable question concerning whether the gift was offered or received to influence a person in
the exercise of proper business judgment. One cannot provide or accept gifts of more than
nominal value.

I. Prevent Theft

 

Emerson Nutritional representatives must not take, convert, consume or use property or funds
belonging to Emerson Nutritional or any company or private person for personal use without the
owner’s consent or proper authorization.

J. Commit to Fairness

 

All Emerson Nutritional representatives must abide by the rules, regulations and policies of equal
employment/educational opportunity and affirmative action. Affirmative action and equal opportunity affect all employment practices.
Emerson Nutritional representatives who consider themselves to be victims of discrimination may
file a grievance in writing with the Equal Employment Opportunity Commission.
Emerson Nutritional reaffirms the principle that Emerson Nutritional representatives have the
right to be free from “sexual harassment”, which is a form of discrimination based on gender.
Emerson Nutritional also does not tolerate gender harassment or discrimination against
individuals who fall within any protected category and treats it as a form of misconduct. Sanctions
are enforced against individuals engaging in such behavior.

K. Avoid Conflicts of Interest

 

A conflict of interest arises if a person’s judgment and discretion is or may be influenced by personal considerations, or if the interests of Emerson Nutritional are jeopardized.

  • Emerson Nutritional representatives must promptly disclose any existing or new relationships
    that may give the appearance of a conflict of interest to the Compliance Officer.
  • Substantial ownership in a competitor, supplier or entity which refers to patients may create a conflict of interest. Any doubts or questions about investment should be reported to the Compliance Officer.
  • Immediate family members should not supervise or report to each other.
  • Other outside employment is prohibited to the extent it interferes with an employee’s performance.
  •  Equipment, materials or proprietary information owned by Emerson Nutritional should not
    be used for any outside employment purpose.

L. Comply Labor and Employment Laws

It is Emerson Nutritional ’s policy to comply fully with all applicable labor laws and other statutes
regulating the employer-employee relationship and the workplace environment. Under federal
and state law, it is illegal for Emerson Nutritional to pay to or receive any money or other thing of
value from any labor organization that represents Emerson Nutritional employees (does not
include amount paid in the normal course of business, e.g., union dues, political action committee).
No Emerson Nutritional representative may interfere or retaliate against another Emerson
Nutritional representative who seeks to invoke his or her rights under those laws. Questions
regarding the laws governing labor and employee relations may be referred to the Human
Resources Manager.

M. Comply with Immigration Requirements

Emerson Nutritional hires only persons who are legally authorized to work in the United States,
consistent with federal law. Only prospective employees who are U.S. citizens or who possess a
“green card” or visa, which entitles them to work, will be hired. The appropriate documentation of
citizenship status must be presented to the Human Resources Office at the time of hire. Questions
on immigration issues should be referred to Human Resources Office.

N. Comply with Environment Health and Safety Requirements

 

All Emerson Nutritional representatives who deal with hazardous materials and regulated medical
waste must comply with environmental laws and regulations, and follow the environmental safety
procedures explained in Emerson Nutritional procedures explained in Emerson Nutritional
programs and existing manuals. These laws pertain to hazardous materials, regulated medical
waste, air pollution and water pollution. Emerson Nutritional representatives are expected to:

  •  Comply with all laws and regulations governing the handling, storage and use of hazardous materials, other pollutants and regulated medical waste;
  • Comply with its permits that allow it to safely discharge pollutants into the air, sewage systems, water pollution control facilities or onto or into land;
  • Hire only reputable licensed services to transport and dispose of hazardous and polluted
    materials and regulated medical waste; and
  • Accurately maintain the records required by the environmental laws and regulations,
    including those that require precise description of the amount, concentration and make-up of
    hazardous materials or other regulated pollutants and regulated medical waste that are used,
    stored, discharged or generated; and the time and place of origin, destination and transporter
    of hazardous materials and discharge of pollutants. These records should be handled
    pursuant to Emerson Nutritional policy.

No one at Emerson Nutritional may participate in concealing improper discharge or disposal of
hazardous materials, pollutants or regulated medical waste. Any Emerson Nutritional
representative who has reason to believe that there have been violations of this or any other
aspect of the Officer, who will in turn investigate and, when appropriate, notify pertinent
government agencies as required by law. Before proceeding to act on any instruction of
questionable propriety, or to take any environment-related action about which they are unsure.
Emerson Nutritional representatives are expected to discuss their questions with Emerson
Nutritional Director.

Should you notice a potential or actual infringement of the laws and rules regarding occupational
safety, you must advise your supervisor or the Compliance Officer.

O. Ensure Proper Control of Medications

Emerson Nutritional and its representatives are legally responsible for the proper distribution and
handling of pharmaceutical products and preventing unauthorized access to them. The diversion
of any prescription drug or controlled substance, including a drug sample, in any amount for any
reason to an unauthorized individual or entity is forbidden. It is Emerson Nutritional ’s policy that
all Emerson Nutritional representatives be both diligent and vigilant in carrying out their
obligations regarding Emerson Nutritional ’s prescription drugs and controlled substances in
accordance with all applicable laws, regulations and Emerson Nutritional policies and procedures.
Drugs dispensed by Emerson Nutritional ’s Pharmacy may not be used by staff for their own use,
unless prescribed according to Emerson Nutritional policy.
Any violation of law or Emerson Nutritional policy involving prescription drugs or controlled
substances will constitute grounds for dismissal. Should you become aware of potential violations
of any law, policy or regulation relating to pharmaceuticals, you must advise your superior or the
Compliance Officer immediately.

P. Ensure Appropriate Use of Emerson Nutritional Information

 

1. Safeguarding the Privacy of Our Patients

To protect individuals against misuse of information, access to patient information must be limited
to the extent permitted by Emerson Nutritional policy and state and federal law. Any Emerson
Nutritional representative who engages in unauthorized disclosure, access or misuse of
information in violation of the privacy rights of our patients or others may be subject to
disciplinary action in addition to possible civil or criminal sanctions. Any person who becomes
aware of such unauthorized disclosure should report it immediately to their supervisor or the
Compliance Officer. Legitimate means must be used to collect information. Whenever practical, it
should be obtained directly from the individual concerned. Special confidentiality rules apply to
patients in drug and alcohol treatment programs as well as to disclosure of information regarding
a patient’s HIV status. When release of any information with respect to patients with these
illnesses is contemplated, these rules must be adhered to strictly. Questions on the confidentiality
rules should be referred to Emerson Nutritional Director.

2. Confidentiality of Emerson Nutritional Information

 

No Emerson Nutritional representative shall disclose to others any confidential information

obtained during the course of employment. Confidential information includes Emerson
Nutritional ’s methods, processes, techniques, computer software, equipment, service marks,
copyrights, clinical and pharmacological data, marketing and sales information, personnel data,
patient lists, patient clinical data, financial data, plans and all other propriety information which
are in the possession of Emerson Nutritional and which have not been published or disclosed to
the public. Emerson Nutritional representatives are responsible and accountable for the integrity
and protection of business information. Documents and electronic media containing sensitive
information concerning patients and Emerson Nutritional representatives should be handled
carefully and must be properly secured. Particular attention must be paid to the security of data
stored on the computer system. If you observe employee misuse of confidential information or
individuals whom you do not recognize using terminals in your area, immediately report this to
your supervisor.

3. Records Retention/Destruction

Emerson Nutritional representatives are expected to comply fully with the records retention and
destruction schedule. If Emerson Nutritional representatives believe that documents should be
saved beyond the applicable retention period, their supervisor should be consulted. This
supervisor should contact Emerson Nutritional Director.

4. Government Investigations

Emerson Nutritional representatives must adhere to the following procedures to ensure Emerson
Nutritional responds in a proper manner to all government investigations. Any Emerson
Nutritional representative who is approached by any federal or state law enforcement Emerson
Nutritional seeking information about any aspect of the operations of Emerson Nutritional or the
job-related activities of any of the company’s officers or Emerson Nutritional representatives
must call the Compliance Officer before turning over any information.
Some agencies are entitled by statute to immediate access to information; they include the Office
of the Inspector General of the United States Department of Health and Human Services and state
Medicaid Fraud Control Unit. Proper identification must be presented by officials of either of
these agencies before access can be provided. In virtually all cases, when a request by personnel

of either Emerson Nutritional is made, access to the requested information should be delayed
pending notification of the Compliance Officer. Such notification should occur simultaneously with
the requested access. Notification will ensure that the organization is aware of the inquiry,
properly responds to it, and can take whatever action is necessary with regard to it.

III. COMPLIANCE WITH THE CODE

 

A. The Compliance Officer for Emerson Nutritional is Carlos Dizon. The Phone Number of the Compliance Officer is 310.266.1408.
B. Questions Regarding the Code

The Compliance Officer is responsible for implementation of Emerson Nutritional ’s Corporate
Compliance Program, including the Code of Conduct. The Compliance Officer will work with others
in Emerson Nutritional as necessary, with respect to elements of implementation, including
training and enforcement of this Code. Any Emerson Nutritional representative who has a
question regarding the applicability or interpretation of the Code should direct the question to the
Compliance Officer in person, in writing or by telephone. Correspondence relating to the Code
should be addressed to the Compliance Officer and marked “CONFIDENTIAL.”

C. Reporting of Suspected Violations

Emerson Nutritional representatives must report suspected violations. As a matter of policy, no
Emerson Nutritional representative will be disciplined or subjected to retaliatory action because
he or she made a report in good faith. Where possible, the confidentiality of Emerson Nutritional
representative making the report will be protected.

Reports of possible violations of law or ethical standards may be made to Emerson Nutritional
representative’s supervisor. If the report is made to the supervisor, the supervisor is then required
to report the suspected violation to the Compliance Officer. Emerson Nutritional representative
can also report directly to the Compliance Officer. An Emerson Nutritional representative need
not be absolutely certain that a violation has occurred before making such a report, reasonable
belief that a violation may have occurred is sufficient. Emerson Nutritional representatives are
required to come forward with any such information, without regard to the identity or position of
the suspected offender. Reports will be acted upon promptly and the complainant will be notified
of the result.

Reporting enables Emerson Nutritional to investigate potential problems quickly and to take
prompt action to deal with them. Reports may be made on a confidential basis to the Compliance
Officer at 310.266.1408.

D. Investigation of Suspected Violations

All reported violations of the Code will be promptly investigated by Emerson Nutritional and will
be treated confidentially to the extent consistent with Emerson Nutritional ’s interests and its legal
obligations. If an investigation of an alleged violation is undertaken and the Compliance Officer
believes the integrity of the investigation may be at stake because of the presence of Emerson
Nutritional representatives under investigation, Emerson Nutritional representative(s) allegedly
involved in the misconduct should be removed from his/her current work activity until the
investigation is completed. In addition, steps should be taken to prevent the destruction of
documents or other evidence relevant to the investigation. It is Emerson Nutritional ’s policy to
cooperate with any government investigation.

E. Discipline for Violations

 Disciplinary actions may be taken for:

  • Authorization of or participation in actions that violate the Code.
  •  Failure to report a violation of the Code or to cooperate in an investigation.
  •  Failure by a violator’s supervisor(s) to detect and report a violation of the Code if such failure
  • reflects inadequate supervision or lack of oversight.  
    Retaliation against an individual for reporting a violation or possible violation of the Code.

Disciplinary action may, when appropriate, include dismissal.

F. Acknowledgment and Certification of Compliance

Emerson Nutritional requires that all Emerson Nutritional representatives sign an
acknowledgment confirming that they have received and read the Code and understand it, and
acknowledge that the Code has been communicated to all Emerson Nutritional representatives.
In addition, each year these Emerson Nutritional representatives will be asked to submit an
updated Code of Conduct acknowledgment and compliance form.

I acknowledge that I have received and read the Code of Conduct, and understand it.

 

 

________________________________________________
Signature                                              Date             

 

 

          

 Revision Date:_____________________

Specializes in billing and collections for home infusion, DME, nursing and specialty pharmacies. A full-service outsourcing partner offering solutions to improve cash flow, reduce claims rejections, and expedite payments for services

Company