ABCM Corporation, as a provider of Long Term Care, adheres to a variety of state and federal laws and regulations. Among these laws are federal statutes that make it a crime to submit a false claim to a third part payer, such as Medicaid or Medicare. Health care providers are subject to these “false claims acts,” outlined in Section 6032 of the Federal Deficit Reduction Act of 2005, which prohibits their employees from knowingly submitting or making any false statements in connection with claims submitted to the federal government for payment. The following example of what constitutes conduct that violates the false claims act include:

• Willfully and knowingly certifying a material and false statement in a resident assessment or willingly and knowingly causing another individual to certify a material and false statement in a resident assessment;
• Billing for items or services that are not actually rendered or provided;
• Providing unnecessary services;
• Using a billing code that provides a higher payment rate than the billing code that actually reflects the services provided; or
• Submitting more than one claim for the same service.

It is ABCM Corporation’s duty, through this policy, to inform all employees that violating any false claims acts may result in criminal and civil penalties. For example, a violation of the false claims provision of the Social Security Act is a felony punishable by a fine of up to $25,000 and/or five (5) years in prison. Furthermore, violating the state regulation relating to false certification of a resident assessment is punishable by a fine of up to $5,000.

Employees may also be individually liable under the false claims acts to the extent of their authority. For instance, a health care practitioner may be individually liable for providing medically unnecessary services to the extent the practitioner had the authority to determine when to provide services or when to submit claims to Medicare or Medicaid for reimbursement.

It is ABCM Corporation’s intent to comply with all applicable state and federal laws. Employees participating in making any false claims will be subject to immediate disciplinary action, including termination, as well as penalties provided for under law. False claims activities may also be reported to any applicable licensing board.

Employees who have any questions or are aware of any suspected violation of the false claims act, are encouraged to immediately consult their supervisor, their administrator, someone in the quality assurance function from the corporate office, or the corporate compliance standards coordinator in accordance with ABCM Corporation’s Code of Conduct Policy. Employees may also call the company compliance hotline at 1-877-889-7850. No employee will be retaliated against for reporting a suspected violation of for participating in any investigation. In addition, any employee who reports any suspected wrongful conduct under the false claims act to federal or state government is protected as a whistleblower in accordance with federal law and will not be retaliated against.