Corporate Compliance ensures that the Center for Disability Services, Prospect Center and St. Margaret’s Center (collectively, the “Center”), and their affiliates, operate in accordance with applicable laws, rules and regulations, as well as Center policies and procedures. The Corporate Compliance Department enhances the Center’s mission and commitment to providing the highest quality supports, care and services by promoting integrity, legal and ethical behavior, prudent practices, and reducing the likelihood of fraud, waste and abuse.
Corporate Compliance Program
Pursuant to Federal and State law, the Center is required to have an effective compliance program. Although the Center’s Corporate Compliance Program is a multi-faceted effort that touches every area of the organization, there is a heavy emphasis on preventing, detecting and correcting billing errors, inaccurate and/or incomplete statements and reports, and impermissible financial transactions, which result in health care fraud, waste and abuse. These prevention and detection measures are summarized below.
The Center is required to designate an employee vested with responsibility for the day-to-day operation of the Corporate Compliance Program. Lisa Marinucci is the Center’s Senior Director of Compliance and HIPAA Privacy Officer. Questions or concerns related to the
Corporate Compliance Program may be directed to her at:
Lisa Marinucci, Senior Director of Compliance and HIPAA Privacy Officer
22 Corporate Woods Blvd., 5th Floor
Albany, NY 12211
Phone: (518) 944-2129
What is Fraud, Waste and Abuse?
It is the policy of the Center to comply with all applicable Federal and State laws pertaining to fraud, waste and abuse in health care programs. Various laws define these terms differently; however, they generally are described as:
Fraud – An intentional deception or misrepresentation by a person with the knowledge that the deception could result in some unauthorized benefit to himself, herself or to some other person.
Waste – Overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the healthcare system, including the Medicare and Medicaid programs. It is not generally considered to be caused by criminally negligent actions, but by the misuse of resources.
Abuse – Practices inconsistent with sound fiscal, business or medical practices that result in unnecessary cost, the reimbursement for services medically unnecessary or that fail to meet professionally recognized standards for health care.
Fraud, waste and abuse also includes any act defined as constituting fraud, waste or abuse under applicable Federal or State law.
Education/Training – Various departments, including, but not limited to, Corporate Compliance, provide education/training through a number of initiatives. These initiatives include annual compliance education, corporate trainings, and an intranet website containing standards of conduct, policies, procedures and educational materials.
Reporting Mechanisms – Concerns related to the Center that potentially implicate the Corporate Compliance Program may be reported to the Corporate Compliance Department at (518) 944-2129 or anonymously to the Corporate Compliance Hotline at (518) 437-5871. In addition, reporting can be made in accordance with the Center’s Whistleblower Policy.
Background Checks – When required by law, criminal background checks are performed on individuals following an offer of employment, but prior to the individual starting work. In addition, checks are performed on vendors, volunteers, and certain employees against various exclusion lists published by Federal and State agencies. These lists identify, among other things, individuals and entities who have been convicted of health care fraud.
Legal Review of Contracts – Contractual arrangements to which the Center is party are reviewed by the Legal Department.
Billing Safeguards – The Center utilizes software designed to assist in the proper documentation of billable services.
Internal Reviews/Audits – Corporate Compliance Program performs reviews/audits across the Organization to ensure compliance with the billing requirements of Federal health care programs. In addition, Corporate Compliance performs periodic internal reviews/audits designed to detect fraud, waste and abuse. Many of these reviews/audits focus on high-risk areas such as those identified in the United States Office of Inspector General’s Annual Work Plan, in the New York State Office of the Medicaid Inspector General’s Medicaid Work Plan, and other areas of special concern identified through investigative and audit functions.
Investigations – The Corporate Compliance Department performs reviews and investigations based upon reports of possible fraud, waste or abuse associated with Federal health care programs. When appropriate, the Center may refer a matter to an outside law enforcement and/or regulatory agency.
Identifying Conflicts of Interest – The Center has adopted a policy that contains standards and procedures for identifying and addressing conflicts of interest.
Other Functions of Corporate Compliance
Compliance with Confidentiality and Privacy Laws – Corporate Compliance also ensures the confidentiality, privacy, and availability of confidential information, protected health information, electronic protected health information, private personal information, and patient information as defined under applicable Federal and State laws, rules and regulations, including, but not limited to, the Health Insurance Portability and Accountability Act (HIPAA), New York Mental Hygiene Law, New York Public Health Law, and New York Security Breach and Notification Act.
What are Examples of Compliance Concerns?
While this list is not exhaustive, some examples of compliance concerns that should be reported include:
- Billing for services that were not actually rendered;
- Charging more than once for the same services;
- Billing for medically unnecessary services;
- Falsifying records used to bill or retain payments from Medicaid or Medicare;
- Not timely reporting and returning an overpayment;
- Inappropriately disclosing or using confidential information regarding Center employees or patients/individuals supported;
- Violating applicable laws, rules and regulations, as well as Center policies and procedures;
- Being unlicensed and performing services that only a licensed professional may render; and/or
- Accepting a bribe or kickback from a vendor or contractor.
What is Your Role in the Compliance Program?
All persons associated with the Center are responsible for conducting themselves in accordance with applicable laws, rules and regulations, as well as the Center’s policies and procedures. This includes Directors, Officers, employees, interns, externs, volunteers, contractors, consultants, and vendors of the Center, all of whom are expected to understand and comply with the Corporate Compliance Program, including reporting suspected compliance concerns.
To Whom Should Compliance Concerns be Reported?
Compliance Concerns related to the Center may be reported:
- To a Supervisor;
- To the Corporate Compliance Department at (518) 944-2129;
- Anonymously to the Corporate Compliance Hotline at (518) 437-5871; and/or
- In accordance with the Center’s Whistleblower Policy.
Under the Center’s Whistleblower Policy, retaliation against anyone who reports a concern in good faith is prohibited. Reported concerns and claims of retaliation will be reviewed and, if required, investigated. Any individual who has engaged in acts of retaliation will be subject to appropriate disciplinary action, which may include termination of employment or other relationship with the Center.
Deficit Reduction Act of 2005
Section 6032 of the Deficit Reduction Act of 2005 requires organizations that receive Medicaid payments in excess of $5 million annually to establish written policies providing detailed information about fraud, waste and abuse in Federal health care programs. The Center’s policy is located here.
These policies must be disseminated to all employees, contractors, consultants, and vendors of the Center who are expected to abide by them while performing services for, or on behalf of, or supplying products to the organization.