False Claims Act Policy
PURPOSE
The purpose of this policy is to educate officers, directors, shareholders, employees, contractors and agents regarding the Federal False Claims Act (“FCA”) and to provide general information regarding the Company’s efforts to detect and prevent fraud, waste, and abuse with respect to its business activities.
FALSE CLAIMS LAWS
A. The Federal False Claims Act
The Federal False Claims Act is a law that bars a person or entity, such as YAI, from “knowingly” presenting or causing to be presented a false or fraudulent claim for payment or approval to the federal government, and from “knowingly” making, using or causing to be made a false record or statement to get a false or fraudulent claim paid or approved by the federal government. The Act also prohibits a person or entity from conspiring to defraud the government by getting a false or fraudulent claim allowed or paid. These prohibitions extend to claims submitted to federal health care programs, such as Medicare or Medicaid.
The Federal False Claims Act broadly defines the terms “knowing” and “knowingly.” Specifically, knowledge will have been proven for purposes of the Federal False Claims Act if the person or entity: (1) has actual knowledge of the information; (2) acts in deliberate ignorance of the truth or falsity of the information; or (3) acts in reckless disregard of the truth or falsity of the information. The law provides that a specific intent to defraud is not required in order to prove that the law has been violated. Examples of potential false claims include knowingly billing Medicare for services that were not provided, billing for services that were provided but not medically necessary, submitting inaccurate or misleading claims for actual services provided, or making false statements to obtain payment for products or services.
A person or entity found guilty of violating this law is obligated to repay all of the falsely obtained payment or reimbursement and will be liable for a civil penalty of up to $11,000, plus three times the amount of actual damages sustained by the government as a result of the prohibited conduct for each violation of the Act. In addition to being liable for damages and civil penalties, violating the Federal False Claims Act can subject a person or entity to exclusion from participation in federal health care programs, such as Medicare and Medicaid.
B. Whistleblower Protections
Private persons are permitted to bring civil actions for violations of the Federal False Claims Act on behalf of the United States (also known as “qui tam” actions) and are entitled to receive percentages of monies obtained through settlements, penalties and/or fines collected. Persons bringing these claims (also known as “relators” or “whistleblowers”) are granted protection under the law. Specifically, any whistleblower who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against by his or her employer because of reporting violations of the Federal False Claims Act will be entitled to reinstatement with seniority, double back pay, interest, special damages sustained as a result of discriminatory treatment, and attorneys’ fees and costs.
POLICY AND PROCEDURE
1. YAI strives to provide detailed information and education to all of its officers, directors, shareholders, employees, contractors and agents regarding the False Claims Act, including, the penalties and remedies for violations of these laws and the applicable whistleblower provisions and protections.
2. YAI requires all of its officers, directors, shareholders, employees, contractors and agents to comply with all federal and state laws and regulations governing the administration and operation of health care entities.
3. YAI prohibits its officers, directors, shareholders, employees (or contractors or agents acting on its behalf) from knowingly submitting to any federally or state funded program a claim for payment approval or reimbursement that includes false or fraudulent information or is based on false or fraudulent documentation.
4. Any person having knowledge or information regarding suspected fraud, waste, or abuse by YAI or any of its officers, directors, shareholders, employees, contractors or agents, should promptly contact your immediate supervisor or one of the following individuals: President Chief Financial Officer Senior Vice President, Adult Mental Health Senior Vice President, Children & Families
5. In accordance with this policy, YAI will investigate all allegations of suspected fraud, waste or abuse and will take prompt and effective remedial action where appropriate.
6. YAI will make every effort to detect and prevent fraud, waste and abuse before it occurs through education, training, and compliance audits. These efforts will include, without limitation: distribution of this policy to all of the Company’s officers, directors, shareholders, employees, contractors and agents; compliance training that aids in the ability to detect and report suspected fraud, waste, and abuse; training with regard to the investigation and response to reports of suspected fraud, waste and abuse; and conducting internal audits and reviews of billing and coding policies and procedures.
7. YAI strictly prohibits retaliation in any form against an individual who (i) makes a good faith report of suspected fraud, waste or abuse, (ii) files a complaint under the various false claims acts, or (iii) participates in an investigation or litigation under the various false claims acts. Any retaliatory action is subject to appropriate disciplinary action, up to and including termination of employment or termination of the business relationship with YAI.