Source: https://www.ynhhs.org/vendors/false-claims-policy.aspx
Timestamp: 2020-03-29 18:55:46
Document Index: 600961669

Matched Legal Cases: ['§ 17', '§ 17', '§ 17', '§ 17', '§ 31', '§ 31', '§ 53', '§ 53', '§ 53', '§ 53', '§ 17', '§ 17']

Yale New Haven Health | False Claims and Payment Fraud Prevention
a) Establish fraud and abuse policies and an effective and comprehensive education plan; Included in annual Health Stream training “Corporate Compliance: A Proactive Stance Course”.
b) Provide detailed explanation of administrative remedies pertaining to civil or criminal penalties for false claims.
c) Provide specific discussion to the rights of employees regarding whistleblower protection under such laws.
d) Ensure the entity has a non-retaliation policy available to all employees.
This policy applies to each licensed hospital affiliated with Yale New Haven Health System (YNHHS), including Bridgeport Hospital, Greenwich Hospital, Yale New Haven Hospital and any other hospital that may affiliate with YNHHS from time to time, Northeast Medical Group and its subsidiaries, Yale New Haven Care Continuum (d/b/a Grimes), and any other providers of health care services owned by or under common control with YNHHS.
All employees, contractors, agents, and volunteers of YNHHS must immediately report any suspicion of fraud, waste, or abuse in connection with the business of YNHHS to the Office of Privacy and Corporate Compliance. YNHHS engages in specific compliance efforts to detect and prevent fraud, waste, and abuse, such as the Corporate Compliance Program.
It is the policy of YNHHS that an employee, contractor, or agent of YNHHS who knowingly and intentionally submits a false claim will be reported to the necessary authorities. Anyone or any company that submits a false claim or statement to the government may be fined under the FCA between $5,500 and $11,000 for each such claim submitted, regardless of the size of the false claim, and the person or company could be required to pay an additional fine of three times the value of any charges. Where a person who violated the FCA reports the violation to the government under certain conditions, the FCA provides that the person shall be liable for not less than double damages.
Part of the FCA's purpose is to create an environment where employees and others feel safe reporting concerns about fraud. Any person, who lawfully attempts to stop any FCA violations or reports information about false claims or suspected false claims that are submitted by others, may not be retaliated against, demoted, suspended, threatened, or harassed for such actions.
The FCA also protects individuals who assist in an investigation, provide testimony, or participate in the government's handling of a false claim. Individuals have the right to FCA whistle blower protection from retaliation in any form as to the result of their whistle blowing. These protections include reinstatement without loss of seniority if fired, recovery of two times lost wages plus interest and recovery of attorney fees and other reasonable costs in connection with pursuing retaliation claim. Confidentiality will be maintained to the extent possible.
In addition, there are also other Connecticut laws that prohibit fraudulent billing. It is a crime in Connecticut to fraudulently bill Medicaid or general assistance programs. All employees, contractors, and agents of YNHHS must immediately report suspicion of any criminal activity, including criminal fraud, to the System Compliance and Privacy Officer.
Connecticut General Statutes § 17b-25a (Toll Free Vendor Fraud Telephone Hotline) Connecticut General Statutes § 17b-99 (Vendor Fraud)
Connecticut General Statutes § 17b-102 (Financial Incentive for Reporting Vendor Fraud) Connecticut General Statutes § 17b-127 (General Assistance Fraud)
Connecticut General Statutes § 31-51m (Protection of Employee Who Discloses Employer's Illegal Activities or Unethical Practices)
Connecticut General Statutes § 31-51q (Liability of Employer for Discipline or Discharge of Employee on Account of Employee's Exercise of Certain Constitutional Rights) Connecticut General Statutes § 53-440 et seq. (Health Insurance Fraud) Connecticut General Statutes § 53a-118 et seq. (Larceny)
Connecticut General Statutes § 53a-155 (Tampering with or Fabricating Physical Evidence) Connecticut General Statutes § 53a-157b (False Statement Intending to Mislead Public Servant)
Regulations of Connecticut State Agencies § 17-83k-1 et seq. (Administrative Sanctions) Regulations of Connecticut State Agencies § 17b-102-01 et seq. (Financial Incentive for Reporting Vendor Fraud and Requirements for Payment for Reporting Vendor Fraud)
Yale New Haven Health System Code of Conduct
Exclusions and Background Checks
Non-Retaliation and Non-Retribution for Reporting
Identifying, Tracking and Processing Overpayments Policy