All personnel associated with Gateway, including all consultants who are contracted by Gateway to deliver services to Gateway service recipients, must avoid all illegal or unethical conduct. No personnel will take any action that he or she believes is in violation of any statute, rule or regulation. In addition, all personnel must strive to avoid even the appearance of impropriety, and must never act in a dishonest or misleading manner when dealing with others, both within and outside Gateway.
All of Gateway’s payments and other transactions must be properly authorized by management and be accurately and completely recorded on Gateway’s books and records in accordance with generally accepted accounting principles and established corporate accounting policies and procedures. No false, incomplete or unrecorded corporate entries shall be made. No undisclosed or unrecorded corporate funds shall be established for any purpose, nor shall Gateway’s funds be placed in any personal or non-corporate account. All corporate assets must be properly protected, and asset records must be regularly compared with actual assets with proper action taken to reconcile any variances. All internal controls must be followed. The Finance Committee of the Board of Directors will review the expenditures by the President & Chief Executive Officer.
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 purchase, recommendation to purchase or referral of any kind or goods or services paid for by Federal, State, or Local Programs. The term “kickback” as defined in these statutes means the giving of remuneration, which is interpreted under the law as anything of value. Under the federal law, the offense is classified as a felony and is punishable by fines and imprisonment. Federal and State “anti-referral” laws impose substantial penalties relative to billing for services referred by anyone who has a contractual or business relationship with Gateway. It is an individual’s responsibility to be familiar with these statutes 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 questions concerning these statutes or any business arrangement subject to anti-kickback or anti-referral laws must be directed to the Chief Quality and Compliance Officer. No employee, board member or affiliate who in good faith reports a suspected violation shall suffer harassment, retaliation, intimidation or adverse employment consequences as per the False Claims Act qui tam provisions.
The laws prohibit accepting a kickback. In addition, there are laws that prohibit the filing of false claims. As this is a highly complex area of the law, this policy cannot list all situations in which the ant-kickback or false claims laws may apply. Therefore, employees must take special care in this area and promptly refer the question to their supervisor, or the Chief Quality and Compliance Officer if appropriate.
Examples of the types of actions that could violate the Federal Medicare/Medicaid anti-kickback statute and similar State laws include the following:
- Offering or paying anything of value to induce someone to refer an individual to GCI.
- Offering or paying anything of value to anyone (consumer or referral sources) in marketing GCI.
- Soliciting or receiving anything of value for the referral of GCI consumers to others.
Employees may not contribute or donate Gateway funds, products, services or other resources to any political cause, party or candidate. However, employees may make voluntary personal contribution to any lawful political causes, parties or candidates, as long as the individual does not represent that such contributions come from Gateway, and as long as the individual does not obtain the money for these contributions from Gateway for the purpose of making such a contribution.
Gateway does not seek to gain an improper advantage by offering business courtesies such as entertainment, meals, transportation or lodging to customer, referral sources or purchasers of Gateway services. Employees should never offer any type of business courtesy to a referral source or a purchaser for the purpose of obtaining favorable treatment or advantage. To avoid even the appearance of impropriety, employees must not provide any referral source or purchaser with gifts or promotional items of more than nominal value (e.g. pens, calendars, and the like).
Employees may pay for reasonable meal, refreshment and entertainment expenses for referral sources and purchasers of Gateway services which are incurred only occasionally, are not requested or solicited by the recipient, and are not intended or likely to affect the recipient’s business decisions with respect to Gateway. An employee may provide or pay travel-lodging expenses of a customer or referral source only with advanced approval of the President & Chief Executive Officer, if the travel or lodging is not for a directly business-related purpose.
Gateway will bill individuals or third parties only for services actually provided and will give assistance to individuals seeking to understand the costs relative to their care. Gateway will attempt to resolve questions and objections to the satisfaction of the individual while also considering the institution’s best interest.
Examples of the types of action that could violate the federal false billing laws include but are not limited to:
- Filing a claim for services that were not rendered or were not rendered as described on the claim form;
- Filing a claim for services that were rendered, but were medically unnecessary;
- Submitting a claim containing information you know to be false; and
- Misusing Social Security or Medicare symbols, emblems or names in marketing.
In addition, billing personnel should refer to specific departmental policies and procedures for guidance regarding reimbursement and billing practices.
It is the policy of GCI that coding changes on bills or accounts can and will only be made if the medical records documentation supports making the changes.
No employee of Gateway may have employment, consulting or other business relationship with a competitor, customer or supplier, or invest in any competitor, customer or supplier (except for moderate holdings of publicly traded securities) unless disclosure is made to the President & Chief Executive Officer. The President & Chief Executive Officer makes these disclosures to the Chairman of the Board of Directors or the Executive Committee.
Gateway employees should never accept anything of value from someone doing business with the Agency or someone whose services are subject to the Agency’s review. To avoid even the appearance of impropriety, the acceptance of gifts or gratuities is not permitted.
An employee may accept meals, drinks or entertainment only if such courtesies are unsolicited, infrequently provided and reasonable in amount. Such courtesies must also be directly connected with business discussions. Gateway employees are not permitted to accept reimbursement for lodging or travel expenses or free lodging or travel without the express written approval of the President & Chief Executive Officer unless such lodging and travel reimbursement is required by contract (e.g. training for computer systems, technological equipment, etc.).
All charitable contributions received from individuals and organizations must directly benefit Gateway. Under no circumstances may a check be made payable to an individual Gateway staff person. Under no circumstances shall donations be accepted that require Gateway to use the donation to purchase supplies or other goods and services from the vendor or persons making the contributions.
Case Record Management – Closure
Incident Management Program Policy & Procedure
Medicaid Compliance Policy
Corporate Compliance Hotline Policy
Business Associate Agreement
Medicaid Pre-billing Review and Notification of Billing Concerns
Business Partner Policy and Procedures
Acceptance of Gifts
Board of Directors: By-Laws, Policies and Procedures
Conflict of Interest Policy
EEO Policy and Affirmative Action Program
Finance Billing Procedures
HIPAA Privacy and Security Standards, Policies and Procedures
Quality Assurance Policy
Political Payments Policy
Purchase Order Policy and Procedure
Use of Cell Phones and Corporate Credit Cards
HR 109 – Complaint Resolution Process
HR 202 – Electronic Communications
HR 106 – Employment Clearances
HR 703 – Sexual Harassment and Other Forms of Harassment
HR 719 – Whistleblower
HR – Regulatory Orientation and training Policy
Revised: 06/20/00, 04/25/05 – Approved: 06/23/05 by BOD
Revised: 09/08, 03/09 (addition of “affiliated entities”), 09/09 (change of title: CCL to CCO)
Revised: 01/13/10, 02/22/10 – Approved: 03/31/10 by BOD
Revised: 01/13/10, 02/22/10, 12/15/10 – Approved: 01/26/11 by BOD
Revised: 12/31/16, approved 1/25/17