The ACO and all ACO Personnel shall have the following duties:
1. Duty to Comply
All ACO Personnel shall comply with these Standards of Conduct and all applicable laws, rules, and regulations, including but not limited to:
- Federal criminal law
- False Claims Act; 31 U.S.C. §3729 et seq.
- Anti-Kickback statute; 42 U.S.C. §1320a-7b(b)
- Civil monetary penalties law; 42 U.S.C. §1320a-7a
- Physician self-referral law; 42 U.S.C. §1395nn.
All ACO Personnel are responsible and accountable for making every reasonable effort to understand and follow the federal and state laws, rules, and regulations that apply to their individual jobs and should seek additional education, advice, and guidance if they have any questions about such laws, rules, and regulations.
2. Duty to Act in an Ethical Manner
All ACO Personnel are expected to act responsibly, trustworthily, honestly, and reliably in everything they do while representing the ACO. All ACO Personnel shall conduct their business activities in an ethical manner and shall comply with the ethical business practices adopted by the ACO, including but not limited to those set forth in this Compliance Plan, ACO policies, and as applicable their ACO participant organization’s compliance plan and code of conduct.
- All ACO Personnel shall take every reasonable precaution to ensure that billing and coding is accurate, timely, and in compliance with federal and state laws and regulations.
- All ACO Personnel shall make every reasonable effort to ensure claims are not submitted that contain any kind of false, fraudulent, or inaccurate statements. Any ACO Personnel who lawfully reports a concern is protected from retaliation as further explained herein and pursuant to federal and state laws governing false claims.
- All ACO Personnel shall ensure that any ACO marketing material is not materially inaccurate or misleading, uses template language developed by CMS, if available, is not used in a discriminatory manner or for discriminatory purposes, and complies with the provisions regarding beneficiary incentives.
- All ACO Personnel shall be prohibited from providing gifts, remuneration, inducements, or other incentives for receiving items or services from or remaining in the ACO or with an ACO provider or supplier.
- No ACO Personnel shall condition the participant of ACO Personnel on referrals of federal health care program business or require that patients be referred only to ACO participants or ACO providers/suppliers within the ACO.
- All ACO Personnel shall promote patient engagement and collaborate with local ACO participant organizations to allow patient’s access to their medical records and to honor their reasonable communication preferences.
3. Duty to Participate in Education & Training
All ACO Personnel shall participate in all training and education programs relative to their areas of responsibility, as offered by the ACO and their applicable ACO participant organization, and be aware of the potential risk of fraud and abuse. Additionally, all ACO participant organizations shall be responsible for providing education regarding the ACO to their staff.
4. Duty to Participating in Auditing and Monitoring
All ACO Personnel shall cooperate in auditing and monitoring processes, as appropriate, based on their area of responsibility.
5. Duty to Report
All ACO Personnel shall be responsible for reporting any activities that they know or reasonably suspect are in violation of federal, state, or local laws, rules, regulations, or the ACO policies, procedures, and this Standards of Conduct as further set forth herein.
6. Duty to Participate in Investigations
All ACO Personnel shall cooperate fully with any compliance investigation initiated by the ACO or otherwise related to the ACO. In the event of an investigation, no ACO Personnel shall conceal, destroy, or alter any documents, make untruthful or misleading statements to an investigator, or attempt to cause another individual to fail to provide accurate information or obstruct, mislead or delay communication of information or records relating to a possible violation of law.
7. Duty to Protect Confidentiality
It is the responsibility of all ACO Personnel to take reasonable precautions to ensure the confidentiality, integrity, and availability of the information they collect and use for ACO related health care and business purposes. The confidentiality protection extends to all information, regardless of location or storage medium, and it applies to both paper and electronic-based information.
Failure to follow this ACO Standard of Conduct may lead to corrective or disciplinary action, removal from participation in the ACO or business with the ACO, and in certain circumstances, legal prosecution.
Reporting and Non-Retaliation
All ACO Personnel have a duty to report any actual or potential violation or concern related to NH Value Care. In addition to each ACO participant organization’s normal channels for reporting, ACO Personnel may use the following anonymous compliance hotline for reports related to the ACO: 833.COMPLYGOH.
There will be no retaliation
or retribution for reporting credible instances of improper or unlawful conduct.