The following pages contain some very important and helpful information for all employees of Westbury Senior Care Pharmacy (“Pharmacy”). This information is intended to serve as a resource as you fulfill your job responsibilities here at Pharmacy. Since the very beginning of this organization, it has been the intent and desire of the owners and those responsible for its operation that all decisions are made with the highest levels of honesty, integrity and ethical behavior. Through the means of this written CODE OF CONDUCT, we reaffirm that Pharmacy is committed to those same values to:
Our Patients-We commit ourselves to providing quality care for those we serve. This care is to be competent, compassionate, timely-delivered, medically necessary and delivered in a cost effective manner.
Our Fellow Employees- We are committed to a workplace that is safe, free from discrimination and harassment of any kind, and provides each Pharmacy employee with opportunities for personal and professional growth. Each employee shall be treated fairly with respect and dignity.
Our Adjunct Healthcare Professionals-We are committed to providing a pharmacy where our attending physicians, specialists, consultants, and other non-employee health care providers will be able to assist us in providing the highest level of care for our residents.
Our Business Associate and Third Party Payors-We are committed to working with those individuals and organizations which help us provide the care and services needed for our residents. We pledge to maintain our business relationships in a most ethical and honest manner that satisfies the agreements between us.
Our Regulators-We are committed to maintaining a corporate environment that is conducive to compliance of all laws, regulations and requirements expected of a health care organization. Additionally, we will audit, survey, and monitor ourselves to make sure we are in compliance with our policies and procedures and this CODE OF CONDUCT.
To Our Families and the Communities We Serve-We are committed to earning the trust that is placed in us by the families of the residents for whom we provide care. We are committed to providing their loved ones with the highest level of quality care that is medically necessary and is provided within a cost effective manner. To the community we serve, we make this same commitment.
THE PURPOSE OF THE CODE
This CODE OF CONDUCT (“CODE”) is to be understood as separate from, and in addition to, Pharmacy Personnel Policies handbook which delineates personnel policies and benefits. Likewise, this CODEis not intended to replace the various departmental policies and procedures. It is, however, intended to serve as a constant source of information as to how we conduct ourselves in compliance with all Federal health care program requirements. This CODE also serves as a means of reminding us that we are committed to the preparation and submission of accurate claims consistent with those requirements.
Quality of Care
It is the policy of Pharmacy that each resident receive the necessary care to attain or maintain the highest practicable physical, mental, and psychological well-being, in accordance with the resident’s comprehensive assessment and plan of care. To achieve this level of care, policies have been developed by Pharmacy which detail each action required to provide the desired results.
Right to Privacy
Pharmacy recognizes that each resident has a right to privacy. We will not disclose confidential information that violates the resident’s privacy rights. We will follow our facility’s privacy policies detailed in the Notice of Privacy Practices.
Compliance With Federal Health Care Program Requirements
Pharmacy has a relationship with both state and federal agencies to provide care for our residents. There are numerous regulations and requirements within each of these heath programs. We expect each employee to comply with all of those requirements as individuals just as Pharmacy, as a company, will comply with those requirements corporately. No employee is free to make independent decisions when it involves a state or federal law, regulation, or requirement if that decision is contrary to such laws, regulations or requirements.
Safe and Healthy Environment
Each employee of Pharmacy is expected to fully comply with all state and federal laws concerning safety and health. This requirement is for the benefit of our residents, guests, vendors, contractors and employees. All employees are charged with the responsibility to report or resolve in an appropriate manner any situations which may be deemed to be unsafe. The facility has a detailed Safety and Health Program and a functioning safety committee. Any employee who has questions or suggestions about safety or health issues should see the facility’s risk manager for more information.
Employees shall not accept any gift, hospitality, or entertainment from or on behalf of a resident of Pharmacy; and shall not accept from any other person any cash or cash equivalents, any gift of more than the nominal value of $25.00 per gift or an aggregate of $100.00 per year from any particular person or entity, or any hospitality or entertainment that because of its source or value might influence the employee’s independent judgment in transactions involving Pharmacy. If any gift is received as allowed under the terms of this provision, employee shall notify his or her immediate supervisor promptly.Small items with company advertisements, such as pens, pencils, key chains, note pads, etc. may be accepted by employees and not counted as a “gift.”
Conflicts of Interest
Employees of Pharmacy shall not:
- Be involved in situations which may conflict with his or her ability to make appropriate and objective decisions within the parameters of his or her job;
- Involve themselves in outside activities which might interfere with his or her job or compromise their effectiveness within the facility;
- Be involved with any individual, organization or entity who attempts to influence them in making personnel, purchasing, or other decisions in regard to Pharmacy and its operation.
- Make personnel, purchasing or other decisions affecting Pharmacy and its operation based on family and friendship connections when those decisions are not in the best interest of the company.
Respect for Others
It is the policy of Pharmacy that all employees exhibit respect for their fellow employees. In order to achieve an atmosphere of mutual respect among employees, certain activities and behaviors are not tolerated by Pharmacy. Among these are:
- Sexual harassment and any type of inappropriate sexual behavior;
- Fighting and violence;
- Possession or carrying of firearms or weapons;
- Threatening, offensive and abusive language or conduct;
- Theft of property.
Substance Abuse-free Workplace
In order to maintain a safe working environment for our employees and a safe living environment for our residents, all employees must be free of the influence of alcohol and illegal drugs when they arrive for work. Anyone reporting to work under the influence of alcohol or illegal drugs or consuming them during their time while at work will be disciplined in accordance with stated policies in the employee handbook, Pharmacy Personnel Policies. Discipline for offenses may result in termination.
Use of Pharmacy Vehicles
Any person authorized to operate any Pharmacy vehicle must do so in complete compliance with driving laws and regulations. Drivers must practice safe driving skills while operating a company vehicle. No employee should ever attempt to operate a Pharmacy company vehicle under the influence of alcohol or illegal drugs. Additionally, drivers should make certain any prescribed, legal drugs being used do not impair his or her ability to drive safely.
It is the policy of Pharmacy that no employee shall offer to pay or shall pay any individual, physician, physician’s practice, hospital, or any entity a referral fee for admissions. We accept admissions only on the basis of their clinical and medical needs and our ability to meet those needs through the services we provide.
It is the policy of Pharmacy that no employee shall solicit or receive any fees or anything of value for referrals of our residents to any other healthcare providers.
Any referral that is made shall be made with the best interest of the resident in mind.
BILLING AND COST REPORTING
Full compliance with all Federal health care program requirements, including a commitment to prepare and submit accurate claims consistent with those requirements is the policy of Pharmacy. Claims are to be made only for services provided in accordance with the requirements of the Federal health care programs. Therefore, Pharmacy and its employees shall specifically refrain from:
- Making claims for items or services not rendered or not provided as claimed (such as billing for three hours of therapy when only a few minutes were provided);
- Submitting claims to Medicare Part A for residents who are not eligible for Part A coverage; in other words, who do not require services that are so complex that they can only be effectively and efficiently provided by, or under the supervision of , professional or technical personnel;
- Submitting claims to any payor, including Medicare, for services or supplies that are not medically necessary or that were not ordered by the resident’s physician or other authorized caregiver;
- Submitting claims to any payor, including Medicare and Medicaid, for individual items or services when such items or services are either included in the health facility’s per diem rate for a resident or are of the type that may be billed only as a unit and not unbundled;
- Double billing (billing for the same item or service more than once);
- Paying or receiving anything of financial benefit in exchange for Medicare or Medicaid referrals (such as receiving non-covered medical products at no charge in exchange for ordering Medicare-reimbursed products); or
- Billing residents for services or supplies that are included in the per diem payment from Medicare, Medicaid, a managed care plan, or other payor.
RECORD KEEPING AND DOCUMENTATION
Accurate and complete record keeping and documentation is critical to virtually every aspect of Pharmacy’s operations. It is the policy of Pharmacy that all documentation shall be timely, accurate, and consistent with applicable professional, legal, and facility guidelines and standards. This includes clinical records, and all billing and payment documentation. Falsification of records is strictly prohibited, including backdating of records, with the exception of appropriate late entries duly noted and made consistent with applicable professional and legal standards.
COMPLIANCE EXPECTED BY ALL “COVERED” PERSONS
It is a requirement of all Covered Persons of Pharmacy to comply with all Federal health care programs requirements and with Pharmacy’s Policies and Procedures. Covered Persons are “all officers, directors, and employees of Pharmacy; and all contractors and agents that provide patient care items or services or that perform billing or coding functions on behalf of Pharmacy, but excluding vendors whose sole connection with Pharmacy is selling medical supplies and equipment to them.”
REQUIREMENT TO REPORT VIOLATIONS
It is a requirement of all Covered Persons of Pharmacy (see the definition of “Covered Persons” in the section COMPLIANCE EXPECTED BY ALL “COVERED” PERSONS above) to report any suspected violations of any Federal health care program requirements or Pharmacy’s own Policies and Procedures. Information about the ways to report concerns is included at the conclusion of this CODE.
CONSEQUENCES OF NON-COMPLIANCE AND FAILURE TO DISCLOSE
It is to be understood by all Covered Persons (see the definition of “Covered Persons” in the section COMPLIANCE EXPECTED BY ALL“COVERED” PERSONS) of Pharmacy that there are consequences for failure to comply with Federal health care program requirements and Pharmacy’s Policies and Procedures including disciplinary action up to and including termination by Pharmacy.
This same policy applies for failure by Covered Persons to report any suspected or known violations of the same. Additionally, Covered Persons are reminded that any illegal activities by Covered Persons may result in legal sanctions by authorities. An individual or entity may be excluded, debarred, suspended, or otherwise ineligible to participate in the Federal health care programs or in Federal procurement or in non-procurement programs. All Covered Persons should be aware that their inappropriate actions or non-compliance could result in sanction against Pharmacy.
IF YOU HAVE ANY QUESTIONS OR CONCERNS
While much thought and effort has been given to making this CODE as complete as possible, it is possible that in the course of conducting your job responsibilities you may find a situation that you feel has not been addressed. Please be aware that if you have any questions whatsoever concerning the ethical, legal, or moral decision of a matter involving compliance, you are expected to bring that to the attention of your supervisor, the corporate compliance officer or the administrator. NEVER ignore a concern you have in this regard. You will not be subject to any retribution for bringing it to the attention of the appropriate party(ies). However, it is very important to understand that any individual who is aware of such a matter and chooses to ignore it, is subject to disciplinary action up to, and including dismissal from his or her job.