Embed Size (px)
Citation preview
2
3 TALLOW WOOD DRIVE • P.O. BOX 1047 ▪ CLIFTON PARK, NEW YORK 12065-0803
Phone 518.371.0176 • Fax 518.371.4322
December 2, 2009
Charles T. Hart, Jr. Purchasing Agent Room 816 City Hall Buffalo, NY 14202 Ref: RFP #09-10-035 Electronic Health Record System Dear Mr. Hart: Kinney Management Services, LLC (KMS) is pleased to submit this proposal to the Buffalo Public School District for consideration. This document will provide you with an overview of our system. As you will see in the following pages, our state-of-the-art software, Ksystems© addresses the ongoing problems related to documentation of services by providers and offers a means to monitor and manage the provision of the scheduled services. Kinney Management Services believes that this document will provide the Buffalo Public School District with all the information you need to make an informed decision when choosing your new solution. If you have any questions or require any additional information with regard to our company, system or this document, please contact Joe Kinney. You may reach him directly at 518-371-0176, ext. 101 or email him at [email protected] Sincerely, Diane Kinney, Managing Member Kinney Management Services, LLC
3
Table of Contents
Section Title Page
Cover Letter 2
Table of Contents 3-4
Why KINNEY and Ksystems© 5
The Current New York Situation 6-7
Ksystems© Overview 8
Student Enrollment 8
Provider Enrollment 9
User Access Controls 10
Electronic Signatures and Records 11
Service Reporting 12
Error Correction 13
Supervisory Review 14
Parental Consent 15
WebDoKs 16
Management Reporting and Tracking 17
Billing and Payment 18
State Report 19
Compliance with Federal and State Requirements 20
Training of Staff 21
Attachments
Responses To Required Standards Attachment I 22
Standard
1. Firm must have demonstrated capabilities of meeting NYS Medicaid documentation requirements
22
2. Provide proof that the electronic signatures and records are accepted by the NYS OMIG
22
4
3. Provide a copy of its compliance plan 22
4. Allow the monitoring of parental consent 22
5. Be capable of billing Medicaid directly using the HIPAA required electronic submission structure
23
6. Have an established process for monitoring provider federal and state excluded provider listing against systems users
23
7. Have multilevel access controls 23
8. Must have digital document storage 23
9. Must allow for supervisory review of note and services and ongoing acceptance and rejection
23
10. Should require the disclosure of any criminal charges by principles, employees, or contractors
23
11. Disclosure of any bankruptcy by any of the above. 23
New York Client References – Attachment II 24
New York Clients – Attachment III 25
Ksystems© Licensing Agreement – Attachment IV 26-33
Kinney Management Service, LLC Compliance Plan Attachment V
34-39
All content of this Agreement are considered proprietary information intended exclusively for use by Buffalo Public School District.
This information is deemed confidential and should not be disclosed to unauthorized persons.
All contents of this Agreement are the copyright of Kinney Management Services, LLC. Unauthorized use of any of its contents is
strictly prohibited.
5
Why KINNEY and Ksystems©
At Kinney Management Services, LLC…EXPERIENCE, TECHNOLOGY and SOLUTIONS drive performance.
Financial and Health Record Solutions for Special Education
Just as your IEP system is specialized in the educational needs of your students, Ksystems© purpose is to help manage the financial and medical side of the program. Ksystems© is built on a medical model, meaning all aspects of the system are up to federal and state standards for billing medical services.
EXPERIENCE AND SERVICES Our Company and our products are like no other. Combined, the KMS team has unprecedented experience with electronic health records in education and how they relate to Medicaid and other funding sources. Our clients consist of counties, school districts, and cooperative education agencies throughout the nation. In 1996 we began developing Ksystems©, our Electronic Health Record (EHR) system, that today addresses all of the issues related to the documentation and storage of students’ electronic health records. Ksystems© is specifically tailored to the unique need of educational providers. We are the only ones in the industry that recognize the significant and problematic difference between the operational and staffing structure of an educational organization versus that of a health care provider. Ksystems©, is not an afterthought or an add-on to an existing system designed to do something else. From its inception over a decade ago it has been created and enhanced to be the premiere electronic health record system in the educational arena. GOAL To help our clients gain greater control over their health records and ensure compliance with Federal and State reporting and funding requirements.
6
The Current New York Situation
For almost a decade New York State has been embroiled in a battle with the federal government over the structure and actions employed in its school based services Medicaid program. After lengthy negotiations the dispute ended this summer with a settlement involving the following:
State Attorney General’s Office State Departments of Education and Health State Office of the Medicaid Inspector General NYS Governor’s Office-Division of Budget United States Attorney-US Department of Justice US Department of Health and Human Services, Center for Medicaid and
Medicare Services Office of the Inspector for the Department of Health and Human Services
The settlement was formalized into the following two precedent documents: 1. A settlement agreement in which the State and the City of New York agreed
to pay approximately $540 million over a 10 year period. 2. A Compliance Agreement (CA) where the State agrees to undertake a series
of actions to ensure the ongoing program is operating in accordance with standards specified by the federal government. To ensure this is happening; the CA requires annual audits of all entities that annually receive over $1 million in payments. If problems are found, the State is required to take appropriate actions, including recovery of all over payments, initiation of corrective action to ensure the identified problems do not reoccur, or possible civil and criminal prosecutions.
The settlement also resulted in other significant changes including the following: 1. The State agreed to no longer take any part of the federal share of the
Medicaid payment. Schools and Counties will now receive double the net revenue they previously received.
2. The state submitted a new State Plan effective July 1, 2009; when approved this plan should result in the first increase in payment amounts since the inception of the program in 1990. It should result in a second doubling of the amount of monies received by schools and counties.
3. Federal Medicaid has told all states that they can include in the school based Medicaid program coverage for aides whose presence with a child is necessary for medical reasons. This accounts for approximately half of the Medicaid revenue in states that have done this.
The State has issued a new statutory requirement that all Medicaid providers paid over $500,000 MUST have a compliance plan in place or they cannot bill. The due date for having these plans in place was October 1, 2009 and a certification must be filed with the OMIG by December 31, 2009. This means that these schools and counties are taking all action necessary to ensure each and every claim submitted is correct and if errors are found, implementing procedures to prevent them from recurring.
7
Another significant change is the work being done in Washington, D.C. on the restructuring of health care. Many factors are being discussed for inclusion/exclusion including the following: 1. Expansion of Medicaid coverage to include persons who currently are
financially ineligible 2. Elimination of life time caps 3. Elimination of annual caps 4. Eliminating preexisting condition exclusions. All of the above actions will eventually lead to schools being able to access new revenue sources to help pay for the services they provide. This is truly a unique time. With the right tools, knowledge and management, Buffalo can safely improve its revenue while maintaining absolute integrity and secure the trust and respect of the Federal and State officials.
8
Ksystems© Overview
Ksystems© is an electronic health record system designed to ensure compliance with health care programs standards. Since it first became operational in 1996 it has been constantly upgraded and improved. Naturally, this is ongoing with improvements and enhancements being continuously added. As a result it is not possible to reduce all of it capabilities and functionality in a written comprehensible document. Therefore, the following is a summary of some of Ksystems© capabilities and a more detailed description of features specifically designed to meet issues currently in the forefront in New York State. In addition to these examples we also routinely match with the federal excluded provider data base, trace providers licenses against expiration, and are adding an attendance matching capability. Ksystems© consists of the following key components:
Student Enrollment Ksystems© is populated with all of the pertinent student demographic information. This is be accomplished by uploading the data from your current IEP system. You can then add new students and edit any of the information on any student.
9
Provider Enrollment
Ksystems© contains all-important
information on the staff member
who provides services to the
students. This information drives
what services a staff person can
report and how those services will
be reported to health care programs
and state aide.
10
User Access Control
The role of each user is defined and their access to staff and students is definable. This ensures the privacy of the students’ records is protected.
11
Electronic Signatures and Records – Irrefutable and Inalterable
The key to the acceptance of electronic records by Federal and State programs is ensuring that the electronic signature irrefutably belongs to only one person and that once records are entered into the system they are permanently retained and are inalterable. A document, once signed, can never be altered.
12
Service Reporting
Service reporting is done by the person who delivers the service or by staff assigned to enter the services on their behalf. Two methods may be used. One is a calendar page that allows the entry of as many services as needed for a single student.
The second method allows the reporting of services on as many as ten children at a time for an entire week. This significantly reduces the time needed to report services.
13
Error Correction
Errors are corrected through the adjustment tools. All entries are tracked and a complete audit trail is maintained
14
Supervisory Review
Through the use of the supervisory review capability supervisors can review the work of their subordinates, comment on their work, and approve or reject the services. Once reviewed, approved services are released for billing health care programs.
15
Parental Consent Parental consent is tracked throughout the system and reports are available to identify where consent is needed.
16
WebDoKs
WebDoKs, our electronic document storage solution, eliminates the manual filing, handling, and routing of paper documents. Information never leaves your control; you maintain your own electronic document storage repositories with security features that let you determine who has access.
The WebDoKs architecture makes it easy to extend the basic application to handle complex, high-volume forms processing, as well as information captured directly from remote locations. No matter what hardware you are using, you can count on WebDoKs to ensure consistent capture, indexing and validation of the vital information you need.
17
Management Reporting and Tracking
Complete sets of reports are available in the Report Center. Many can be produced based on user specified criteria.
18
Billing and Payment
Billing and payment can be tracked through the report center.
19
State Reports
Information for the SED-4, RS-2, and the ST3 is available.
20
Compliance with Federal and State Requirements
Ksystems© is an electronic health records system that adheres to both Federal and State Medicaid guidelines. Specifically, Ksystems© meets these standards by conforming to FERPA and HIPAA, which govern the design and implementation of all of our processing, confidentiality, LEA specific concerns, and data/documentation storage. In addition, when there are any discrepancies between Federal and State regulations, we always implement the Federal guidelines in order to ensure that our clients are protected. We are constantly monitoring CMS action in a number of manners including our involvement with national groups, monitoring OIG audits in all states, contacting CMS representatives, and receiving HHS/CMS information directly. Our staff is routinely informed of changes in Federal and State regulations. We are in constant communication with State program administrators and routinely attend State sponsored seminars. Additionally, we are involved with numerous associations that monitor federal regulations, and any changes that may affect the Medicaid program. At Kinney Management Services, LLC we take a proactive rather than reactive approach.
EXAMPLE: Tracking of service time in minutes versus units. Districts are in compliance with federal law by tracking the actual time of services. Ksystems© collects data that way.
Obviously changes in governmental regulations that will impact the program are a top priority. As a result, Kinney Management Services, LLC provides its clients with an “Electronic Alert Notification” in order to keep them updated on the ever changing regulations at both the federal and state level. Whether these changes impact the provider reporting or the Medicaid claims processing, KMS works with its clients to ensure that they are in compliance with Federal and State regulations.
EXAMPLE: Clinical Supervision of non-licensed staff. “Under the direction of” versus “clinical supervision”. Districts are in compliance with federal law by actually having the licensed speech pathologist clinically supervise the non-licensed staff. Ksystems documents the day to day supervisory relationship.
21
Ksystems© Support and Training for Staff
The standard for our system is to provide training to the administrator and any other staff Buffalo wants us to directly interact with. Buffalo staff that will be training others will have direct access to our staff for support and training. Additionally, we utilize web meetings to provide hands on training to staff in any location they are in. This avoids the need to pull staff from their locations and allows the scheduling of training in a very short period of time. As part of the setup process we provide on site training and support. We also provide it using web meetings. Once a contract is in place, we will schedule a training date with the district. The District will have the option to decide which training approach works best for their situation. In a “Train the Trainer” scenario we will train any point people/administrators involved in the training process and administrative aspects of Ksystems©. This will include extensive training on the use of the system from a provider’s perspective, as well as from management’s viewpoint. It is critical that the individuals training the end users have a complete understanding of Ksystems© and the Medicaid process. Kinney will spend as much time as necessary with these individuals to ensure they gain the knowledge necessary to appropriately train the staff. Our training will include information related to “best practices” related to Medicaid guidelines/regulations. On the training day(s) we will also meet with the individuals designated as the point person(s)/administrators to explain the overall process and how to utilize the reports to ensure optimal reporting and reimbursement. We provide ongoing support through several channels: A Help Desk – Our help desk is available to users Monday through
Friday from 8:00am to 5:00pm by calling our office.
Email Help – We provide email assistance while using the system. During normal work hours, users will receive timely answers to questions via email.
Online User Manual – We provide all staff with access to our online user manual, which is updated with all recent system changes. This manual can be viewed at http://www.kinneyassoc.com/usermanual/Default.asp. It is also accessible by going to our home page and clicking on User Manual in the left-hand column.
22
Responses To Required Standards - Attachment I
1. Firm must have demonstrated capabilities of meeting NYS Medicaid documentation requirements.
Kinney Management Services, LLC is a leader in providing electronic health records designed to meet the need of educational agencies and comply with federal health care program requirements. The acceptance by NYS OMIG is demonstrated by the following email to Orange Ulster BOCES: Dennis J. Dame [[email protected]] From email dated: Wed 11/8/2006 12:09 PM To: [email protected] Dennis J. Dame, OMIG Comments New York State recognizes the electronic records and signatures in Ksystems as service documentation for Medicaid. It is the school district’s responsibility to ensure that the system is used properly (i.e. passwords are not to be shared). However, as with all programs, the school district should be given assurances by the vendor that the electronic documentation will be in compliance with New York State Codes, Rules and Regulations in accordance with Article 1 of the State Technology Law which establishes the Electronic Signatures and Records Act (ESRA). Among the SSHSP requirements is the school district’s ability to have Speech Language Pathologists (SLP) co-sign service reports and progress notes when Speech teachers are providing services "Under the Direction of " the SLP and when OTAs and PTAs are under the supervision of OTs and PTs respectively. Otherwise, the service reports and progress notes must be printed out and signed by the appropriate person providing direction or supervision.
2. Provide proof that the electronic signatures and records are accepted by the NYS OMIG
See above.
3. Provide a copy of its compliance plan
Included in Appendix V
4. Allow the monitoring of parental consent Ksystems provide full reporting on parental consent. See page 15.
23
5. Be capable of billing Medicaid directly using the HIPAA required electronic submission structure
Ksystems currently produces bills in the HIPAA mandated format.
6. Have an established process for monitoring provider federal and state excluded provider listing against systems users.
Matching is done periodically with the excluded provider file made available by the Office of the Inspector General for the United States Department of Health and Human Services.
7. Have multilevel access controls Ksystems provides full access control of the users. See page 10.
8. Must have digital document storage
Ksystems provides full digital document storage through its WebDoKs component. See page 16.
9. Must allow for supervisory review of note and services and ongoing acceptance and rejection Ksystems allows for full documentation of the supervisor/staff relationship. See page 14.
10. Should require the disclosure of any criminal charges by principles, employees, or contractors No principle, employee, or contractor is under investigation or has ever been convicted in a criminal matter.
11. Disclosure of any bankruptcy by any of the above. Kinney Management services, LLC, nor any of its owners, have ever filed bankruptcy.
24
New York Client References ATTACHMENT II
CLIENT CLIENT CONTACT ADDRESS & TELEPHONE
Bay Shore Union Free School District
Donna Rock CSE Secretary-Medicaid Pt
Person Dr. Russell Endes
Director of Special Education
75 West Perkal Street BayShore, NY 11706
631-968-1232
Cohoes City School District
Karen Kemp Director of Special Programs
21 Page Avenue Cohoes, NY 12047
518-237-0990 ext.6226
East Ramapo Central School District
Sherry Ehrlickman Director of Special Student
Services
105 South Madison Ave Spring Valley, NY 10977
845-577-6040
Freeport Union Free School District
Dr. Jane Albert Director of Pupil Personnel
Services
235 North Ocean Avenue Freeport, NY 11520
516-867-5217
Huntington Union Free School District
David Grackin Asst. Superintendent for Business
Vicki Mingin Director, Special Education Pupil
Services
50 Tower Street Huntington Station, NY 11746
631-673-2111 631-425-4727
Lockport City School District
Judith Wills Student Services Office
130 Beattle Avenue Lockport, NY 14094
716-478-4825
Poughkeepsie City School District
Kevin Sheldon Business Manager
11 College Avenue Poughkeepsie, NY 12603
845-451-4960
Watervliet City School District
John Heid Business Administrator
2557 Tenth Avenue Watervliet, NY 12189
518-629-3203
Orange County
Sheila D. Warren Director of the Division of Early
Intervention Services
1887 County Building 124 Main Street
Goshen, NY 10924 845-291-2349
Orange-Ulster BOCES Kerri B. Stroka Director of Special Education
53 Gibson Road Goshen, NY 10924
845-291-0100 ext. 10210
Monroe County Department of Health
Mike Dedee Director
691 St. Paul St. 4th Floor
Rochester, NY 14605-1798 585-753-5274
25
New York Clients ATTACHMENT III
Amityville Union Free School District Mineola Union Free School District
Ardsley Union Free School District Minisink Valley Central School District
Attica Central School District Monroe County
Auburn Enlarged City School District Monroe-Woodbury Central School District
Bay Shore Union Free School District Monticello Central School District
Bellmore Union Free School District Mount Morris Central School District
Bethpage Union Free School District Naples Central School District
Bloomfield Central School District Newark Valley Central School District
Canandaigua City School District North Babylon Union Free School District
Carthage Central School District North Rockland School District
Center Moriches Union Free School District Nyack Union Free School District
Chenango Forks Central School District Onondaga County
Cohoes City School District Oppenheim Ephratah Central School District
Copiague Union Free School District Orange County
Delhi Central School District Orange-Ulster BOCES
Dundee Central School District Owego-Apalachin Union Free School District
East Ramapo Central School District Pearl River Union Free School District
East Rochester Union Free School District Penfield Central School District
East Rockaway Union Free School District Perry Central School District
East Williston Union Free School District Poughkeepsie City School District
Ellenville Central School District Ramapo Central School District
Fairport Central School District Sayville Union Free School District
Freeport Union Free School District South Country Central School District
Green Island Union Free School District South Kortright Central School District
Hancock Central School District Starpoint Central School District
Hartford Central School District Susquehanna Valley Central School District
Honeoye Central School District Tarrytowns School District
Honeoye Falls Lima Central School District Tioga Central School District
Hudson City School District Troy City School District
Huntington Union Free School District Valley Stream Central High School District
Irvington Union Free School District Warsaw Central School District
Johnson City Central School District Warwick Valley Central School District
Lewiston-Porter Central School District Washingtonville Central School District
Livonia Central School District Waterloo Central School District
Lockport City School District Watervliet City School District
Menands School District Whitney Point Central School District
26
ATTACHMENT IV
Ksystems© and/or WebDoKs© Licensing Agreement
THIS LICENSING AGREEMENT made and entered into, by and between the School Board or District of
Buffalo Public School District, a public body corporate, herein after referred to as “Board”, and Kinney
Management Services, LLC, herein referred to as “KINNEY”.
WHEREAS, the Board and KINNEY have agreed upon the following terms and conditions to purchase an
annual license for the use of Ksystems© ©, KINNEY's web based electronic health record system, and for
KINNEY to perform other activities that the Board needs in order to be fully compensated for rendering
services to disabled persons and others in accordance with the laws of the United States and the laws of the
State of New York.
NOW, THEREFORE, in consideration of the premises and obligations set forth herein and for other good
and valuable consideration, the receipt of which and the adequacy of which are hereby acknowledged by
each of the parties, it is agreed as follows:
1. TERM
1.1. This Licensing Agreement is only valid if signed within 60 days of receipt by the Board. This
Licensing Agreement shall commence upon signature of both parties. It shall remain in effect for
an initial period of one (1) year. The Agreement shall automatically be renewed annually for one
(1) year terms thereafter upon payment of the annual licensing fee. Ksystems© is not being sold
and remains the property of Kinney Management Services, LLC. It is understood that if the fee is
not paid when due access to Ksystems© will be suspended until the account is brought up to date.
Each renewal will include an increase in the annual licensing fee of 3% rounded up to the nearest
dollar.
1.2. This Agreement can be terminated prior to the start of the annual licensing period by notifying
KINNEY in writing of the termination ninety (90) days prior to the start of the next annual
licensing period. Under no circumstances, will licensing fees be refunded upon termination. In
addition, the Board will be responsible for the shipping cost of any, and all, records it wishes
returned to it by KINNEY.
2. SOFTWARE LICENSE GRANT
Upon the following terms and conditions including payment of any applicable fees KINNEY
hereby grants to the District and the District hereby accepts from KINNEY, a non-exclusive, non-
transferable and non-assignable license, for the District’s end-use purposes only (excluding the
commercialization of information technology products and/or services).
2.1. OWNERSHIP AND INTELLECTUAL PROPERTY RIGHTS
The Software Product is protected by copyright and the Software Product and the Services are
proprietary and confidential property of KINNEY (and/or its third party suppliers). All rights,
title and interest in and to the Software Product and Services (including associated intellectual
property rights) are and will remain vested in KINNEY and/or its third party suppliers. National
and other laws and international treaties protect these rights. The District acknowledges that it
has no rights, license or interest to any KINNEY product or processes.
2.2. LICENSE RESTRICTIONS - Ksystems© and WebDoKs©
The District agrees that it and all employees and contractors granted access to the products that are
the subject of this agreement are bound by the following terms:
2.2.1. The software products, which are the subject of this agreement, are licensed to the District,
NOT SOLD.
2.2.2. The District may not sublicense, assign, resell, share, pledge, rent or transfer any of its
rights under this agreement in relation to the software product or any of the services or any
portion thereof.
2.2.3. The District may not use or copy the software product, in whole or in part, except as
expressly provided for in this license.
2.2.4. The District may not modify, translate, reverse engineer, decompile, disassemble or create
derivative works of the software product or otherwise attempt to (A) defeat, avoid, by-pass,
27
remove, deactivate or otherwise circumvent any software protection mechanisms in the
software product including, without limitation, any such mechanism used to restrict or
control the functionality of the software product or (B) derive the source code or the
underlying ideas, algorithms, structure or organization form of the software product.
2.2.5. In connection with the services provided by KINNEY, the District agrees as follows:
2.2.5.1. Only the District’s designated users may use the software product and services,
2.2.5.2. District may not use the software product or the services for any unlawful purpose,
2.2.5.3. District may not use the software product or services in a manner that may damage,
disable, overburden or impair either the services or the networks connected to the
service,
2.2.5.4. District may not attempt to gain, nor grant, unauthorized access to the service,
including but without limitation, through hacking or password mining.
2.3. ADDITIONAL LICENSE RESTRICTIONS - WebDoKs©
In addition the District agrees it will not distribute through WebDoKs©
or Ksystems© any
attachments, documents or files that:
2.3.1. Infringe on any copyright, patent, trade secret, trademark, or other third party proprietary
rights.
2.3.2. Violate any law, statute, ordinance, or regulation;
2.3.3. Are defamatory or libelous;
2.3.4. Are obscene; and /or
2.3.5. Contain viruses, trojan horses, worms, time bombs, or similar harmful programming
routines.
3. LICENSING FEE
3.1. The Board agrees to pay KINNEY an annual licensing fee at the rate and in the manner set forth
in Appendix A of this Agreement.
3.2. An annual invoice will be generated by KINNEY upon signing of this agreement and is due 30
days thereafter. Fees paid after the due date will be subject to a 5% late charge.
4. KINNEY RESPONSIBILITIES
4.1. Provide access to Ksystems© and/or WebDoKs©, KINNEY's web based electronic health record
systems.
4.2. Assign the initial ID and password to the District's Ksystems© administrator.
4.3. Within Ksystems© ©, where possible, identify the Medicaid Eligible population for the district. It
is recognized that in many instances a child's Medicaid eligibility is not available from the state
until months after its effective date.
4.4. Maintain supporting claim documentation, such as; IEPs, Physician Orders, M-team Reports,
other evaluations, notes and transportation logs. (Note: No documents sent to KINNEY are
retained by KINNEY. Only copies that can be shredded should be sent.)
4.5. Provide management reports through Ksystems© ©
4.6. Provide monthly reports on claiming.
5. SCHOOL DISTRICT RESPONSIBILITIES
5.1. The Board will use its best efforts to assist KINNEY in performing its responsibilities under this
agreement, including, but not limited to providing all necessary information for the expeditious
implementation of Ksystems© and to facilitate processing of claims, billings, and provide the
necessary parental consent information in the manner prescribed by KINNEY.
5.2. Provide the name of the school district representative assigned to this project. Such
representative will be responsible for providing information to KINNEY and ensuring that all
KINNEY confidentiality agreements are in place for the providers.
28
5.3. Provide student information to be added to Ksystems© in the manner prescribed by KINNEY.
The District will transmit the information using a file structured to meet KINNEY specification at
the time of the transmission. The requirements of this file are updated from time to time to reflect
federal and state program changes. An example of the information needed on this file is found in
APPENDIX D. Use the process specified by KINNEY to verify student Medicaid eligibility.
5.4. Provide timely notification of related personnel changes within the school district that assist in
facilitating processing.
5.5. Ensure there is a signed KINNEY Confidentiality Agreement (APPENDIX B) for each provider
and a signed KINNEY Confidentiality Agreement (APPENDIX C) for each school district
administrator given a KINNEY ID and password to KINNEY's web site on file at the District.
5.6. Immediately disable all ID's and password for any staff member who leaves the district.
5.7. Immediately notify KINNEY whenever a staff member who has access to the system leaves the
district or has his/her system access revoked for any reason.
5.8. Immediately report to KINNEY any identification and password security breaches.
5.9. Ensure all services reported to KINNEY for Medicaid billing are on a child’s IEP.
5.10. Ensure all services reported for Medicaid billing meet Federal and State Medicaid requirements,
including prescription and professional licensing standards.
5.11. Report all services to KINNEY on an ongoing basis through Ksystems© - the web-based
electronic health records system.
5.12. If necessary, provide mileage necessary for billing transportation.
5.13. Maintain supporting claim documentation, such as; IEP’s, Physician Orders, Mteam Reports,
other evaluations, notes and transportation logs. (Note: No documents sent to KINNEY are
retained by KINNEY. Only copies that can be shredded should be sent.)
5.14. Intrust all staff, where applicable, to adhere to the terms of this licensing agreement.
5.15. Arrange for the provision of necessary therapy services to eligible persons.
5.16. Follow all Federal and State laws concerning the provision of service to children.
6. SUPPLEMENTAL SERVICES
6.1. The supplemental services and the related fees are outlined in APPENDIX A.
7. CONFIDENTIALITY OF RECORDS
7.1. KINNEY shall make reasonable efforts to ensure that all personally identifiable student and staff
information obtained by or furnished to KINNEY or its subcontractors by the Board and all
reports and studies containing such information prepared or assembled by KINNEY, is not
provided or disclosed to a third party without written permission of the Board. Provided
however, KINNEY shall be permitted to share access to such material in its control to its
employees and/or subcontractors performing services pursuant to this Agreement, provided such
employees or subcontractors likewise comply with the confidentiality provisions of this
paragraph; and further provided that KINNEY will share access to such information as may be
required by governmental authorities in accordance with law.
7.2. Both parties acknowledge that they may receive and/or come into contact with protected health
information, as defined by the Health Insurance Portability and Accountability Act (HIPAA) the
parties hereby acknowledge their respective responsibilities pursuant to HIPAA and shall comply
29
with said regulations, where applicable. If at any time during the course of this Agreement it is
determined by agreement of both parties or an entity with appropriate jurisdiction that the District
is a “covered entity” as defined by HIPAA, the parties agree to enter into a Business Associates
agreement to ensure compliance with Standards of Individually Identifiable Health Information
pursuant to HIPAA.
8. TERMINATION
8.1. This Agreement can be terminated prior to the start of the annual licensing period by notifying
KINNEY in writing of the termination ninety (90) days prior to the start of the next annual
licensing period. Under no circumstances, will licensing fees be refunded upon termination. In
addition, the Board will be responsible for the shipping cost of any, and all, records it wishes
returned to it by KINNEY.
8.2. Upon notice of termination, KINNEY will remove the Districts access to Ksystems© at the end
of the annual license term or if the agreement is terminated prior to the end of the annual license
term, at such termination. It is the Districts responsibility to access any report it may want prior to
the expiration of the licensing period.
8.3. Records in Ksystems© will be copied to a CD or DVD and sent to the District. The District has
30 days to confirm the files are readable. If after the 30 day period KINNEY is not notified that
the District has problem with reading the files KINNEY will over write all file in Ksystems©
removing any student identifiable information. KINNEY WILL NOT BE ABLE TO RESTORE
ANY INFORMATION AFTER THIS POINT.
9. GENERAL TERMS
9.1. Governing Law. The laws of the State of New York shall govern this Licensing Agreement. In
the event that any proceeding of a judicial nature is brought to determine any matter arising out
of, or in connection with, this Agreement, the proceeding shall be brought in a court of competent
jurisdiction in the State where the district is located.
9.2. Headings. The heading of the various sections of this Agreement are inserted only for
convenience of reference and are not intended, nor shall they be construed to modify, define,
limit, or expand the intent of the parties as expressed in this Agreement.
9.3. Severability. In the event any provision of this Agreement shall be held to be invalid or
unenforceable, the remaining provisions of this Agreement shall remain in full force and effect.
9.4. Interpretation. When the context in which the words are used in this Agreement indicates that
such is the intent, the words in the singular number shall include the plural and vice versa, and
words in the masculine gender shall include feminine and neuter genders and vice versa.
9.5. Successors. This Agreement shall be binding upon the parties hereto, (and if assigned in
accordance with the provisions hereof, their respective assigns), and their successors in interest,
personal or legal representatives, estates, heirs and legatees.
9.6. Notices. Whenever under this Agreement one party is required or permitted to give notice to the
other, such notice shall be in writing and shall be deemed given upon the earliest of (a) delivery
or (b) five calendar days after such notice is mailed by registered or certified United States mail,
return receipt requested, postage prepaid, and addressed to the addressee at its address set forth
below.
Buffalo Public School District Kinney Management Services, LLC
Name: _____________________________ Diane Kinney
Title: ______________________________ Managing Member
___________________________________ 659 Plank Road
___________________________________ P.O. Box 1047
___________________________________ Clifton Park, NY 12065
30
9.7. Assignment. Neither this Agreement nor any of the rights, interests or obligations hereunder
shall be assigned, transferred or otherwise alienable by either party without the express written
consent of the other party. Such consent shall not be unreasonably withheld.
9.8. Amendments and Waivers. This Agreement may not be modified, amended, extended or
augmented without the prior written consent of both parties. Any breach of this Agreement or
part hereof shall not be waived or released other than by written acknowledgment by the non-
breaching party.
9.9. Full Integration. This Agreement, including the documents incorporated by reference into this
Agreement, constitutes the entire agreement between KINNEY and Board.
9.10. Non-Recourse Obligations. Recourse for any payment or other obligation for either party under
or in connection with this Agreement or any document or instrument related hereto shall be had
only against the assets of such party, and no individual shareholder, partner or principal of such
party shall have any personal liability for any obligations of such party under or in connection
with this Agreement or any document or instrument related hereto.
9.11. Limitations on Damages. Neither KINNEY nor the board shall be liable to the other for any
amounts representing loss of profit or loss of business or special, indirect, incidental,
consequential or punitive damages to the other of any nature whatsoever.
9.12. Special Limitations. Should the District or its employees or contractors violate the terms of
section 2, “SOFTWARE LICENSE GRANT”, the District agrees to hold harmless KINNEY
(and/or its third party suppliers and contractors) for any, and all, liabilities arising out of the
violation of the licensing terms.
9.13. Relationship Between the Parties. The Board, its employees, agents, and subcontractors
performing under this Agreement are not employees or agents of KINNEY. Neither KINNEY
nor the Board employees shall hold themselves out or claim to be employees of the other.
Additionally, the District is not responsible for the withholding of any payroll taxes related to the
services provided by Kinney or its employees under this agreement
Signed:
Buffalo Public School District
Name: ______________________________
Title: _______________________________
Signature: ___________________________
Date: _______________________________
Kinney Management Services, LLC.
Diane Kinney
Title: Managing Member
Signature: ___________________________
Date: _______________________________
31
ELECTRONIC HEALTH RECORDS MANAGEMENT SERVICES
APPENDIX A
Licensing Fee:
Ksystems© - Electronic Health Record System:
Ksystems© software is available on SHI’s New York State Contract, #PT60652, Group #79518, titled “Miscellaneous Software Catalog.” TERMS:
Ksystems© Electronic Health Record System A licensing fee of $40,000 will be paid for the period of July 1, 2009 through June 30, 2010. The annual licensing fee for the second year, July 1, 2010 through June 30, 2011, is $75,000. Each subsequent year will be increased by 3%. The annual fee under this agreement is solely for the use of KINNEY’s electronic health record system, Ksystems© ©, for up to 12,000 students in each school year.
SPECIFICATIONS OF AGREEMENT:
Purchase Order issued to SHI and payments made to the SHI specified address.
Licensing agreement signed within 30 days of issuance of Purchase Order and Returned to KINNEY.
OPTIONAL ADDITIONAL SERVICES
Training and ON-Site Support A fee of $600 per day per person will be charged for each day or part there of, of training and support provided at the District (does not apply to the initial training). This fee includes all travel expenses.
Data Entry An hourly fee of $35.00 will be charged for data entry the District requests KINNEY to complete. Customization Cost Customization of District requested web-based reports or the addition of features not included in Ksystems© will be done for per hour charge. Once the feature is added to Ksystems© it is part of Ksystems© and is owned by KINNEY. At KINNEY’s choice it may be made available to all users and will remain part of Ksystems© even if the District cancels its contract.
ATTACHMENT IV
32
ELECTRONIC HEALTH RECORDS MANAGEMENT SERVICES
APPENDIX B
KINNEY Confidentiality Agreement
Service Providers
District:_________________________________________________________________ Name:______________________________________Therapy:_____________________ E-mail Address:__________________________________________________________ License/Certification Number:______________________________________________ If not Licensed: Name of Licensed Professional of the Healing Arts who provides direction for Medicaid Services: ____________________________________________ I have received my user Identification (UserID) and Password and agree to the following:
I will not share my UserID and Password. I will keep my UserID secure and password secure, i.e. not accessible to anyone else. If my UserID or Password is compromised or lost I will immediately notify District's KINNEY
Access/Security Manager identified below and KINNEY by calling 1-518-371-0176 or emailing "Ksystems© @kinneyassoc.com".
When entering services on the KINNEY web site I will ensure that no one is able to observe. I will make sure that my monitor is not viewable by others and will sign off when I am finished entering information.
When entering and/or accessing information on the KINNEY web site I will comply with all federal and state regulations controlling its treatment and release. This includes, but is not limited to the Family Education Rights to Privacy Act (FERPA) and the Health Insurance Portability and Accountability act of 1996 (HIPAA).
I will immediately report to the District's KINNEY Access/Security Manager if the security/confidentiality of my password is compromised in any way.
I accept full responsibility for the accuracy of the information I report.
By signing this document I am certifying that 1. I have read and understand all of the above terms of use and agree to them; 2. if licensed, I will report only services that I have personally provided; and 3. if not licensed, I will report only services that I have personally provided
under the direction of a licensed professional. Print Name:______________________________________ Signature:________________________________________ Date:_________________ Name of the District's Ksystems© Access/Security Manager: Print Name:______________________________________ Signature:________________________________________ Date:_________________
User ID: _____________________ Password: _________________
ATTACHMENT IV
33
ELECTRONIC HEALTH RECORDS MANAGEMENT SERVICES
APPENDIX C
KINNEY Confidentiality Agreement
ADMINISTRATORS ONLY District:_________________________________________________________________ Name:______________________________________Therapy:_____________________ E-mail Address:__________________________________________________________
I have received my user ADMINISTRATOR Identification (UserID) and Password and
agree to the following:
I will not share my UserID and Password. I will keep my UserID secure and password secure, i.e. not accessible to anyone
else. If my UserID or Password is compromised or lost I will immediately notify KINNEY by
calling 1-518-371-0176 or emailing Ksystems© @kinneyassoc.com. When assigning user identification and initial passwords I will verify the
identity of the person to whom they are assigned. When entering services on the KINNEY web site I will ensure that no one is able to
observe. I will make sure that my monitor is not viewable by others and will sign off when I am finished entering information.
When entering and/or accessing information on the KINNEY web site I will comply with all federal and state regulations controlling its treatment and release. This includes, but is not limited to the Family Education Rights to Privacy Act (FERPA) and the Health Insurance Portability and Accountability act of 1996 (HIPAA).
I will immediately report to the District's KINNEY Access/Security Manager if the security/confidentiality of my password is compromised in any way.
I accept full responsibility for the accuracy of the information I report. I will only assign ID’s and password where I have verified the user identity.
By signing this document I am certifying that 1. I have read and understand all of the above terms of use and agree to them; 2. If I report services, I will report only services that have been either provided by a licensed professional or under the direction of a licensed professional.
Print Name: ___________________________________ Signature: _______________________________________ Date: ___________ Name of KINNEY security manager assigning District security manager’s ID and password. Print Name:______________________________________ Signature:_____________________________________ Date: ___________
User ID: _____________________ Password: _________________
ATTACHMENT IV
34
Compliance Plan – Attachment V
Kinney & Associates, Inc. Kinney Management Services, LLC Title: Duty to Report Wrongdoing; Whistleblower Protection Purpose: To advise employees, contractors, and volunteers when and how to report wrong doing and of their protection against reprisal or retaliation for reporting. Policy: Any person who has knowledge of or, in good faith, suspects any wrongdoing in the documenting, coding, or billing for services, equipment, or supplies, in either our practices or those of our clients, or violation of the Standards of Conduct should report it internally so that an investigation can be conducted and appropriate action taken. Retaliation or reprisal against anyone for such a report is strictly prohibited. Definitions: Wrongdoing: In addition to a violation of Federal or state law, wrongdoing includes violation and the impermissible billing practices such as:
billing for services not performed at all or not performed as described;
submission of claims for unnecessary or undocumented services, equipment, or supplies;
double billing;
upcoding;
unbundling;
misuse of coding modifiers;
false cost reports;
billing for services by an unlicensed or excluded provider;
paying or accepting money, gifts, or favors in return for referrals. Implementation: 1. Anyone who becomes aware of or in good faith suspects wrongdoing by another employee, a board member, a client, a vendor, a contractor, or any other person should report it to their supervisor as well as Joe (Compliance Officer or Diane Kinney or Sandra Steinhardt. 2. The individual making the report may do so by reporting the concern in writing or by using any anonymous method such as leaving a note on one of the above person desk, etc. Anyone making an anonymous report must realize that the Compliance Officer will not be able to ask additional questions of the person reporting nor advise the person of the outcome. We will attempt to maintain the confidentiality of the person reporting the concern. 3. Self-reporting is also encouraged. Anyone who self-reports wrongdoing or a violation of law will be given due consideration in mitigation of any disciplinary action that may be taken. 4. Upon a report of wrongdoing, the Compliance Officer will then conduct an investigation into the allegations to determine the nature, scope, and duration of wrongdoing, if any, and shall follow the steps set to remedy the situation. These steps are likely to include contacting appropriate state or federal officials when the allegation is confirmed. 6. Retaliation or reprisal in any form against anyone who makes a report of wrongdoing, cooperates in an investigation, or participates in the compliance program is strictly prohibited. If an employee or a contractor believes that an adverse action in the form of reprisal or retaliation has been taken against him or her as the result of making a report or cooperating in an investigation pursuant to this or any other compliance policy, he or she should report it to the Compliance Officer immediately. 7. The Compliance Officer shall maintain a confidential log in a secure place of all reports of compliance concerns and shall update management as often as necessary. 8. Anyone who makes a report of wrongdoing maliciously, frivolously, or in bad faith will be subject to disciplinary action up to and including termination. 9. We seeks to investigate all nonfrivolous claims of wrongdoing internally so that corrective action can be instituted. Kinney encourages the reporting so that appropriate corrective action can be instituted. However, any person who discovers wrongdoing that is a false claim or statement may report that information to the Department of Justice or the U.S. Attorney by filing a complaint under seal in the court pursuant to the False Claims Act (described in the Appendix). They may also report to the appropriate state’s Medicaid Fraud Control Unit, Medicaid Inspector General, local prosecutors and other law enforcement authorities. If assistance is needed in identifying the appropriate
35
official please contact one of the individuals identifies above.
Appendix 1 Billing and Coding Standards; Liability for False Claims Policy Title: Billing and Coding Standards; Liability for False Claims Purpose: To set forth the standards that are applicable to reimbursement for medical services, supplies and equipment in order to comply with Kinney’s Standards of Conduct and Federal and state law. Policy: Each employee, contractor, or vendor involved with providing or obtaining reimbursement for medical services, supplies, or equipment from or on behalf of our clients is responsible for submitting honest and accurate bills to Medicaid, Medicare, and other Federal and state health care programs. In addition to complying with Kinney's Standards of Conduct, all employees, contractors, and vendors are expected to comply with Federal and state laws and administrative remedies designed to prevent fraud, abuse, and waste in Federal and state health care programs. Implementation:
A. Medically Necessary Services
All services, equipment and supplies billed for will be reasonable and fully documented.
All bills will be for services provided by providers who are properly credentialed and licensed and provide services within their scope of practice.
B. Completeness and Accuracy in Medical Records and Billing
Documentation will be in sufficient detail so that an accurate bill can be submitted for each treatment or procedure performed.
Provider numbers will be accurate and will not be shared.
Services performed by therapist who require supervision will be billed only in compliance with Federal and state laws and regulations including the presence of a supervising licensed professional.
Bills submitted for services performed shall describe the services in sufficient detail, be based on proper documentation in Ksystems (HER), or on paper, not duplicate bills for the same services, be accurate, be based on the correct provider number, and be in compliance with Federal and state law, as well as the payor’s contracts.
Billing and Coding staff will comply with CMS and state program instructions and policies. B. Impermissible Billing Practices
The following practices are not permitted:
Billing for services that were not performed at all or not performed as described,
Submitting claims for medical equipment, supplies, or services that were not necessary,
Double billing,
Upcoding or assigning a code that secures a higher reimbursement, rather than the code that matches the services performed,
Unbundling or billing the parts of a global fee separately,
Knowingly misusing provider numbers,
Failing to use coding modifiers accurately or appropriately,
Preparing or submitting false cost reports,
Billing for services performed by an unlicensed provider or one who has been excluded from a Federal health care program,
B. Compliance with Federal Law
All employees, contractors and board members will comply with Federal and state law and regulations concerning fraud and abuse in federal health care programs, especially the Federal False Claims Act and administrative remedies associated with their enforcement (see Appendix to this Policy).
No employee and/or contractor is permitted to give cash, gifts, favors, payment, services, entertainment, tips or any other items of value to anyone in exchange for their signing a contract or reporting services to be billed to Medicaid, Medicare or any other government or private health care program.
B. Government Reporting
All reports required to be submitted to state or Federal health care programs must be truthful and accurate. No member, manager, officer, or employee shall attest to the accuracy of a submitted report unless he or she has been able to satisfy himself or herself that the data submitted or the representations made are truthful and accurate.
If it is determined that a clients has been overpaid by a government program or third party payor Kinney will promptly adjust the payment in the future billing to the proper party. If our contractual
36
relationship with client has ended we will notify the former client of their need to return the over payment.
All cost report data, schedules and worksheets must be truthful, accurate, and complete.
No employee or contractor will attempt to improperly influence the actions or decisions made by government bodies, officials, employees, or contractors.
Kinney will cooperate and be truthful in responding to government inquiries, requests, and investigations, including audits, surveys, and certifications reviews.
APPENDIX 2 FEDERAL AND STATE LAWS
Civil False Claims Act (31 U.S.C. ' 3729 et seq.):
The False Claims Act is a statute that imposes civil liability (between $5,500 and $11,000 a claim and three times the total damages) on any person or entity who;
knowingly submits a false claim to the Federal government for payment
knowingly makes or uses a false record or statement to obtain payment or approval of a claim by the Federal government
uses a false statement to decrease an obligation to the government.
Knowingly:
actual knowledge of the truth or falsity of a claim or statement
acting recklessly, or
acting with deliberate ignorance of the truth or falsity of the claim. Claim: The definition of claim includes a claim submitted to Medicaid, Medicare or Tricare.
Bringing an Action under the False Claims Act: A private person can bring an action under the False Claims Act in the name of the United States.
The person can file a complaint "under seal" or confidentially on the court docket. "Under seal" means that the records are kept secret on the docket of the court.
The U.S. Attorney has sixty days, or more if an extension is requested of the court, to review the complaint and consider the allegations and whether the U.S., through the Department of Justice, will join in and take over the complaint.
The Department of Justice then investigates the allegations of violations of the False Claims Act and may involve the FBI or the Office of the Inspector General of the Department of Health and Human Services and may issue subpoenas for documents or electronic records, may interview witnesses, and may compel testimony from certain individuals within the organization.
After the investigation is complete, the Department of Justice decides whether it will intervene in the action filed by the employee, decline to intervene, or dismiss the complaint.
If the action is pursued and is successful, the employee is entitled to part of the recovery, from 15 to 30%, depending on whether the Justice Department, becomes involved in the case.
Civil Monetary Penalties: These statutes provide administrative remedies and penalties against those who submit false claims or make false statements to Federal agencies.
The Program Fraud and Civil Remedies Act ("PFCRA") (31 U.S.C. 3801-3812) is another tool the Federal government can use to penalize false claims involving Federal agencies and is designed to provide them with an administrative remedy for losses resulting from false claims. The PFCRA provides for civil penalties of $5,000 per claim for each false claim submitted to a Federal agency and an assessment of twice the amount of the claim against anyone who submits a false, fictitious or fraudulent claim, includes a false statement of material fact or omits a material fact, or makes claims for property or services that were not provided as claimed.
The Civil Monetary Penalties Law "CMPL" (42 U.S.C. Sec. 1320a-7a) provides for penalties against anyone who presents a claim to a Federal or state officer, employee or agency he knows or should know was not provided as claimed or is based on upcoding. CMPL can also be assessed against a provider who:
-- submits a bill for the services of someone who is not licensed or is excluded from Federal or state health care programs or
violates the anti-kickback statute or
is in violation of the Stark self-referral law.
Criminal Penalties for Acts Involving Federal Health Care Programs (42 U.S.C. ' 1320a-
37
7b): Anyone who makes a false statement in any application for a benefit or payment under a federal or state health care program or solicits or receives any payment for referring someone for a service or item reimbursable by a Federal or state health care program can be fined up to $25,000 and imprisoned.
Anti-kickback Statute: The Federal anti-kickback statute was passed to prevent fraud and abuse in Federal health care programs by making it a crime for anyone to knowingly and willfully receive or pay anything of value to influence the referral of Federal health care program business, such as Medicare and Medicaid.
Since it is a criminal law, the intent of the wrongdoer to violate the law has to be shown.
The punishment for violations of the law is up to five years in jail, criminal fines up to $25,000, administrative civil monetary penalties up to $50,000, and exclusion from Federal health care programs.
There are 23 anti-kickback safe harbors that provide protection from prosecution for certain payment and business practices implicated by the anti-kickback statute.
Safe harbors include personal services and management contracts, lease agreements for space or equipment, joint ventures in and recruitment to medically underserved areas, but anyone who is trying to fit within a safe harbor should consult with an attorney.
Stark Law (I and II): The Stark law prohibits a physician from referring Medicare and Medicaid health care program patients for certain "designated health services" to an entity with which the physician or an immediate family member has a financial relationship.
New State False Claims Act can be found at http://www.ag.ny.gov/bureaus/whistle_blowers/false_claims_act.html. The penalties include a civil penalty of not less than six thousand dollars and not more than twelve thousand dollars, plus three times the amount of damages which the state sustains because of the act of that person; and (ii) to any local government for three times the amount of damages sustained by such local government because of the act of that person.
Subject: Responding to Detected Offenses and Developing Appropriate Corrective Action Issued By: Kinney & Associates, Inc. and
Kinney Management Services, LLC Prepared By: Joseph Kinney Approved By: Sandra Steinhardt and Diane Kinney Effective Date: January 1, 2007
Purpose: To outline our response to a report regarding a compliance concern. Policy: The purpose of this policy is to set forth the procedures used to respond to information received by the Compliance Officer that a Board member, member officer, employee, consultant or vendor is engaging in activity that may be contrary to applicable Federal or State law or the requirements Kinney’s compliance program. Implementation:
a. Investigation - Purpose of Investigation. The purpose of an investigation is to:
identify situations in which applicable Federal or State laws, including the laws, regulations and standards of the Medicare and Medicaid programs, or the requirements of our compliance program may not have been followed,
to identify individuals or clients who may have knowingly or inadvertently violated the law or compliance program requirements,
to facilitate the correction of any violations or misconduct,
to implement procedures necessary to ensure future compliance,
To protect our clients, and Kinney, in the event of civil or criminal enforcement actions. a. Control of Investigations.
All reports of alleged non-compliance must be forwarded to the Compliance Officer. Serious or otherwise sensitive matters for investigations should be conducted under the direction of our Compliance Officer. If the involvement of legal counsel is warranted, the Compliance Officer is responsible for determining the extent of their involvement. Regardless the Compliance Officer will (1) initiate an investigation of the conduct in question, (2) report findings to the executives, and (3) recommend the appropriate actions to be taken by the Kinney. At all times relevant to the investigation, anyone assisting in the investigation, will function under the direction and control of the Compliance Officer.
b. Investigative Process.
38
Upon receipt of information concerning alleged misconduct, the Compliance Officer/Contact will, at a minimum, take the following actions:
Complete a Compliance Report Form that includes, if known, the name of the employee who made the report, the date of the report, and a detailed narrative of the employee’s concern. Anonymity of the individual who made the report (if requested) and confidentiality will be maintained.
Notify the Executive Director of the nature of the alleged improper conduct and, if the involvement of legal counsel is warranted, obtain a memorandum from senior management authorizing legal counsel to initiate an investigation.
Ensure that the investigation is initiated as soon as reasonably possible but in any event not more than [three (3)] business days following receipt of the information. The investigation shall include, as applicable, but need not be limited to:
Interviews of all persons who may have knowledge of the alleged conduct and a review of the applicable laws, regulations and standards to determine whether or not a violation has occurred.
Identification and review of relevant documentation, including, where applicable, representative bills or claims submitted to the Medicare/Medicaid programs, to determine the specific nature and scope of the violation and its frequency, duration and potential financial magnitude.
Interviews of persons who appeared to play a role in the suspected activity or conduct. The purpose of the interviews is to determine the facts surround the conduct, and may include, but shall not be limited to:
The person’s understanding of the applicable laws,rules and standards; Identification of relevant supervisors or managers; Training that the person received; The extent to which the person may have acted knowingly or with
reckless disregard or intentional indifference of applicable laws; Preparation of a summary report that (1) defines the nature of the
alleged misconduct, (2) summarizes the investigation process, (3) identifies any person who is believed to have acted deliberately or with reckless disregard or intentional indifference of applicable laws, (4) assesses the nature and extent of potential civil or criminal liability, and (5) where applicable, estimates the extent of any resulting overpayment by the government.
a. For all investigations ensure that significant developments are promptly reported to the Compliance Officer.
b. Ensure that the investigation is completed in a reasonable and timely fashion and that the appropriate disciplinary or corrective action is taken, if warranted.
D. Organizational Response. Non-Compliance/Suspected Criminal Activity.
In the event the investigation identifies employee misconduct or suspected criminal activity, Kinney will undertake the following steps.
As quickly as possible, cease the offending practice.
If the conduct involves the improper submission of claims for payment, we will immediately cease all billing potentially affected by the offending practice and or client.
Consult with legal counsel, if necessary, to determine whether voluntary reporting of the identified misconduct to the appropriate governmental authority is warranted.
If applicable, calculate and process adjustments for any improper payments made by a Federal or State government program as a result of the misconduct.
Initiate appropriate disciplinary action, which may include, but is not limited to, reprimand, demotion, suspension and/or termination. If the offense involves the action of an employee of a client we will immediately report the instance to the appropriate executive at the client.
If the investigation uncovers what appears to be criminal conduct on the part of an employee or client, appropriate disciplinary action against the employee or employees who authorized, engaged in or otherwise participated in the offending practice will include, at a minimum, the removal of the person from any position of oversight and may include, in addition, suspension, demotion, and termination. In the case of possible criminal conduct by an employee of a client, referral to the appropriate government official will be made.
39
Promptly undertake appropriate training and education to prevent a recurrence of the misconduct.
Conduct a review of policies and procedures to determine whether revisions or the development of new policies and/or procedures are needed to minimize future risk of noncompliance.
Conduct, as appropriate, follow-up monitoring and auditing to ensure effective resolution of the offending practice.
This policy and procedure shall be periodically reviewed and updated consistent with the requirements and standards established by the management, Federal and State law and regulations, and review organizations. Last Update: 9/30/2009.
