CODE OF CONDUCT

PASSION WELLNESS MENTAL HEALTH COUNSELING (PWMHC) COMPLIANCE PROGRAM

Introduction

PWMHC is committed to conducting its activities in compliance with all federal, state, and local laws and regulations and with the highest professional and ethical standards. This includes a commitment to promoting evidence-based services; effective patient engagement; and cost-effective, high-quality, patient-centered care. All PWMHC members, employees, contractors, and practitioners (hereinafter referred to as “Participants”) play an integral role in helping achieve these goals.

This Code of Conduct has been adopted by the PWMHC in support of the PWMHC’s Compliance Program. The Code of Conduct describes the standards by which all Participants are expected to conduct themselves when working for or on behalf of PWMHC. Participants are required to adhere to both the spirit and letter of the Code of Conduct. In addition to the Code of Conduct, Participants are expected to follow all policies and procedures affecting their activities in PWMHC.

Participants remain subject to the requirements of their own organization’s compliance programs and Code of Conduct, in addition to the requirements of PWMHC’s Compliance Program and this Code of Conduct.

Standards of Conduct

Honest and Lawful Conduct: PWMHC and Participants will abide by all applicable laws and regulations. All Participants must maintain a high level of integrity and honesty in their conduct relating to the operations and performance of the PWMHC and will be held accountable for behaviors and actions inconsistent with this Code of Conduct.

Quality of Care: PWMHC treats all patients with respect and dignity, providing care that is both necessary and appropriate. PWMHC is committed to providing high-quality health care to its patients and to delivering health care services in an ethical, professional, and effective manner. PWMHC and its Participants are committed to delivering people-centered, high-quality healthcare services with compassion, dignity, and respect for each individual.

No Reduction in Medically Necessary Services: PWMHC and its Participants are committed to improving health, enhancing the quality of care, and lowering the costs of healthcare services. PWMHC and Participants will not deny, reduce, or limit the provision of medically necessary services to any patient.

No Discrimination: PWMHC prohibits any form of discrimination in the provision of services, marketing, or enrollment practices. PWMHC and Participants will not deny, limit, or condition services to patients based on race, color, religion, gender, sexual orientation, marital status, national origin, citizenship, age, disability, or any other characteristic protected by law or any factor that is related to health status, such as nature and extent of medical condition, medical history, or genetic information. PWMHC prohibits any practice that would reasonably be expected to have the effect of denying or discouraging the provision of medically necessary services to eligible individuals.

Licensure: All individuals and entities providing care to PWMHC patients will be properly licensed or permitted in New York State or designated or approved by the Office to provide services and possess the necessary experience and expertise to deliver high-quality, effective care. Only qualified Participants will be permitted to make clinical assessments or to develop plans of treatment for patients. Participants will confirm the licensure of all employees, agents, and contractors rendering services to PWMHC patients. Complying with licensure requirements is an important component of PWMHC’s commitment to ensuring that patients receive high-quality, effective care.

Gifts to Medicare Beneficiaries: Participants are prohibited from offering or providing gifts or remuneration to Medicare beneficiaries, either individually or on behalf of PWMHC, as inducements for receiving services or remaining in PWMHC or with a particular provider within PWMHC. Limited in-kind items or services may be provided by PWMHC to Medicare beneficiaries for free or below fair market value provided they are either 1) preventative care in nature; or 2) advance the clinical goals of the Medicare beneficiary. Limited in-kind items or services will not be provided directly by physicians or practices to Medicare beneficiaries except as part of a program approved by the Board of Directors.

Eligibility to Participate in Federal and State Health Care Programs: PWMHC and Participants will not knowingly hire, employ, contract, or do business with any individual or entity excluded, debarred, or otherwise ineligible to participate in federal or state health care programs such as Medicare and Medicaid, or whose officers, directors or employees are excluded from participating in federal or state health care programs. Participants are responsible for taking all necessary steps to ensure employees involved in providing goods or services to PWMHC, directly or indirectly, remain eligible to participate in federal and state health care programs.

Documentation, Coding, and Billing: All Participants will adhere to federal and state laws and regulations governing billing, coding, and documentation requirements for medical services billed to Medicare, Medicaid, and other payers. All billing, coding, and documentation must be accurate and truthful. Only medically necessary services that are consistent with accepted standards of medical care may be billed. Billing and coding are to be based on adequate documentation of the medical justification for the service provided and for the claim submitted, and medical documentation must comply with applicable payer requirements. Only codes that correspond to the service rendered and documented are to be used.

Mandatory Reporting: PWMHC will ensure that all incidents that are required to be reported under applicable federal and state mandatory reporting laws, rules, and regulations are reported timely. This includes but is not limited to, the reporting of probable violations of law to an appropriate law enforcement agency and the disclosure and repayment of identified overpayments from Medicare or other third-party payers as required by law.

Accuracy and Integrity of Records: PWMHC and Participants shall maintain accurate and complete records relating to all business activities, claim submissions, arrangements, or transactions.

Privacy and Security of Patient Information: Federal and state laws require PWMHC and Participants to maintain the privacy and security of patient health information (“PHI”) in all forms – paper, electronic records, films and images, and verbal discussions. All Participants will keep PHI confidential, except when disclosure is authorized by the patient or permitted by law. Personnel:

• Will not access or use PHI except as necessary to perform their jobs.

• Will access, use, and disclose only the minimum amount of PHI necessary to perform their jobs.

• Will not discuss PHI with others who do not have a job-related need to know such information, including co-workers, family, and friends.

• Will not leave PHI unattended, unsecured, or otherwise available to the public.

• Will not store PHI on laptops, tablets, storage media, or other portable devices unless authorized and approved for use by PWMHC or their employer organization.

• Immediately notify their supervisor or their organization’s Privacy Official if PHI has been lost, stolen, or accessed inappropriately.

Cooperation with PWMHC Compliance Program: All Participants will cooperate with and support PWMHC’s Integrity and Compliance Program through adherence to the standards described herein and participation in activities such as:

• Periodic internal audits, including allowing PWMHC staff or agents to conduct audits of Participants’ medical records documentation, quality data collection, and claims submission.

• Compliance and other training of Participants as required by CMS regulations, including distribution of compliance communication and training materials such as this Code of Conduct.

• Implementation of procedures to ensure the accurate collection, submission, or transmission of quality data, as required.

• Responding to compliance audits, investigations, reviews, and inquiries, and implementation of corrective actions, as needed.

Compliance with Fraud and Abuse Laws: Federal and state laws prohibit the exchange of anything of value to induce or reward patient referrals for business payable by a federal or state health care program, except as permitted by law. By these laws, PWMHC and Participants will not offer, solicit, pay, or receive anything of value, directly or indirectly, for referring a patient or furnishing or arranging for a good or service payable by a federal, state, or other third-party payer. All referral decisions will be based solely on the healthcare needs of PWMHC patients.

Conflicts of Interest: A conflict of interest exists whenever an individual’s outside personal or financial interests influence, or appear to influence, decisions made involving PWMHC. Participants are expected to exercise good judgment, maintain objective business relationships with external parties conducting business with PWMHC, and avoid conflicts of interest. PWMHC decisions are to be made fairly and objectively, without favor or preference based on personal considerations. Participants may not use their positions or knowledge gained through their relationship with PWMHC for personal advantage. Personnel may occasionally find their duties to PWMHC in conflict or may appear to be in conflict, with other relationships and responsibilities. Such matters should be disclosed to the individual’s supervisor, a higher-level manager, or PWMHC’s Compliance Officer to ensure appropriate actions are taken to manage any conflicts of interest.

Reporting Requirement: PWMHC promotes an environment that encourages all Participants to seek answers to questions and report issues and concerns. Participants are expected to report, in good faith, any actual or suspected fraud, waste, and abuse, violations of law, regulation, professional standards, or PWMHC policies. Participants may choose one or more of the following methods for reporting:

• Participant Organization Management: Participants are encouraged, but not required, to report compliance matters directly to their direct supervisor, to other management of their organization, or to their own organization’s compliance officer.

• PWMHC Compliance Officer: Participants may at any time report compliance matters directly to PWMHC’s Compliance Officer as follows:

  • Edirin Abada, Compliance Officer

  • PWMHC Compliance, 2552 Pitkin Avenue, Suite 3, Brooklyn, NY 11208 (Mailing purposes)

  • Phone: 516-748-4202

    No Retaliation: PWMHC prohibits retaliation, in any form, against any individual reporting issues and concerns in good faith. Retaliation is subject to discipline up to, and including, termination of employment, or termination of participation in or business relationships with PWMHC. PWMHC will attempt to maintain, within the limits of the law, the confidentiality and identity of individuals reporting issues and concerns.

    Investigation of Alleged Fraud, Waste, and Abuse: PWMHC will promptly investigate any reports of alleged violations of law, regulations, or policies related to PWMHC activities. Participants are expected to fully cooperate in such investigations and, where appropriate, in taking corrective actions in response to matters identified, as needed. The Federal False Claims Act and similar state laws make it a crime to present a false claim to the government for payment. These laws also protect “whistleblowers” (people who report noncompliance or fraud, or who assist in investigations) from retaliation. PWMHC strictly prohibits retaliation or reprisal against individuals exercising their rights under the Federal False Claims Act or similar state laws.

    Lines of communication to the compliance officer are made available to all recipients of service:

    • Compliance Officer: Edirin Abada

    • Compliance mailing address: PWMHC Compliance, 2552 Pitkin Avenue, Suite 3, Brooklyn, NY 11208