AMG CORPORATE COMPLIANCE

PROGRAM

It’s About Doing

The Right Thing...

Revised-8/2016

AMG COMPLIANCE PROGRAM

Established to ensure the company operates in accordance with laws and regulations

The Program is designed to:

PREVENT/DETER any accidental and intentional violations of laws

DETECT violations if they occur

CORRECT any future non-compliance

1. STANDARDS AND PROCEDURES - Code of Ethics and Business Conduct, the foundation of the Compliance Program

2. OVERSIGHT – The designation of Corporate Compliance Officer

3. EDUCATION AND TRAINING - Ensures our workforce can perform job functions in compliance with rule and regulations

4. AUDITING AND MONITORING- Ongoing review and risk assessment

5. REPORTING – Hotline and communication without fear of retaliation

6. ENFORCEMENT AND DISCIPLINE – Ensure disciplinary actions are imposed for non-compliance 7. RESPONSE AND PREVENTION – Respond and develop corrective action

SEVEN PILLARS OF COMPLIANCE

EVERYONE’S RESPONSIBILITY

Compliance is EVERYONE’S Responsibility RESPONSIBILITY OF WORKFORCE MEMBERS:

UNDERSTAND how the Compliance Program applies to your job and ask questions when necessary

REPORT any suspected violations

Actively PARTICIPATE in compliance activities (Training)

RESPONSIBILITY OF SUPERVISORS AND MANAGERS:

CREATE and MAINTAIN a culture of compliance

PREVENT, DETECT, RESPOND to compliance problems

PREVENT RETALIATION against employees who report violations in good faith

HEATHCARE REGULATORY

ENVIRONMENT

Healthcare is a government enforcement

priority because of the potential for fraud and

abuse

FRAUD AND ABUSE

FRAUD - making material false statements or representations of facts that an individual knows to be false or does not believe to be true in order to obtain payment or other benefit to which we would otherwise not be entitled

ABUSE –practices that directly or indirectly result in unnecessary costs or improper payments for services which fail to meet recognized professional standards of care

Fraud and Abuse Explanation Fraudulent activity is an action that is done for one’s own benefit or for the benefit of another. The activity can be knowing, willful, reckless, or unintentional. Fraudulent activity may involve false statements or representations of facts in order to benefit or obtain payment. Abuse involves practices that result in unnecessary increased costs or use of medical services or products.

Examples of Fraud and Abuse:

Billing for Services not provided Billing for Services not medically necessary Falsifying records Substandard quality of care Restriction of patient choice Offering, soliciting, giving or receiving

anything of value for a patient referral

SIGNIFICANT LAWS

Healthcare is an industry with strict standards and regulations that are aimed at reducing fraud, waste and abuse. These laws are to prevent financial motive from influencing medical judgment. The laws seek to protect patients, improve the quality of care delivered, and in turn reduce cost.

LAW THESE LAWS:

False Claims Act Deficit Reduction

Act Fraud and

Enforcement Recovery Act (FERA)

Fight fraud and abuse

Encourage reporting by whistleblowers

Outlaw retaliation against whistleblowers

Aim to reduce rising healthcare spending

Establish liability for presenting false claim

FALSE CLAIMS ACT

Providers can be prosecuted for a wide variety of conduct that leads to the submission of false claims. Such conduct includes: Falsifying records

Knowingly making false statements

Double-billing for items or services

Submitting bills for services never performed

Potential penalties for violating the False Claims Act are severe and include: Civil or monetary penalties ranging from $10,781 to $21,563 per claim

Criminal prosecution, including imprisonment

Exclusion from federal healthcare programs

The False Claims Act includes a “qui tam” or

whistleblower provision to

encourage people to come forward

and report wrongdoing

without retaliation

ANTI-KICKBACK STATUTE

LAW THIS LAW: Anti-Kickback Statute Prohibits the offer or receipt of certain

remuneration in return for referrals Includes any kickback, bribe, or rebate Defines a violation as a criminal offense

Potential Penalties for Violation:

$50,000 civil monetary penalty per violation

Criminal penalties of up to $25,000 in fines and/or up to 5 years in prison

Exclusion from federal healthcare program

LAW THESE LAWS:

Health Insurance Portability and Accountability Act (HIPAA)

American Recovery and Reinvestment Act (ARRA)

Health Information Technology for Economic and Clinical Health Act (HITECH)

Omnibus Rule

Provide insurance portability

Establish Standards for privacy and security of patient information

Strengthen HIPAA privacy and security standards and penalties for breaches of information

HIPAA PENALTY TIERS

HIPAA Violation Civil Monetary Penalty

CAUSE $ AMOUNT

Violation was not known $100-$50,000 per violation

Due to reasonable cause and not to willful neglect

$1,000-$50,000 per violation

Due to willful neglect, but is corrected

$10,000-$50,000 per violation

Due to willful neglect and is not corrected

$50,000 per violation

Questions regarding HIPAA and any other privacy or

security questions should be directed to Susan Wallis, RHIT,

CHC- Privacy Officer swallis@amgihm.com or 337-269-9566. Full HIPAA

training is available on Medline U for reference.

All Privacy or Security related events should be immediately

reported to the Privacy Officer

STARK LAW

LAW THIS LAW: The Stark Law is also referred to as

the Physician Self-Referral Law

Prohibits physicians from referring Medicare patients for certain services to an organization with which the physician or a member of the physician’s immediate family has a financial relationship unless an exception exists.

Prohibits an entity from presenting (or causing to be presented) a bill or claim to anyone for a service furnished as a result of a prohibited referral.

Potential Penalties for Violation: $10,000 for each failure to report when required by statute $15,000 for each item or service subject to improper

referral $100,000 for each circumvention scheme Exclusion from Medicare/Medicaid Programs Possible False Claims Act Liability

PPACA

LAW THIS LAW:

Patient Protection and Affordable Care Act (PPACA)

Supports healthcare reform Establishes health insurance

exchanges Provides new tools to fight

fraud and abuse Increased Criminal and civil

penalties Expansion of Recovery Audit

Contractors (RAC)

Government Resources

The Office of Inspector General (OIG) uses 5 strategies to prevent healthcare fraud, waste and abuse:

1 Enrollment: Scrutinize provider applicants

2 Payment: Use reasonable, responsive methods

3 Compliance: Assist providers to comply

4 Oversight: Monitor for fraud, waste, and abuse

5 Response: Punish fraud, remedy vulnerabilities

HEALTHCARE FRAUD PREVENTION AND

ENFORCEMENT ACTION TEAM (HEAT)

The HEAT Team makes fighting Medicare fraud a Cabinet-level priority for Health

and Human Services and the Department of Justice (DOJ). The Medicare Fraud Strike Forces include teams from the

following:

DOJ- Criminal Division FBI CMS HHS’ Office of Inspector

General

AMG COMPLIANCE PROGRAM BASICS

To be Proactive NOT REACTIVE

STANDARDS AND PROCEDURES

The AMG Code of Ethics and Business Conduct requires you to follow federal and

state regulations for fraud, waste and abuse as well as

company compliance policies. It requires that you behave in

a way that helps the organization keep a good

reputation in the communities in which we

serve

CODE OF ETHICS AND BUSINESS CONDUCT

Every member of the workforce must do their job ethically and with professionalism

Workforce members MUST:

Follow AMG Policies and Procedures Comply with Federal, State, and Local

regulations Commit to reporting any compliance

concerns/violations Read and sign that you understand the

Code Follow the Code in your daily activities Contact Stephen Devall at 337-269-9566

with questions regarding the Code

CONFLICT OF INTEREST

All workforce members, including but not limited to employees, vendors, medical staff, leadership, and governing board members, must disclose any situation which would potentially be a conflict of interest with AMG.

Workforce members MUST disclose:

Any employment arrangement; Financial interest; Official position; Ownership interest; Loan to or from; Guarantee of any obligation; and/or Any other relationship that such employee (or

MEMBER OF HIS/HER IMMEDIATE FAMILY) has with AMG’s customers, vendors, competitors, or other business relation that could potentially be a conflict of interest at the time of hire/contracting/appointment and per policy thereafter

Immediate Family Member: spouse, child or spouse of a

child, brother, sister, or spouse of a brother or sister, mother-in-law, father-in-law, brother-in-law or sister-in-law.

CONFLICT OF INTEREST – continued

Financial interest does not include ownership of an immaterial amount of stocks or bonds in a publicly held company

No person shall be permitted

to participate in the decision-making process with respect to a transaction in which such person may have a conflict of interest

PROHIBITED BEHAVIOR

Behavior that is prohibited under the AMG Code of Ethics and Business Conduct

Behavior that is prohibited: Billing for services that are not medically necessary Retaliation Sexual harassment or workplace violence Using company property for personal use without supervisory

approval Destroying or altering company records beyond what AMG

policy allows Falsification of mileage or timesheets Improper billing of services Engaging in activity that is a conflict of interest for AMG Inappropriately accessing patient information without a “need to

know” Inappropriately disclosing patient health information Discrimination based on race, color, religion, gender, national

origin, sexual orientation, disability, or age Offering or paying a referral source anything in exchange for a

referral Contracting, employing, or billing services rendered by an

individual or company that is excluded from participation in federal healthcare programs

Disregard of company policies and procedures

OVERSIGHT

The AMG Corporate Compliance Officer is

STEPHEN DEVALL

For questions or concerns the Compliance Officer may

be reached at 337-269-9566

EDUCATION AND TRAINING

Every workforce member will be trained

Training will be provided:

Upon hire Annually When there is a significant

change in regulation determined by the Compliance Officer

AMG COMPLIANCE RISK AREAS

Summary of AMG Key Compliance Risk Areas:

The federal Anti-Kickback Statute HIPAA Privacy and Security Rules Risk identified by the Office of Inspector General and other government agencies Submission of accurate claims and the federal False Claims Act The referral-based statutes listed in the Stark Law (Physician Self-Referral Law) Coding and Documentation Disclosure of Physician Ownership Hospital Readmissions Substandard Care

COMPLIANCE AUDITING AND MONITORING

ACTIVITIES:

The AMG Compliance Committee assesses risk and oversees

company wide mitigation of risks. An ongoing auditing and

monitoring program is maintained to monitor adherence to AMG

policies and procedures , including state and federal laws. The

Government also performs audits through various programs.

AUDITING AND MONITORING

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) calls for auditing and monitoring as “an ongoing evaluation process (that) is critical to a successful compliance program.”

The OIG states that auditing and monitoring should be:

an ongoing process; thorough with regular reporting on it to

senior officials, including the board; regular, periodic audits by qualified people

focusing on programs with substantive exposure to government enforcement actions; and

ensuring compliance with specific federal, state, and internal rules and policies.

RESPONDING TO GOVERNMENT REQUESTS

All government audit requests such as ADR, RAC, MAC, CERT,

Probe, ZPIC, OIG, OCR, etc., should be sent to the Corporate office for

review and instruction.

CMS

OIG

OCR

ENFORCEMENT AND DISCIPLINE

Always do the right thing! Failure to follow the AMG Compliance program may

result in: • Disciplinary Action • Termination • Criminal Prosecution • Monetary Fines • Exclusion from Federal

Healthcare Programs

WORKFORCE RESPONSIBILITY

All Workforce members should: Disclose conflicts of interests Report suspected compliance violations, without

the fear of retaliation, including, but not limited to, violations of:

AMG Code of Ethics and Business Conduct Policy and procedure Patient Safety and Quality

Concerns State or Federal law/regulations

HOW TO REPORT VIOLATIONS

There are several ways to report a potential Compliance violation including:

Notifying your Supervisor or department manager Via the “File a Compliance Report Online” link on the AMG website at

www.amgihm.com under “Contact Us” Contacting the Corporate Compliance Officer, Stephen Devall, at 337-269-

9566 Via mail at 101 La Rue France, Suite 500, Lafayette, LA 70508 Anonymously via the Compliance Hotline at 844-523-2091

RESPONSE AND PREVENTION

INVESTIGATION/RESPONSE/CORRECTIVE ACTION:

All reported concerns are investigated confidentially and expeditiously. No

retaliation or disciplinary action will be taken against any individual for reporting

an issue or concern in “good faith”. Anyone who retaliates against an

individual for reporting a compliance concern will be subject to disciplinary

action, up to and including termination. If the reported concern is validated through

investigation the Company will appropriately respond and implement

corrective action to prevent future non-compliance

Please see the AMG Non-Retaliation Policy #015 for more information

QUESTIONS

FOR QUESTIONS REGARDING THIS TRAINING PLEASE CONTACT STEPHEN

DEVALL, CORPORATE COMPLIANCE OFFICER AT 337-269-9566