“The most important part of my job is ensuring that excellent care is given to our customers, and that, when they leave, we have exceeded their expectations. Our staff gives excellent care and fosters that same culture of customer service. Our Personal Wellness Plan ensures that our Residents meet their personal goals and are able to have a successful discharge to home. It brings me great joy when a Resident is able to return home safely.”

– RN/Director of Health Services

General Compliance Standards and Procedures
Deficit Reduction Act (False Claims Act)
Reference(s): 31 U.S.C. 3729-3733

Definitions

  1. Fraud: An intentional (willful or purposeful) deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him/herself or some other person. It includes any act that constitutes fraud under applicable Federal or State law.
  2. False Claims Act: The provisions under the FCA state that it is a violation to:
    1. Knowingly present or cause to be submitted a false claim to the government.
      1. For purposes of this section, the terms “knowledge” and “knowingly” mean that a person, with respect to information-
        1. has actual knowledge of the information;
        2. acts in deliberate ignorance of the truth or falsity of the information, or
        3. acts n reckless disregard of the truth or falsity of the information and no proof of specific intent to defraud is required.
    2. Knowing use of a false record or statement to obtain payment on a false claim paid by the government.
    3. Engage in a conspiracy to defraud the government by the improper submission of a false claim for payment.
    4. Damages and penalties for violating the FCA may include:
    5. Civil penalties of not less than $5,500 and not more than $11,000 per violation, plus
    6. Three times the amount of damages that the government sustains because of the violation.
  3. Qui Tam Provisions (whistleblower rights): The provision of the FCA allows a person to bring an action under the Act on behalf of the federal government and share in the recovery.
  4. Retaliation or retribution for reporting issues “in good faith” is prohibited.

Policy

  1. All employees must conduct themselves in an ethical and legal manner as defined in Paragon Rehabilitation’s Employee Standards and Code of Ethical Conduct. See Employee Standards and Code of Ethical Conduct.
  2. All employees, contractors and agents are responsible for reporting potential or suspected incidents of fraud and abuse, and other wrongdoing directly to their supervisor and/or executive director or report suspected incidents to Paragon Rehabilitation’s Compliance Officer directly or via the Hotline. See Compliance Plan and Manual.
  3. All employees should be educated about fraud and abuse, including the detailed provision of the FCA, administrative remedies, State laws pertaining to civil or criminal penalties and Qui Tam provisions through mandatory compliance training. See Compliance Plan and Manual and Policy and Procedure Compliance Training.

Procedures

  1. All employees will receive training related to the provisions of the FCA during the annual compliance program training as outlined in applicable Compliance Procedures.
  2. Contractors and agents will have access to training material related to the provisions of the FCA and policies and procedures will be made readily available in either electronic or paper form upon request.
  3. Training will be provided in accordance with current mandatory Compliance Training procedures.
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