Effective: 01-21-21
Supersedes:
Policy
It is the policy of Brewster and EasCare Ambulance Services to conduct business with integrity. We make this commitment to our employees, customers, partner agencies, and the communities we serve. We are committed to ensuring that billing to Medicare, Medicaid, third-party private insurance, and any other federal or state health care programs is accurate and in full compliance with all applicable laws and regulations.
Brewster and EasCare encourages employees to contact their direct supervisor or the designated compliance officer for the company with any questions regarding billing compliance, or to report any known or suspected fraud or abuse. Any person may, under certain circumstances, become a whistleblower and notify the government if they believe the company is not responding appropriately to reports of problems or concerns.
Procedure
In accordance with the company’s “Patient Care Report Documentation” policy, each patient care report shall be accurate, prepared contemporaneously with or as soon as practicable after, the EMS call that it documents, and shall, at a minimum, include all required patient care and billing data elements.
Federal False Claims Act, the federal Program Fraud Civil Remedies Act and certain Massachusetts laws prohibit the knowing submission of false claims or statements to the government for payment. Although they differ in their specific detail, these laws define false claims as knowingly submitting false or fraudulent claims for payment to the federal or state government, or failing to disclose the occurrence of events that affect the right to benefits. Examples of false claims include billing for services not provided, falsifying certificates of medical necessity, falsifying medical records, and failing to report overpayments.
Federal False Claims Act (31 U.S.C 3729-3777)
Under the federal False Claims Act, any person or entity that knowingly submits a false or fraudulent claim for payment of United States Government funds, or knowingly retains an overpayment of such funds more than 60 days, is liable for significant penalties and fines.
The federal law contains a “qui tam” provision, commonly referred to as the “whistleblower” provision. This allows a private person with knowledge of a false claim to bring a civil action on behalf of the United States Government to recover the funds paid by the Government based on the false claim. The federal False Claims Act also contains a provision that protects a whistleblower from retaliation by their employer. This applies to any employee who is discharged, demoted, suspended, threatened, harassed, or discriminated against in his or her employment because of the employee’s lawful acts in furtherance of a false claims action.
State False Claims Act(s)
The Massachusetts False Claims Act (MGL Ch 12 Section 5A-5O), allows private citizens to file a whistleblower, or ‘qui tam,’ lawsuit on behalf of the Commonwealth of Massachusetts when they suspect an entity submitted false claims to a government program. The whistleblower is entitled to protection from employer retaliation and a percentage of any government recovery. Similarly, other States in which Brewster and EasCare Ambulance have base locations and typically operate have mechanisms to report fraud and abuse, and whistleblower protection legislation as well.
Massachusetts: https://www.mass.gov/service-details/attorney-generals-false-claims-division
Rhode Island: http://www.omb.ri.gov/internal-audit/fraud/
New Hampshire: https://www.dhhs.nh.gov/oii/fraud.htm
Florida: https://ahca.myflorida.com/executive/inspector_general/complaints.shtml
Reporting Concerns Regarding Fraud, Abuse and False Claims
Brewster and EasCare Ambulance Service takes issues regarding potential false claims, fraud and abuse seriously. The Company encourages all employees to be aware of the laws regarding fraud and abuse and false claims and to identify and attempt to resolve any issues immediately. The Company encourages employees with any questions or concerns regarding billing issues to report such concerns to their immediate supervisor for clarification or resolution.
Alternatively, in accordance with the company’s “open door” policy, concerns, suggestions and questions may be brought to the attention of management or ownership at any time. Concerns may also be brought to the Company’s designated Compliance Officer by telephone at 781-808-9038 or email at COMPLIANCE@BrewsterAmbulance.com. All reports will be treated confidentially to the extent reasonably possible.
Brewster / EasCare will not take any adverse action against an individual who notifies the Company or any government agency in good faith about potential violations, or participates in the investigation of an alleged violation. Brewster and EasCare Ambulance Service commits to providing all the protections set forth in the applicable laws regarding anti-retaliation for the reporting of potential law violations. However, if an employee knowingly provides a false report in order to injure or cover for someone else or to cover for themselves, Brewster and EasCare Ambulance Service may take disciplinary actions as appropriate.