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Community Memorial Health Systems
Billing and Coding Issues Concerns regarding questionable billing, coding and medical record documentation practices.
Clinical Trials Misconduct in connection with any clinical trial, for instance, falsifying any study results or reports; failure to maintain adequate documentation as required by the IRB-approved study protocol; failure to follow the IRB study protocol; making a false or misleading statement in any material submitted to an IRB; making a false or misleading statement in any study report or other documentation, including the failure to report negative results; violation of adverse event reporting requirements; violation of FDA or ICH standards for the conduct of human clinical trials (e.g., ICH E6 Good Clinical Practices Consolidated Guidance or 21 C.F.R. parts 50, 54, 56).
Conflict of Interest A conflict of interest is defined as a situation in which a person, such as a public official, an employee, or a professional, has a private or personal interest sufficient to appear to influence the objective exercise of his or her official duties. (Examples include: inappropriate vendor relations, bribery, misuse of confidential information, inappropriate customer relations)
Discrimination or Harassment Uninvited and unwelcome verbal or physical conduct directed at an employee because of his or her sex, religion, ethnicity, or beliefs. (Examples include: bias in hiring, bias in assignments, wrongful termination, bias in promotions, bias in educational decisions, unfair compensation, inappropriate language)
Embezzlement To appropriate (as property entrusted to one's care) fraudulently to one's own use. (Examples include: bookkeeping errors, misapplication of funds, and mishandling of cash)
Falsification of Contracts, Reports or Records Falsification of records consists of altering, fabricating, falsifying, or forging all or any part of a document, contract or record for the purpose of gaining an advantage, or misrepresenting the value of the document, contract or record.
Health Insurance Portability and Accountability Act This Category should be selected if there is a concern with the improper use or disclosure of Protected Health Information. Protected Health Information is information that:
(1) is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and (2) relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and (i) that identifies the individual; or (ii) for which there is a reasonable basis to believe the information can be used to identify the individual.
Misconduct or Inappropriate Behavior Intentional wrongdoing; specifically: deliberate violation of a law or standard.
Patient Abuse/Physical Intentionally causing harm to a patient or neglecting a patient who needs medical attention or assistance.
Patient Abuse/Verbal Any language directed at a patient by an employee, which would be offensive (swearing), or language used to berate, belittle, or otherwise cause the patient to feel intimidated or threatened.
Patient Care Failure of those responsible for patient care, to properly attend to the everyday needs of a patient(s).
Patient's Rights Failures of those responsible for patient care to allow a patient(s) to follow/complete his/her daily routine, i.e. bathing, watching television, smoking, etc.
Physician Payment and Referral Concerns Concerns specifically related to physician payments/benefits and/or payment for referrals. (Examples include: paying a provider to refer patients to a facility, paying physicians more than fair market value for services provided, paying a provider without an executed contract, awarding a benefit to a physician that may violate the Stark regulations, etc.)
Sabotage or Vandalism Destruction of an employer's property (as tools or materials) or the hindering of manufacturing by discontented workers (Examples include: Equipment destruction, stealing, work slowdown, computer virus)
Substance Abuse Substance abuse is defined as the misuse of both legal and illegal drugs including alcohol. (Examples include: cocaine, narcotics, marijuana, stimulants)
Theft The act of stealing; specifically: the felonious taking and removing of personal property with intent to deprive the rightful owner of it.
Unauthorized/Fraudulent Use of Company facilities and equipment The misuse/abuse of Company Support Services, equipment, or assets.
Violation of Policy Willful or innocent actions that are in direct violation of company policy, procedures, code of conduct, and/or implied contractual responsibilities. (Examples include: non- disclosure agreements, hiring standards, safety, Internet usage, corporate guidelines)
Violence or Threat Violence is an expression of the intention to inflict evil, injury, or damage to a person or their property. (Examples include: direct, veiled, conditional, violent)
Other If you feel that the definitions above do not describe the event, action or situation you are looking to report about, please use this header.
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