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Capital Health System, Inc.
Accounting and Auditing Matters The unethical systematic recording and analysis of the business and financial transactions associated with generally accepted accounting practices. (Examples include: misstatement of revenues, misstatement of expenses, misstatement of assets, misapplications of GAAP principles, wrongful transactions.)
Billing and Coding Issues Concerns regarding questionable billing, coding and medical record documentation practices.
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.
Improper Lobbying or Political Contribution Inappropriate activities in violation of federal and state lobbying and political action, including the contribution or acceptance of funds meant for another candidate or the improper use of contributed funds for personal gain.
Patient Abuse/Physical Intentionally causing harm to a patient or neglecting a patient whom 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 every day 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.)
Theft The act of stealing; specifically: the felonious taking and removing of personal property with intent to deprive the rightful owner of it.
Unsafe working conditions Failure of meeting requirements needed to perform all duties in a secure environment. Potential areas of harm. (Examples include: environmental damage, OSHA, EPA, supervisor directive, poor housekeeping)
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)