Accounting and Financial

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. Securities Violations Infringement, transgression; specifically: an infringement of the rules which securities acts define. (Examples include: insider trading)

Compliance with Laws and Standards

Emergency Medical Treatment and Fair Labor Act (EMTALA) Matters Concerns relating to the Emergency Medical Treatment and Active Labor Act (EMTALA). An example includes a delay in performing medical screening exams or stabilization procedures of an emergency room patient in order to obtain financial information Excluded/Sanctioned Provider Matters Failure to take the necessary precautions to ensure individuals employed and/or entities that provide services to the organization have not been excluded from participating in a federally funded health care program. Mental Health Parity Providing the same or better services or benefits for Mental Health or Substances Abuse services.

Confidentiality

Disclosure of Confidential Information Unauthorized and unlawful disclosure of corporately owned intellectual property or trade secrets, as well as employee, customer or consumer information, marketing and other corporate data bases, marketing plans, business proposals and strategies. Health Insurance Portability and Accountability Act/Disclosure of Protected Health Information (PHI) 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.

Fraud and Theft

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) 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. Theft The act of stealing; specifically: the felonious taking and removing of personal property with intent to deprive the rightful owner of it.

Gifts and Donations

Gifts and Entertainment Refers to the inappropriate offering, solicitation or accepting of items of more than nominal value (nominal value = $50) from vendors, customers or other third parties in a capacity as an employee of the Company. 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.

Harassment and Inappropriate Behavior

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) Misconduct or Inappropriate Behavior Intentional wrongdoing; specifically: deliberate violation of a law or standard.

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) 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)

Misuse of Company Resources

Unauthorized/Fraudulent Use of Company facilities and equipment The misuse/abuse of Company Support Services, equipment, or assets.

Member Care and Member Rights

Member Abuse/Physical Intentionally causing harm to a patient or neglecting a patient whom needs medical attention or assistance. Member 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. Member Care Failure of those responsible for patient care, to properly attend to the every day needs of a patient(s). Member 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.

Provider Relations

Provider Payment and Referral Concerns Concerns specifically related to provider payments/benefits and/or payment for referrals. (Examples include: paying a provider to refer patients to a facility, paying providers more than fair market value for services provided, paying a provider without an executed contract, awarding a benefit to a provider that may violate the Stark regulations, etc.)

Workplace Safety

Safety, Health and the Environment Failure to provide a safe working environment or training required by company policies; failure to report accidents, etc. concealing of actual or potential environmental damage; failure to comply with environmental laws.

Other

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. Suggestion   Concern   Inquiry