Policies:


UMHS Policy 01-04-012 Kickback Concerns

(Formerly UMHS Policy 230)

Date of Issue: 9/2000 Last Revised: 9/2000 Last Reviewed: 8/2005

I. POLICY STATEMENT

It shall be the policy of the University of Michigan Health System (UMHS) that UMHS employees and contractors shall report known or suspected kickback schemes or occurrences.

II. POLICY PURPOSE

The purpose of this policy is to educate UMHS employees and contractors about kickback schemes and occurrences and to establish the procedures for reporting any known or suspected kickback scheme or occurrence.

III. DEFINITIONS

Contractors - Persons who are contracted to perform work on behalf of UMHS.

Employees - For the purposes of this policy, employee refers to faculty, house officers, fellows and staff of UMHS.

Kickback Schemes - Arrangement made with or for individuals or entities that knowingly and willfully offer, pay, solicit or receive remuneration in order to induce business for which payment may be made under the Medicare program or other state health programs.
 

IV. POLICY STANDARDS

A. All UMHS employees and contractors are subject to the provisions and the reporting requirements of this policy.

 B. All medical, business, and legal activities performed by UMHS employees and contractors are subject to the provisions and the reporting requirements of this policy.

C. All UMHS employees and contractors shall report known or suspected violations of laws/regulations or the UMHS Code of Conduct in accordance with the requirements and procedures of this policy.

D. Employees and contractors reporting known or suspected violations under this policy are protected from retaliation for such reporting. If an employee believes that he/she has been retaliated against, they should contact the UMHS Compliance Officer (CO) or his/her designee immediately.

E. The employee’s and contractor’s first option is to report his/her concerns to his/her supervisor or to another member of management.

F. If the employee or contractor is uncomfortable with that direct approach or if the issues have not been resolved satisfactorily, the employee or contractor should report the situation to the CO or his/her designee in accordance with the procedure below.

V. PROCEDURE ACTIONS

Responsible Party

Action

Reporting Employee

Call (888) 296-2481 or submit a completed Compliance Concern Report Form (Exhibit B). In the report, describe the situation completely including dates, names, facilities and/or departments involved and the names of other employees who could provide additional information.

CO or Designee

1. Review the report.

2. Contact the reporter for clarification or additional information.

3. Assign the report to the appropriate department to initiate an inquiry or investigation, as appropriate.

4. Determine or be advised of recommended corrective action.

5. Implement or be apprised of the implementation of the correction action.

6. Monitor the effectiveness of the corrective action.

7. Ensure that the appropriate employees are educated in the violation and the corrective action, as appropriate, to prevent recurrence of the violation.

8. Keep the reporting employee/ contractor informed of the status of the complaint, as appropriate.

9. Oversee the status of all compliance complaints by obtaining monthly reports from the appropriate departments/personnel assigned to the investigation and/or corrective action.

10. Generate a quarterly report to the UMHS Executive Director and the Dean of the UM Medical School (or designees) regarding the status of complaints.

VI. EXHIBITS

Exhibit A: Kickbacks: Discussion and Example

Exhibit B: Compliance Concern Report Form

VII. REFERENCES

United States Code

Federal Register

Office of Inspector General

Author: UMHS Legal Office; UMHS Corporate Compliance Committee

Approved by: Executive Vice President for Medical Affairs, September 8, 2000

Reviewed August, 2005 by Corporate Compliance Office - no changes recommended

UMHS Policy 01-04-012 Kickback Concerns

EXHIBIT A

KICKBACKS: DISCUSSION AND EXAMPLE

Section 1128(b) of the Social Security Act, commonly referred to as the "Anti-Kickback Statute," provides criminal penalties for individuals or entities that knowingly and willfully offer, pay, solicit or receive remuneration in order to induce business for which payment may be made under the Medicare program or other state health programs. An offense is classified as a felony, with each violation punishable by a fine of up to $25,000 and/or imprisonment for up to five (5) years.

The types of conduct and remuneration covered by the Anti-Kickback Statute include kickbacks, bribes, and rebates from providers to others in exchange for patient referrals. The Anti-Kickback Statute proscribes any such remuneration whether made directly or indirectly, overtly or covertly, or in cash or in kind. Moreover, prohibited conduct includes not only remuneration intended to induce referrals, but remuneration intended to induce the purchasing, leasing, ordering or arranging for any good, facility, service, or item paid for by the Medicare and Medicaid programs.

An example of a prohibited kickback scheme would be the payment by a drug company to a hospital employee or contractor that encourages, induces or compensates the hospital employee or contractor for prescribing or using a particular drug.

Original policies are held by Carolyn Ladd, Policy Coordinator, Office of the Director and CEO, UMHHC, telephone 647-2510

 

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