JEMCARE CORPORATE COMPLIANCE PLAN

Policy

It has been and continues to be the policy of JEMCare (sometimes referred to hereinafter as “JEM”, “Agency”, or “the Agency”) to comply with all applicable federal, state, and local laws and regulations, and payer requirements, and to adhere to the Agency’s code of conduct as contained in the Employee Handbook.  We have always been and remain committed to our responsibility to conduct our business affairs with integrity based on sound ethical and moral standards.  We will hold our employees, volunteers, contracted practitioners, and vendors to these same standards. 

Mission, Philosophy and Code of Conduct

JEMCare is dedicated to enhancing the health outcomes and holistic well-being of all program members through a client-centered approach. We provide comprehensive Home and Community Based Services, along with case management, tailored to each individual's linguistic, socioeconomic, and developmental needs, as well as cultural and spiritual preferences. Our goal is to facilitate cohesive care by connecting members to a network of providers, services, and educational/government/community resources, ensuring their medical, behavioral, and social needs are met. Our objective is for every member to graduate from the program having achieved their personal, social, medical, and behavioral goals. Our trained providers use evidence-based models, trauma-informed care, and a recovery-based approach to treatment, recognizing that recovery is an ongoing journey. We focus on empowering our clients by nurturing their internal strengths and skills and fostering connections to community and social supports, even after they have completed our program

We uphold the dignity of every individual we serve, regardless of race, religion, creed, or life circumstances. Our commitment is to ensure that all aspects of client care and business conduct align with our mission statement, policies, professional standards, and legal regulations. At JEM, we expect all personnel providing services to our clients to adhere to the highest ethical standards, promoting ethical behavior. Any deviation from these standards will result in appropriate disciplinary action.

Our employees are prohibited from engaging in any behavior that conflicts with the best interests of JEM or even gives the perception of such a conflict. JEM officers, employees, and staff are unwavering in their dedication to providing consistently high-quality care and services. Our services are delivered with cultural competence, a commitment to conflict-free practices, a person-centered approach, and a trauma-informed perspective. Every member of the JEM team is bound by all relevant laws and JEMCare policies governing the delivery of care and services. Respect is paramount, and we expect all clients, colleagues, supervisors, and supervised staff to be treated with accordingly. 

When any person knows or reasonably suspects that the expectations above have not been met, this must be reported to immediate supervisors, the Compliance Officer (CO) or the Director of Human Resources, so each situation may be appropriately dealt with. 

Compliance Program Oversight

JEM has a designated Compliance Officer (CO).  The CO is directly obligated to serve the best interests of JEM, our clients and employees. Responsibilities of the CO include but are not limited to:

• Overseeing and monitoring the implementation of the compliance program
• Directing Agency internal audits established to monitor effectiveness of compliance standards
• Providing guidance to management, medical/clinical program personnel, and individual departments regarding policies, procedures and governmental laws, rules, and regulations
• Maintaining a reporting system (hotline) and responding to concerns, complaints, and questions related to the compliance program
• Acting as a leader regarding regulatory compliance issues
• Investigating and acting on issues related to compliance
• Coordinating internal investigations and implementing corrective actions

For the purposes of this Compliance Plan, the role of the JEM Compliance Committee is to advise and assist the Compliance Officer in the implementation of the Compliance Plan.  Compliance issues are reported by the Compliance Officer to the Compliance Committee, where appropriate.  

Exclusion Screening and Credentialing:

Any employee or prospective employee who holds, or intends to hold, a position with substantial discretionary authority for JEM is required to disclose any name changes and any involvement in non-compliant activities including health care related crimes.  In addition, JEM performs reasonable inquiries into the background of such applicants, contractors and vendors.

The following organizations may be queried with respect to potential employees, contractors and vendors:

a)  The Federal System for Award Management available on the SAM website: http://www.sam.gov/

b)  U. S. Department of Health and Human Services, Office of Inspector General  (OIG)’s List of Excluded Individuals and Entities (LEIE) available on the website: http://exclusions.oig.hhs.gov/

c)  New York State Office of the Medicaid Inspector General list: http://www.omig.state.ny.us/data/content/view/72/52/

d) New York State Staff Exclusion List(SEL) https://www.justicecenter.ny.gov/staff-exclusion-list

Education and Training

Education and training are critical elements of the Compliance Plan.  Compliance policies and standards will be communicated to all employees and volunteers through required participation in training programs.  All personnel shall participate in training and/or discussion on the topics identified below:

• History and background of Corporate Compliance
• Applicable laws and regulations
• Legal principles regarding compliance and responsibilities related thereto
• General prohibitions on paying or receiving remuneration to induce referrals and the importance of fair market value
• Prohibitions against submitting a claim for services when documentation of the service does not exist to the extent required
• Prohibitions against alterations to medical records and appropriate methods of alteration
• Prohibitions against rendering services without a signed physician’s order or other prescription, if applicable
• Proper documentation of services rendered
• Duty to report misconduct.

As part of their orientation, each employee, volunteer and contractor shall receive a written copy of the Compliance Plan, laws and regulations that affect their position.  All education and training relating to the Compliance Plan will be verified by attendance and a signed acknowledgement of receipt of the Compliance Plan and standards. Attendance at compliance training sessions is mandatory and is a condition of continued employment. 

Effective Confidential Communications

Open lines of communication between the CO and every employee and agent subject to this Plan (including all JEM clients and their guardians) are essential to the success of our Compliance Program. 

Both Employees as well as clients and interested parties have the right to report any concerns of fraud, waste, abuse, and neglect. This includes any misuse or overuse of Medicaid resources as well as concerns regarding the behavior of JEM staff toward or regarding clients. The JEM CO can be contacted by email, phone, or mail to discuss or report any concern or grievance. If a report would like to be made anonymously, please utilize an anonymous email address or phone number or mail an anonymous letter to the address provided below.

Detection and Response

The Compliance Officer shall initially investigate all reports made and together with the Compliance Committee shall determine whether there is any basis to suspect that a violation of the Compliance Plan has occurred.

If it is determined that a violation may have occurred, the Compliance Officer and the Compliance Committee will conduct amore detailed investigation.  This investigation may include, but is not limited to, the following:

• Interviews with individuals having knowledge of the facts alleged
• A review of documents
• Legal research and contact with governmental agencies for the purpose of clarification

If advice is sought from a governmental agency, the request and any written or oral response shall be fully documented.

At the conclusion of an investigation, a report shall be issued, summarizing the findings, conclusions, and recommendations and an opinion as to whether a violation of the law has occurred.

Regardless of whether a report is made to a governmental agency, the Compliance Officer shall maintain a record of the investigation, including copies of all pertinent documentation.  This record will be considered confidential and privileged and will not be released without the approval of the Compliance Committee or legal counsel.

Whistleblower Provisions and Protections

The False Claims Act provides protection to qui tam relators who are discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of their employment as a result of their furtherance of an action under the False Claims Act.

JEM will not take any retaliatory action against an employee if the employee discloses information about the Agency’s policies, practices or activities to a regulatory, law enforcement or other similar agency or public official.  Protected disclosures are those that assert that the Agency is in violation of a law that creates a substantial and specific danger to the public health and safety or which constitutes healthcare fraud under the law or that assert that, in good faith, the employee believes constitute improper quality of client care.

Contact Information

Promptly report any issues, concerns, violations or suspected violations to the Compliance Officer utilizing the contact information below.

Compliance Officer:            Marissa O’Brien

Compliance Hotline:           929-477-9048

ComplianceEmail:             compliance@jemcare.org

Compliance Drop Box:       
Compliance Officer Mailbox
626 Sheepshead Bay Road Ste 580
Brooklyn, NY 11224