The entire Pure Healthcare organization is committed to preventing fraud, waste, and abuse in the health care industry. As an organization that receives federal funding, it is our responsibility to abide by all federal and state laws to effectively implement and enforce procedures to prevent and detect any violations through education and training of our employees and compliance management. All workforce members, contractors, and agents will be responsible for reporting potential or suspected violations of fraud and abuse directly to their supervisor or the organization’s compliance officer.
The False Claims Act
The False Claims Act (FCA) is a federal law that prohibits any submission of false information, records, or claims by any person or organization to a federal health care program. This includes any plan or program that provides health benefits, whether directly or through insurance and otherwise, that are funded in whole or in part by the United States Government or any state healthcare system. Examples of false claims can include billing for services not rendered or deemed medically necessary, billing for the same service more than once, or falsifying documentation to receive payment for services. Violations can occur either by actively knowing about a false claim or through acts of negligence and disregard to whether a claim is false.
Civil Penalties for Violations
The False Claims Act states that any person who knowingly submits false claims to the government is liable for a civil mandatory penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages (called treble damages), which the Government sustains because of the act of that person. The FCA has been amended several times and now includes the provision that violators are liable for treble damages plus a penalty that is linked to inflation (The United States Dept of Justice, January 14th, 2021).
In addition to allowing the United States government to pursue perpetrators of fraud on its own, the FCA allows private citizens the right to file suits on behalf of the government (called qui tam suits) against those who have defrauded the government. By doing so, these private citizens who successfully bring qui tam actions may receive a portion of the government’s recovery.
Whistleblower Protection Under the False Claims Act
The federal FCA law also protects employees who report a violation under the False Claims Act from discrimination, harassment, suspension, or termination of employment as a result of reporting possible fraud within an organization. Employees who report fraud and consequently suffer discrimination may be awarded two-times their back pay plus interest, reinstatement of their position without loss of seniority, and compensation for any costs or damages they incurred.
The Federal Civil False Claims Act, Section 3279 through 3733 of title 31 of the United States Code.Pure Healthcare Compliance Department 4179 S Riverboat Road, Suite 203 Taylorsville UT 84123 Compliance Hotline Phone:(801) 823-0120 Email: firstname.lastname@example.org
THIS NOTICE OF PRIVACY PRACTICES (“NOTICE”) DESCRIBES HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION AND HOW YOU CAN GET ACCESS TO SUCH INFORMATION. PLEASE READ IT CAREFULLY.
ABOUT THIS NOTICE
This Notice of Privacy Practices is NOT an authorization. This Notice of Privacy Practices describes how we, our Business Associates, and our Business Associates’ subcontractors, may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO), and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.
“Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services.
We are required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and other applicable laws to maintain the privacy of your health information, to provide individuals with this Notice of our legal duties and privacy practices with respect to such information, and to abide by the terms of this Notice. We are also required by law to notify affected individuals following a breach of their unsecured health information.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your protected health information may be used and disclosed by your physician, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
Healthcare Operations: We may use or disclose, as needed, your protected health information to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment, employee review, training of medical students, licensing, fundraising, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students who see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to
sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment, and inform you about treatment alternatives or other health-related benefits and services that may be of interest to you. If we use or disclose your protected health information for fundraising activities, we will provide you with the choice to opt out of those activities. You may also choose to opt back in.
We may use or disclose your protected health information in the following situations without your authorization. These situations include as required by law, public health issues as required by law, communicable diseases, health oversight, abuse or neglect, food and drug administration requirements, legal proceedings, law enforcement, coroners, funeral directors, organ donation, research, criminal activity, military activity and national security, workers’ compensation, inmates, and other required uses and disclosures. Under the law, we must make disclosures to you upon your request.
Under the law, we must also disclose your protected health information when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements under Section 164.500.
USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization, or opportunity to object, unless required by law. Without your authorization, we are expressly prohibited from using or disclosing your protected health information for marketing purposes. We may not sell your protected health information without your authorization. We may not use or disclose most psychotherapy notes contained in your protected health information. We will not use or disclose any of your protected health information that contains genetic information that will be used for underwriting purposes.
You may revoke the authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has acted in reliance on the use or disclosure indicated in the authorization.
The following are statements of your rights with respect to your protected health information.
You have the right to inspect and copy your protected health information (fees may apply) – Pursuant to your written request, you have the right to inspect or copy your protected health information whether in paper or electronic format. Under federal law, however, you may not inspect or copy the following records: Psychotherapy notes, information compiled in reasonable anticipation of, or used in, a civil, criminal, or administrative action or proceeding, protected health information restricted by law, information that is related to medical research in which you have agreed to participate, information whose disclosure may result in harm or injury to you or to another person, or information that was obtained under a promise of confidentiality.
You have the right to request a restriction of your protected health information – This means you may ask us not to use or disclose any part of your protected health information for the purposes
of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Your physician is not required to agree to your requested restriction except if you request that the physician not disclose protected health information to your health plan with respect to healthcare for which you have paid in full out of pocket.
You have the right to request confidential communications – You have the right to request confidential communication from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively i.e., electronically.
You have the right to request an amendment to your protected health information – If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures – You have the right to receive an accounting of disclosures, paper or electronic, except for disclosures: pursuant to an authorization, for purposes of treatment, payment, healthcare operations; required by law, that occurred prior to April 14, 2003, or six years prior to the date of the request.
You have the right to receive notice of a breach – We will notify you if your unsecured protected health information has been breached.
You have the right to obtain a paper copy of this notice from us even if you have agreed to receive the notice electronically. We will also make available copies of our new notice if you wish to obtain one.
We reserve the right to change the terms of this notice and we will notify you of such changes on the next appointment.
You may complain to us personally or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our Compliance Office of your complaint. We will not retaliate against you for filing a complaint. If you wish to do so anonymously, you may call our Compliance Hotline at (801) 823-0120.
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. We are also required to abide by the terms of the notice currently in effect. If you have any questions in reference to this form, please ask to speak with our HIPAA Privacy or Compliance Officer in person or by phone by calling our main phone number.