Review the following: .Statement from Tenet CEO regarding their compliance progr

Question

Review the following:

.Statement from Tenet CEO regarding their compliance program

.Articles 1-3

Comment on the following areas:

1. The issues at hand and the violations

2. Effectiveness of the compliance program in place

3. Suggestions for improvement for example, what would you have done differently, if any,

Statement from CEO of Tenet

“Doing What’s Right. The First Time. Every Time.”

Chief Compliance Officer

We Are Committed to Standing Up for Our Values and Promoting a Culture of Integrity.

Compliance matters. It’s as simple as that. Tenet’s compliance program represents a shared undertaking on the part of all employees, who are expected to take ownership of compliance and to perform all tasks with integrity.

Tenet Healthcare’s ethics and compliance program helps ensure that everyone in the company understands and complies with all related laws and policies as outlined in our Standards of Conduct. Without exception, these standards apply to every colleague, active staff physician, hospital governing board member and our corporate board of directors.

Our compliance program is managed by our Ethics and Compliance Department, including our more than 100 compliance professionals, in accordance with Tenet's Quality, Compliance and Ethics Program Charter.

When our employees need guidance or want to report concerns, they may contact our Ethics Action Line, 24 hours a day, 7 days a week, at 1-800-8-ETHICS (1-800-838-4427). They may also send an email message to Ethics@tenethealth.com. Callers may remain anonymous, and those who choose to give their names will have their identities protected to the fullest extent of the law.

View additional details about our Ethics and Compliance Program and read our Frequently Asked Questions regarding Tenet, our contractors and the Deficit Reduction Act of 2005.

Articles 1-3:

1.Tenet Healthcare to pay $513 million over referral, kickback scheme

Payout settles allegations of illegal kickbacks paid to clinic owners in exchange for referring patients for labor and delivery to Tenet hospitals.

Tenet Healthcare Corp. and two of its Atlanta-area subsidiaries have agreed to pay a total of $513 million to settle allegations of a scheme in which its hospitals paid bribes and kickbacks to prenatal clinic owners in exchange for referral of patients for labor and delivery services to Tenet facilities, the Department of Justice and multiple other agencies jointly announced Monday.

According to the DOJ, criminal information and civil complaints filed in 2013 and 2014 show Atlanta Medical Center, North Fulton Medical Center, Spalding Regional Medical Center and Hilton Head Hospital all participated in a scheme where bribes and kickbacks were paid to the owners and operators of prenatal care clinics that mostly served undocumented Hispanic women. The complaint claimed the kickbacks were paid in exchange for referring those patients for labor and delivery medical services to Tenet hospitals. More than $145 million in Medicaid and Medicare reimbursements were paid to Tenet based on the referrals, the DOJ said.

Authorities said clinics sometime told expectant mothers that Medicaid would cover the childbirth and newborn care costs only if they delivered at one of the Tenet hospitals. Sometimes they were informed they were required to deliver at one of the Tenet hospitals, giving them the impression they could not choose their hospital themselves, the DOJ said.

"As a result, many expectant mothers traveled long distances from their homes to deliver at the Tenet hospitals, placing their health and safety, and that of their newborn babies, at risk," the DOJ said in a statement.

As part of their civil settlement, which allows Tenet to avoid prosecution, Tenet will pay $368 million to the federal government, the state of Georgia and the state of South Carolina to resolve the claims, which were part of a whistleblower, or qui tam, lawsuit filed by Ralph D. Williams, a Georgia resident, under the federal and Georgia False Claims Acts. The laws allow whistleblowers to file suit for false claims against the government entities and to share in any recovery. Mr. Williams' share of the combined civil settlement amount is approximately $84.43 million, according to the DOJ.

In addition to the monetary penalty, Tenet must enhance their compliance and ethics programs and internal controls, and must staff an independent compliance monitor. The agreement is in place for three years but can be extended for up to another year.

One measure Tenet said they are already implementing to reduce the likelihood of similar fraudulent behavior is to restrict their facilities from contracting with referral sources for services when a non-referral source or vendor is available to perform the same service, a Tenet spokesperson said.

The two Tenet subsidiaries that previously operated Atlanta Medical Center and North Fulton Hospital in Georgia were also charged Monday in relation to the scheme. They will plead guilty to a single count of conspiracy to violate the Federal Anti-Kickback Statute and defraud the United States, and will forfeit over $145 million to the United States, an amount equal to monies paid to Atlanta Medical Center Inc. and North Fulton Medical Center Inc. by the Medicare and Georgia Medicaid programs for services provided to patients as part of the referral scheme, the DOJ said.

Tenet completed the divestiture of both facilities on March 31, 2016, and the subsidiaries currently have no operating assets.Tenet said in a statement.

Additional charges against those two subsidiaries stem from the violation of a corporate integrity agreement that was put in place in 2006 and was in effect as many of the unlawful kickbacks and bribes were paid. The criminal information filed said Tenet employed in-house lawyers and also engaged outside counsel to review and approve agreements between the Tenet Hospitals, Atlanta Medical and North Fulton and the clinics. It alleges that certain executives at Tenet hospitals, Atlanta Medical Center and North Fulton concealed the kickbacks from Tenet in-house lawyers and outside counsel "because they knew that the agreements would not be approved if the true nature of the Clinica arrangements were disclosed to the lawyers," legal documents said.

The same document said those executives caused Tenet to authorized or make payments to Clinica without valid contracts in place, and make payment without proper documentation, which violated company policies and controls. The activities were also hidden from the Office of the Inspector General, and executives falsely certified compliance to the integrity agreement.

"The conduct in this matter was unacceptable and failed to live up to our high expectations for integrity," Trevor Fetter, Tenet chairman and chief executive officer, said in a statement. "The relationships between the four hospitals and Clinica de la Mama violated the explicit requirements of our compliance program and were inconsistent with the strong culture of compliance we've worked hard to establish at Tenet."

2. Tenet Healthcare ‘Proud’ To Settle Medicare Fraud Charges For $43 Million

The second-biggest for-profit hospital chain in the U.S. has agreed to pay $42.8 million to settle allegations it overcharged Medicare during the middle of the last decade. The Justice Department’s deal with Tenet Healthcare is the latest salvo in regulators’ assault against health care fraud.

Tenet, according to the government, inappropriately billed Medicare for more expensive services than patients needed. The 50-facility chain moved patients from ordinary hospitals into more costly facilities intended for those who need intensive follow-up treatment after undergoing hospital procedures, Reuters reported. The alleged overbilling took place from 2005 to 2007, the Justice Department says. Neither the Justice Department nor the company said how much Tenet may have overcharged Medicare.

It was Tenet who alerted federal authorities to the overbilling that led to its settlement, the company says in a press release. Tenet discovered in 2007 that the rehab unit of one of its Georgia hospitals was treating patients it shouldn’t have been. “As odd as it might sound, it is something that Tenet is proud of,” Tenet spokesman Rick Black told Modern Healthcare.

Health care fraud against government programs and private insurance companies costs Americans $60 billion every year, Attorney General Eric Holder has said. The administrations of presidents George W. Bush and Barack Obama stepped up enforcement of health care fraud over the past five years by coordinating the efforts of the Department of Justice and the Department of Health and Human Services.

The Obama administration recovered $4.1 billion for taxpayers last year, a 50 percent increase since 2009, the Associated Press reported in February.

The Obama administration has pledged to improve the government’s ability to detect Medicare and Medicaid fraud as it happens instead of just working backwards to chase dollars already lost. The health care reform law enacted two years includes new anti-fraud tools the administration says helped nab Texas physician Jacques Royand his cohorts, who are alleged to have bilked Medicare and Medicaid of $275 million.

This isn’t Tenet’s first run-in with federal anti-fraud authorities and a previous agreement made to settle other fraud allegations actually compelled the company’s disclosure of the improper billing in Georgia, Tenet says in its press release.

Tenet paid more than $900 million to settle federal charges that it overcharged Medicare by manipulating the program’s payment rules and paid kickbacks to physicians who referred patients to its facilities. The company sold off 11 hospitals at the time to cover the cost of the penalties.

As part of that 2006 deal, the government required Tenet to institute a compliance program to root out improper billing practices and report its findings to the Department of Health and Human Services’ Office of Inspector General. When Tenet uncovered the problem in Georgia, that’s just what it did. Tenet also settled fraud charges in the 1990s and early 2000s related to overcharging for psychiatric care (when the company was called National Medical Enterprises) and for performing unnecessary heart surgeries.

Ironically, Tenet accused a rival hospital chain, Community Health Systems, of Medicare fraud last year after Community Health Systems launched a hostile takeover bidagainst Tenet.

3. Whistleblower suit: Hospitals defrauded Medicaid

Two large hospital operators paid kickbacks to clinics that directed expectant mothers living in the U.S. illegally to their hospitals and filed fraudulent Medicaid claims on those patients, a federal whistleblower lawsuit unsealed late Wednesday said.

Naples, Fla.-based Health Management Associates and Dallas-based Tenet Healthcare and their affiliates entered into contracts with clinics operated by Hispanic Medical Management and Clinica de la Mama and their affiliates, the lawsuit says.

The clinics then referred pregnant women living in the country without authorization to for-profit hospitals operated by HMA and Tenet in exchange for kickbacks from fraudulent Medicaid claims, the lawsuit says.

The Medicare and Medicaid Patient Protection Act, known as the anti-kickback statute, prohibits paying for or accepting money to arrange for medical treatment under federally funded programs.

An HMA representative said in an email that the company does not comment on pending litigation.

Tenet issued a statement on behalf of its hospitals named in the suit, saying it believes the agreements "were appropriate and provided substantial benefit to women in underserved Hispanic communities served by those hospitals. The services provided under these agreements included translation, determination of Medicaid eligibility, and other services designed to improve the delivery of obstetric care and increase the likelihood of a safe birth and a healthy baby."

Phone numbers for Hispanic Medical Management and Clinica de la Mama, both in Georgia, could not immediately be found.

The federal whistleblower lawsuit, filed by Ralph Williams, a former chief financial officer for HMA, says the kickback scheme went on for more than a decade. The state of Georgia has also joined the lawsuit to recover state Medicaid funds.

"These hospitals paid Clinica kickbacks camouflaged as interpreter service payments to funnel emergency Medicaid patients their way and increase their bottom line," Georgia Attorney General Sam Olens said in a statement. "As attorney general, I take seriously my responsibility to protect the integrity of Georgia Medicaid and to ensure that those who defraud the program are held accountable.

Clinica recruits pregnant women who are in the country illegally to its prenatal clinics using the slogan, "we care about your health, not your immigration status," the lawsuit says. The clinics then directed these vulnerable patients to the HMA and Tenet hospitals, which pay for the referrals, the lawsuit says.

Those in the country illegally are not eligible for Medicaid coverage although hospitals can be reimbursed for treatment of emergency services provided to those in the country illegally and Medicaid rules consider childbirth an emergency medical condition.

The lawsuit says Williams began working at HMA in April 2009 and one of his duties was to monitor contracts and approve the payment of bills. Shortly after he arrived, he discovered a contract between an HMA hospital in Monroe, Ga., and Clinica for Spanish interpreter services, the lawsuit says. He investigated and found no evidence of interpreter services, but eventually found that Clinica was being paid for referring pregnant women in the country illegally "for government subsidized deliveries," the lawsuit says.

Soon after he voiced his concerns about the fraudulent arrangement to company leaders, Williams was fired without reason, the lawsuit alleges.

The lawsuit says Williams' direct supervisor had previously worked for Tenet in South Carolina. The lawsuit alleges that Tenet used a similar scheme in a number of its hospitals, including Atlanta Medical Center, four others in Georgia and Hilton Head Hospital in Hilton Head, S.C.

Explanation / Answer

Solution:-

Introduction- The issue/s at hand and the violations:

An ethics program is an important tool used to communicate the company's business philosophies to all its stakeholders such as the employees, investors, vendors, customers and the general public. A good ethics program can help strengthen a company's relationships with employees and customers and improve the company’s reputation. Employees might be familiar with their company’s stand on ethics but instituting a program eliminates any confusion and provides everyone with the same information regarding ethical business behavior.

The code of ethics guides all managerial decisions and helps in creating a common framework upon which critical decisions are founded. This can help in creating a thorough understanding of the boundaries of the company and the standards set for interacting with external stakeholders. A formal, well-communicated code of ethics can also help to protect a company's reputation and legal standing in the event of a breach of ethics by an individual employee.

The ethics program should have clear guidelines on what constitutes acceptable ethical behavior and what not. Some examples of documented ethical standards include whether employees should accept gifts from vendors, what can be accepted, what is the maximum value of acceptable gifts, etc. When an employee is faced with such a situation and is in a dilemma regarding his / her course of action, referring to the ethics program can provide useful answers. As a step further, if an ethics compliance officer is appointed, employees can use the officer to clear any queries they have regarding ethical dilemmas they face at work.

A public commitment to ethics is important to all stakeholders -- owners, employees, suppliers, customers and the community at large -- because it communicates the mission, vision, and direction of the company. They self-imposed a set of standards by which the organization and it's people are measured. Suppliers will know that favors or gifts will not sway purchasing staff. Customers will know that the company's products and/or services are backed by integrity, and no inappropriate inducements will be offered. Employees will know that they will be treated fairly and with respect and that they have the company's ethical standards to uphold. The community will know that the business is a good neighbor in every sense of the phrase.

Thus having a defined ethical program, helps in creating a working environment that fosters ethical behavior and serves as the doctrine that can be used to ensure ethical behavior from employees. A strong ethical culture also results in increasing the reputation of the company as a good place to work for and hence helps in attracting the desirable talent.

Ethics-related Policy is vital to an organization because,

Ethics and Code of Business conduct go hand in hand and it provides the guidelines related to what employees must.
It covers inputs viz., all employees have a responsibility to hold themselves and others to a high level of conduct.
It lays Policies and Guidelines related to self-positioning and reporting in the organization, how to deal with confidential and anonymous reporting, Treatment-related to reports and complaints, Retaliation related issues, Disciplinary process etc.,
Develop the code of Ethics applicable to the company: Any organizations develop their code of Business Conduct and Ethics guidelines based on one or many of the following. General Ethic’s guidelines cover the following.
The effectiveness of the compliance program in place:

Code of Business Conduct and Ethics Policies & Guidelines:

Organizational Commitment – The CEO of the organization provides the commitment that all employees have towards the organization. This segment widely covers the Integrity and Trust Principles
Purpose & Values – Clarifying the Purpose of organizations existence which is likely to cover tangible and intangible components viz., Innovation and Performance principles, Trust and Collaboration principles respectively.
To whom the code applies to
What Employees must do – do’s & don’ts
What Leaders of the organization must do.

Using Assets and Information Properly:

Appropriate usage of Organization tangible resources
Proper utilization of Computers and Communication devices
Taking care of Confidential data and Information
Maintaining Data Privacy
Sustaining IP - Intellectual Property Rights
Security Law and Insider Trading
Handling Media and Public Inquiries
Promoting Respect, Safety, and Security in the Workplace:

Equal Employment Opportunities
Preventing Discrimination and Harassment
Employee Health, Safety, Security, and Environment
Prevention of Drugs and Alcohol
Working with Customers and Other Third Parties:

Fair Competition, Antitrust and Competitive Intelligence among employees
Policy around giving or receiving Payments, Benefits or Gifts to customers, suppliers, vendors etc.,
Contractual Authorization and Process
Political and Charitable Conduct and Contributions
Recognizing and Avoiding Conflicts:

Conflicts of Interest
Working for Other Companies and on Board.

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