I. 目的及范围
本政策的目的是告知员工, 承包商, 十大博彩推荐排名-希区柯克(D-H)代理联邦和州(新罕布什尔州)虚假索赔法(fca)条款, including their right to report violations of federal and state law. This policy also includes general information regarding D-H's efforts to combat fraud, 浪费和滥用，并描述某些类型的欺诈活动可能导致的违规行为的补救措施和罚款.
II. 政策
报告欺诈、浪费和滥用
所有员工, 承包商, and 代理s of D-H must immediately report to the Corporate Compliance Officer any suspicion of fraud, 浪费, 或滥用与D-H的业务有关的资料. D-H engages in specific compliance efforts to detect and prevent fraud, 浪费, 和滥用, 例如公司合规计划.
For more information on the D-H Corporate Compliance Program and specific compliance policies, 或者如何报告任何问题, please contact the 合规及审计服务 Department at 603-650-3480 或者访问网站. 该组织已经与第三方供应商签订了合同，该供应商维护了一条24/7的帮助热线，可以通过以下方式联系 1-844-733-0094.
联邦虚假申报法的详细信息
联邦FCA对故意提交虚假索赔的个人和实体实施民事(在某些情况下是刑事)处罚, 或故意无视索赔的真实性或虚假性，或不计后果地无视其真实性或虚假性，或合谋通过获得虚假或欺诈性索赔来欺骗政府. 不需要明确的欺诈意图.
FCA包括一项重要条款，允许普通公民代表联邦政府提起诉讼，并要求政府加入诉讼. In return, that citizen may share a percentage of any recovery or settlements. This type of lawsuit is known as a qui tam and the individual, 或关系词, 是一个“告密者”, who brings forth evidence of the alleged improper conduct. 这一规定的目的是激励举报人帮助政府发现和避免支付欺诈性索赔，并通过奖励举报人一定比例的赔偿来起诉那些提交虚假索赔的人.
胜诉在诉讼中胜诉, the relator must be the "original source" of the information reported to the federal government. 具体地说, 相关人员必须对虚假申报活动有直接和独立的了解，并自愿向政府提供这些信息. If the matter disclosed is already the subject of a federal investigation, or if the healthcare provider or supplier has previously disclosed the problem to a federal agency, the relator may be barred from obtaining a recovery under the FCA.
根据FCA的私人法律诉讼必须在向政府提交虚假索赔之日起六(6)年内提起. 视情况而定, a government-initiated claim may be brought up to 10 years after the false claim.
FCA并不局限于医疗保健索赔, but extends to any payment requested of the federal government. The FCA applies to billing and claims sent from D-H to any government payor program, 包括医疗保险和医疗补助.
这是D-H的政策，员工, contractor or 代理 of D-H who knowingly submits a false claim will be reported to the necessary authorities. 根据FCA, 任何人或任何实体向政府提交虚假的索赔或陈述，都可能被处以5美元的民事罚款,500美元和11美元,每提出一项索赔, 不管虚假索赔的大小, 个人或实体可能被要求支付政府所承受的三倍的损害赔偿金. 除了, the government can exclude violators from participating in Medicare, 医疗补助计划, 以及其他联邦医疗保健项目.
潜在的虚假声明的例子包括, but are not limited to: (a) billing of items or services that were never rendered by the health care provider; (b) billing for services that are medically unnecessary; (c) upcoding (practice of billing for Medicare/医疗补助计划 using a billing code providing a higher payment rate than the billing code intended to be used for the service or item furnished to the patient); (d) billing separately for services that should be bundled; (e) billing separately for outpatient services that were provided within 72 hours (before or after) an inpatient stay; (f) billing for a discharge in lieu of a transfer.
保护举报人-联邦法律
The federal FCA protects 员工s who are discharged, 降级, 暂停, 骚扰, or in any manner discriminated against by their employer because of their participation or assistance (e.g., testimony, initiation of investigation) in a false claim action.
The Act entitles 员工s to relief to "make them whole", including restatement with the same seniority status they would have had but for the discrimination, 拖欠工资的两倍, 欠薪利息, 以及因歧视而遭受的任何特殊损害赔偿，包括诉讼费用和合理的律师费.
Detailed Information of the Federal Program Fraud Civil Remedies Act
Individuals or entities that commit fraud against the federal government, 通过虚假的声明或陈述, 除了FCA根据《十大博彩推荐排名》(PFCRA)的处罚外，还可以评估罚款。. PFCRA罚款5美元,如果个人或实体向联邦政府提交的声明中:个人或实体知道或有理由知道是虚假的，则适用每虚假声明或陈述1万美元, 虚构的, 或欺诈; includes or is supported by written statements containing false, 虚构的, 或欺诈 information; includes or is supported by written statements that omit a material fact, 是什么导致这些陈述是错误的, 虚构的, 或欺诈 and the individual submitting the statement has a duty to include the omitted fact; or is for payment of property or services that are not provided as claimed.
的5美元,如果个人或公司提供与索赔有关的书面备份或材料，其中个人或实体断言的重大事实是虚假的，则罚款也适用, 虚构的 或欺诈; or omits a fact that the individual had a duty to include, 遗漏导致陈述是假的, 虚构的, 或欺诈, and the statement contains a certification of accuracy.
新罕布什尔州法律NH RSA 167:61-a等.
The state of New Hampshire has its own FCA, which is very similar to the federal FCA. 根据NH法规，任何人不得故意做出, 出现的:出现或引起的, any false 或欺诈 claim for payment of any good or service, or for the determination of any rights or benefits under 医疗补助计划 or other state assistance program. Liability to the state for such actions is a civil penalty of not less than $5,000元，不超过10元,000, plus three (3) times the amount of damages that the state sustains because of the act of that person.
该法规将索赔定义为任何请求或要求, 无论是根据合同还是其他方式, 付给军官的钱或财产, 员工, 代理, or other representative of the state or to a contractor, 受让人, 或者其他人, if the state provides any portion of the money or property that is requested or demanded, 或者州政府是否会赔偿承包商, 受让人, or other recipient for any portion of the money or property that is requested or demanded.
该法规将“故意”定义为故意作出或导致作出任何虚假或欺诈性陈述, or intentionally offering or causing to be offered or presented, 全部地或部分地, 任何欺诈记录, 文档, data or instrument to any state official or law enforcement personnel, 与医疗补助或其他类似的州计划下的任何商品或服务的付款索赔或付款率的任何审计或调查有关.
根据NH法规，针对虚假索赔的诉讼必须在违法行为发生之日起六(6)年内提起，或者在负责在这种情况下采取行动的司法部长办公室内的官员知道或合理地应该知道对诉讼权利至关重要的事实之日起三(3)年内提起, but in no event more than 10 years after the date on which the violation is committed, 以最后发生的为准.
New Hampshire - The Whistleblowers' Protection Act (RSA 275-E)
D-H员工应该意识到，如果他们认为D-H在收到潜在违规通知后没有作出适当回应，他们可以自己通知政府. D-H禁止对该雇员采取任何不利行动，该雇员应直接通知政府. Protection is available to 员工s who report violations of law, 参与政府调查或听证会, 或者拒绝执行非法指令.
任何员工依法举报他人提交的虚假申报或涉嫌虚假申报的信息, 或者参与调查, 听力, or inquiry conducted by any government entity or any court, 或拒绝执行违反新罕布什尔州或美国政治分支机构通过的任何法律或规则的指令，不得解除, 威胁, 或者受到歧视.
如果发生这种情况, the 员工 is entitled to reinstatement with the same seniority status, 拖欠工资金额的两倍, 欠薪的利息, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys' fees.
3. 定义
- Dartmouth-Hitchcock: All Dartmouth-Hitchcock Clinic and Mary Hitchcock Memorial Hospital facilities.
- 员工: 十大博彩推荐排名-希区柯克的所有员工, 包括但不限于医生, 护士, 支持人员, 和管理员.
- 承包商或代理: 包括任何承包商, 分包商, 代理, 或者其他的人, 代表实体, 提供, or otherwise authorizes the furnishing of 医疗补助计划 health care items or services, 执行计费或编码功能, or is involved in monitoring of health care provided by an entity. [NOTE: The definition of "Contractor" or "Agent" is quoted from the December 13, 2006 letter from the Centers for Medicare and 医疗补助计划 (CMS) to State 医疗补助计划 Directors. In January 2007 CMS confirmed that billing and coding vendors are considered 承包商, 但没有直接获得医疗补助的复制和粉碎服务提供商或制造商不被视为承包商.]