Montana Health Cooperative
Corporate Compliance Program
Established June 2014
Montana Health Cooperative
Corporate Integrity and Compliance Program
I. CO-OP POLICY AND COMMITMENT REGARDING ETHICS, INTEGRITY AND COMPLIANCE
It is the policy and commitment of Montana Health Cooperative (the “CO-OP”) to observe the highest standard of business ethics and integrity, and to consistently and fully comply with all laws and regulations governing its business operations as a private, nonprofit Consumer Operated and Oriented Plan (“CO-OP”), whose mission is to issue qualified health plans in the individual and group insurance markets.
The CO-OP demands that all members of its Board of Directors and its officers, employees, workforce members and contractors (collectively referred to as “workforce”) adhere to the highest legal and ethical standards to ensure and reinforce the CO-OP’s status as a responsible corporate citizen and to maintain the utmost confidence of the CO-OP’s members, providers, employees and the public in its honesty and integrity.
In order to effect the CO-OP’s commitment to the highest legal and ethical standards and establish an environment that promotes legal and ethical behavior, the CO-OP has adopted this Corporate Integrity and Compliance Program which includes the “Code of Business Ethics and Conduct” attached as Appendix A (hereafter “the Code”). The Code is intended to reinforce, on a day-to-day basis, the CO-OP’s commitment to a working environment which encourages and requires ethical behavior, maintains the CO-OP’s high standards for integrity and honesty and demonstrates the CO-OP’s strong commitment to ethical and lawful conduct. The policy of the CO-OP is to deter or prevent the occurrence of unethical or unlawful behavior, to detect as early as possible such behavior whenever it occurs, to appropriately disclose or report such behavior to authorities and to actively and fully cooperate in any investigation or regulatory inquiry.
The CO-OP may enter into and perform services under certain government contracts. The CO-OP is committed to full and comprehensive compliance with all of its contractual obligations regarding these services, and will, as appropriate, adopt specific policies, procedures and corporate standards for all workforce members who work on such contracts, provide appropriate training and resources, and operate an effective compliance program in regards to such contracts.
As used in this document, the term “employee” shall be deemed to include all workforce members where the context so allows. Revised 09/10/13
A. Detailed Policies, Procedures and Corporate Standards
General. The Code sets forth the fundamental legal and ethical principles for conducting all aspects of CO-OP business. The CO-OP has adopted, or will adopt from time to time, detailed CO-OP policies, procedures and standards for conducting its business and other CO-OP manuals, memoranda, instructions and directions applicable to particular job functions. The Compliance Officer shall coordinate with management to ensure that all employees have open access to the Code and to all such policies, procedures and standards and specific policies which bear on their duties and responsibilities, and that all employees receive periodic notification as to the location of such resources. The CO-OP policy assuring non-retaliation for bringing forward good faith issues of concern to the CO-OP is incorporated in Appendix B, hereto.
II. DESIGNATION AND ADMINISTRATION OF THE COMPLIANCE PROGRAM
A. Board of Directors
The CO-OP’s Board of Directors has adopted and will support and monitor the implementation of this Corporate Integrity and Compliance Program, including the Code of Business Ethics and Conduct, (referred to herein collectively as the “Compliance Program”) to demonstrate the CO-OP’s commitment to full and comprehensive compliance with all applicable laws and regulations, and contract terms and conditions, including, without limitation, the CO-OP’s obligation under any and all government contracts. At least annually, the CO-OP’s Board of Directors shall review the Corporate Integrity and Compliance Program and the Code of Business Ethics and Conduct and shall ratify or amend the Compliance Program and Codes as appropriate.
B. Board Audit & Compliance Committee
General. The Audit & Compliance Committee of the CO-OP’s Board of Directors (hereinafter the “Board Audit & Compliance Committee”) is comprised of at least three (3) Directors, a majority of whom are not employed by the CO-OP or its affiliates.
Responsibilities. The Board Audit & Compliance Committee is responsible for maintaining a strong Board involvement in ensuring that the CO-OP has fully implemented the Compliance Program and the Code and that the Program is operating in an effective manner. At least annually, the Committee shall review the Code and the Compliance Program and shall present the Code and the Compliance Program to the Board for approval, together with such changes and amendments to the Code and the5 Revised 09/10/13 Compliance Program as the Committee considers appropriate. The Committee and the Corporate Compliance Officer shall maintain close communications among themselves and with the CO-OP Board of Directors as a whole, and shall address and review matters concerning or relating to the Compliance Program so that it can take appropriate action or make appropriate recommendations for Board action.
Duties. In carrying out its responsibilities under the Compliance Program, the Board Audit & Compliance Committee shall:
- Provide sufficient opportunity for the members of the CO-OP Board of Directors to be briefed regularly in an appropriate manner on the CO-OP’s compliance with applicable laws, and regulations, contractual terms and conditions, and the Compliance Program and Code.
- Provide oversight of and support for the implementation, administration and continuing operation of the Compliance Program.
- Review matters relating to education, training and communication in connection with the Code and the Compliance Program to ensure that CO-OP policies, procedures and corporate standards on compliance are properly disseminated, understood and followed.
- Present to the CO-OP Board of Directors, at least annually, for ratification or approval, the Compliance Program and the Code together with such changes or amendments as the Committee considers appropriate.
- Present to the CO-OP Board of Directors such measures, and recommend to the CO-OP Board of Directors such actions, as may be appropriate to assist the CO-OP in conducting its business activities in full compliance with all applicable laws and regulations, terms and conditions of Government Contracts, and the Compliance Program and Code.
C. Compliance Officer
General. The CO-OP’s Chief Operating Officer (“COO”) shall serve as Corporate Compliance Officer (the “Compliance Officer”). The Compliance Officer is responsible for administration of the Compliance Program for the CO-OP. The Compliance Officer reports to the Board of Directors and to the President and Chief Executive Officer.6 Revised 09/10/13
Duties and Responsibilities. The duties and responsibilities of the Compliance Officer includes the following:
- Serve on the Corporate Compliance Committee (see Section II.D).
- Design and direct the implementation, administration and operation of the Compliance Program to effectively detect and deter violations of applicable laws and regulations, terms and conditions of Government Contracts, or the Compliance Program and Code by the CO-OP’s Directors and employees.
- Direct the development of and participate in regular, multifaceted communication, educational, and training programs to ensure all Directors and employees are knowledgeable about and comply with the Code, the Compliance Program and all applicable laws and regulations, including, as applicable, the terms and conditions of the CO-OP’s Government Contracts.
- Ensure by coordinating with management that consultants, contractors, vendors and producers are aware of the CO-OP’s Compliance Program and with the CO- OP’s expectation that they will comply with the Program’s requirements when performing contractual functions. Further coordinate with management to determine whether and to what extent a consultant, contractor, vendor or producer is subject to the training requirements of the Compliance Program and provide for such training.
- Report directly on a regular basis to the CEO and the Board Audit & Compliance Committee regarding the operation of the Compliance Program and all significant issues relating to compliance with the Code, the Compliance Program, applicable laws and regulations, and Government Contracts. On no less than an annual basis, the Compliance Officer shall meet with the Board Audit & Compliance Committee in executive session to report on the operation and efficiency of the Program and to respond to any questions raised by the Committee.
- Ensure that employees receive communications that emphasize the CO- OP’s commitment to compliance with all applicable laws, regulations and government contracts, that the Code is available to all employees, and that the Compliance Officer is available to all employees.
- Maintain a log of all calls and other contacts received regarding concerns or possible violations, maintain a record of all allegations which may constitute a violation of the Code, the Compliance Program and applicable laws or regulations and the terms and conditions of Government Contracts and conduct a timely preliminary7 Revised 09/10/13 review and, if necessary, an internal investigation, of any credible allegation of misconduct received.
- Work with the CO-OP’s Controller/CFO and external auditors, as necessary, to ensure effective communication and implementation of programs to audit, monitor and validate adherence with the Code and the Compliance Program.
- Responsibility to ensure:
(i) the effective coordination of workforce related issues that are brought to the attention of the Compliance Officer;
(ii) compliance with Compliance Program requirements by workforce members;
(iii) that discipline under the Compliance Program and the Code is enforced in a manner that is appropriate, consistent and equitable; and
(iv) the implementation of an exit questionnaire program that includes questions regarding whether an existing employee observed any violations of the Compliance Program, the Code, applicable laws and regulations, or terms and conditions of Government Contracts.
- Work with the appropriate Directors and employees to ensure effective implementation and communication of the Compliance Program and any specific compliance program or detailed policies, procedures and corporate standards with respect to performance under Government Contracts.
- Ensure that the compliance risks to which the CO-OP is exposed, both internal and external, are assessed on a regular basis with special attention paid to those areas identified by any state or federal regulatory or oversight agency as high risk in regards to the CO-OP’s Government Contracts and other activities and direct the implementation of internal systems and controls to reinforce compliance and other activities, as appropriate (the “compliance audit plan”) to ensure the Compliance Program is responsive to those risks.
- Report all significant actions taken with respect to the implementation; administration and operation of the Compliance Program to the Corporate Compliance Committee.
- Prepare recommendations on compliance-related policies, procedures and corporate standards for review by the Board Audit & Corporate Compliance Committee.8 Revised 09/10/13
- Represent the CO-OP, or designate a representative as may be appropriate, before all governmental agencies in addressing compliance issues or requirements.
- Represent the CO-OP, or designate a representative as may be appropriate, in outside organizations devoted to the furtherance of corporate ethics and compliance.
- Annually review the Compliance Program to ensure its relevance and recommend to the CO-OP Chief Executive Officer, and the Board Audit & Compliance Committee modifications to account for changes in applicable laws or regulations, changes in the nature of the CO-OP’s business, and the CO-OP’s experience in the operation of the Program, and to incorporate and follow industry best practices and standards.
- Periodically engage an external vendor as appropriate to assess that CO- OP’s Compliance Program is effective as it is implemented and enforced. Results from this assessment will be reported to the Corporate Compliance Committee and the Board Audit & Compliance Committee.
- Be responsible for oversight of all certifications filed by Directors and employees relating to compliance and training. The Compliance Officer has authority to communicate promptly and personally to the Board Audit and Compliance Committee on any matter involving criminal conduct or potential criminal conduct. If a serious issue reported by the Compliance Officer is not adequately addressed by Senior Management, or if a matter directly involves a senior officer of the CO-OP, the Compliance Officer shall promptly notify the Chair of the Board Audit & Compliance Committee and shall promptly initiate an independent investigation. The Corporate Compliance Officer, at his or her sole discretion, may, upon notice to the Chair of the Board Audit & Compliance Committee but without prior approval of any other officer, retain independent outside counsel to assist him or her in the implementation, administration and operation of the Compliance Program, including but not limited to i) the internal investigation of allegations of misconduct; and ii) assessment and implementation of any modifications to the Program made in light of an instance of non-compliance. (Other aspects of the Compliance Officer’s duties with respect to allegations of misconduct are set forth in Section V, below.) The Compliance Officer shall also serve as the designated Privacy Official responsible for the development and implementation of the CO-OP’s policies and9 Revised 09/10/13 procedures regarding Privacy of Individually Identifiable Health Information (45 CFR Part 164, Subpart E).
The Compliance Officer shall also serve as the designated Security Official responsible for the development and implementation of the policies and procedures required by the Security Standards for the Protection of Electronic Protected Health Information (45 CFR part 164, Subpart C).
The Compliance Officer shall also be responsible for the CO-OP’s compliance with applicable provisions of Health Information Technology for Economic and Clinical Health Act regulations regarding Notification in the Case of Breach of Unsecured Protected Health Information (45 CFR part 164,
Subpart D). D. Corporate Compliance Committee
General. The Corporate Compliance Committee shall provide oversight, advice, support and general guidance, as appropriate, to the Corporate Compliance Officer in the discharge of his or her responsibilities. The Corporate Compliance Committee shall be comprised of the following officers and employees: the Corporate Compliance Officer, Controller/Chief Financial Officer, Chief Executive Officer and Legal Counsel. The CEO shall appoint such other persons to the Corporate Compliance Committee as he or she deems appropriate. The Committee shall be chaired by the Corporate Compliance Officer.
The Corporate Compliance Officer shall keep the Corporate Compliance Committee informed of any significant actions taken with respect to the implementation, administration and operation of the Compliance Program and shall prepare recommendations on compliance-related policies, procedures and corporate standards for review by the Committee.
Responsibilities. The Corporate Compliance Committee shall assist and support the Compliance Officer overseeing the continual improvement in the performance of the Compliance Program, including, but not limited to:
- Building an appropriate infrastructure for the administration of the Compliance Program, including mechanisms and systems for long-term support.
- Ensuring that the Compliance Program effectively detects and deters violations of applicable laws and regulations, terms and conditions of Government Contracts, and the Compliance Program and Code by the CO-OP’s Directors and employees.10 Revised 09/10/13
- Conducting a periodic assessment of the CO-OP’s corporate values, culture and potential areas of compliance vulnerability as perceived by management and/or employees.
- Ensuring proper documentation of the Compliance Program and its effectiveness.
- Establishing heightened awareness of compliance issues and improving management and employee skills in dealing with these issues.
- Conducting any other aspects of the implementation, administration or operation of the Compliance Program as the Compliance Officer may request. Duties. In carrying out its responsibilities, the Corporate Compliance Committee shall undertake the following duties:
- Compliance Program Development. Provide support and guidance to the Compliance Officer in the formulation of policies, procedures, corporate standards and mechanisms that are the basis of the Compliance Program. This includes, but is not limited to, providing support and guidance related to compliance training and education.
- Compliance Oversight. Monitor CO-OP compliance activities, including serious issues raised in calls or other reports to the Compliance Officer, as well as compliance issues involving management, (a) to ensure CO-OP compliance with all applicable laws and regulations, terms and conditions of Government Contracts, and the Compliance Program and Code and (b) to assess and improve the effectiveness of the Compliance Program in detecting and deterring improper or non-compliant conduct.
- Compliance Communication Program. Assist the Compliance Officer in (a) communicating to all employees the requirements set forth in the Compliance Program, (b) ensuring that procedures and programs are developed for informing employees of all applicable laws and regulations on a timely basis, (c) ensuring that CO-OP policies, procedures and corporate standards, including those regarding Government Contracts are developed, updated and communicated in a timely manner as necessary to provide appropriate guidance for employees.
- Compliance Program Improvements. Review the activities of the11 Revised 09/10/13 Compliance Officer and oversee the development of remedial actions and Compliance Program improvements to ensure that violations of applicable laws and regulations, terms and conditions of Government Contracts, or the Compliance Program and Code are not repeated.
- Compliance Enforcement. Oversee the Compliance Officer’s system for uniform response, enforcement and corrective action on matters relating to compliance so they are correctly and consistently handled and are reported in a timely fashion. Ensure that CO-OP policy provides effective and accessible procedures so that individuals can report in confidence (to the extent permitted by law) and without fear of retaliation, any improper activities, misconduct, and violations of law, regulations or the Code. The decision to report violations to appropriate governmental agencies shall be vested in the Compliance Officer.
- Incident Review and Response. Consult with and advise the Compliance Officer regarding particular incidents, cases and situations and appropriate responses.
- Otherwise consult with and advise the Compliance Officer in carrying out Compliance Program duties and responsibilities.
It is the responsibility of all executive, management and supervisory personnel to ensure that all employees comply with all applicable laws and regulations, including but not limited to those related to health insurance issuers, terms and conditions of Government Contracts, and the Compliance Program and Code. This responsibility is of the highest priority, and CO-OP management is required to take an active role in promoting and enforcing the Compliance Program. It is the responsibility of management to assure that each employee attends all required compliance training and executes and returns to the Ethics and Compliance Department all training and compliance related certifications. Management is responsible for actions of employees and must maintain an atmosphere conducive to compliance and disclosure and vigilance with respect to violations of applicable laws and regulations, terms and conditions of Government Contracts, or the Compliance Program and Code. Promotion of and adherence to the CO-OP’s compliance initiatives shall be part of each member of management’s performance standards and evaluation.
In order to ensure that the requirements of the Compliance Program are fully12 Revised 09/10/13 communicated to employees and that an atmosphere of compliance is fostered, all CO- OP management shall set high ethical standards for themselves and demonstrate their commitment to the Compliance Program by exemplary behavior. They shall also make themselves available to discuss ethics concerns raised by employees or by third parties. Each member of management shall be required to provide the CO-OP annually with a completed certification attesting that he or she has: (i) discussed with each subordinate under his or her direct supervision the content and application of the Code and the Compliance Program; (ii) informed each such subordinate that strict compliance with the Code and the Compliance Program is a condition of employment; and (iii) informed each such subordinate that the CO-OP shall take disciplinary action, up to and including termination of employment, for violation of any applicable law or regulation, terms and conditions of Government Contracts, the Code or the Compliance Program. These certifications shall be retained in the employee human personnel file. F. Legal Counsel
The CO-OP shall make available to the Compliance Officer, the Board Audit and Compliance Committee, and the Corporate Compliance Committee such CO-OP legal counsel, assistance and representation (whether in-house or external counsel) as shall be necessary to ensure corporate compliance with applicable laws, regulations and contracts, and assisting the Compliance Officer and the CO-OP in interpreting applicable laws and regulations, determining whether proposed or existing conduct complies with law or regulations, government contracts, and addressing other legal issues arising in the course of the implementation, administration, operation or improvement of the Compliance Program.
G. Human Resources
The COO is responsible for the review and appropriate resolution of workforce relations related issues and for ensuring that discipline under the Compliance Program is applied on a basis that is appropriate, consistent and equitable.
III. TRAINING AND EDUCATION
The Compliance Officer shall direct the development of new employee and annual CO-OP-wide training and education programs on the Code, the Compliance Program, and applicable laws and regulations. The purpose of the program will be to ensure that all Directors and employees are familiar with the requirements of, the importance of compliance with, and their responsibilities pursuant to the Code, the13 Revised 09/10/13 Compliance Program, applicable laws and regulations, and terms and conditions of Government Contracts. The Compliance Officer shall ensure that mechanisms exist for testing the efficacy of the education program and for updating the training program to account for developments in laws and regulations and in the CO-OP’s business. The Corporate Compliance Committee shall ensure that the compliance communication and training program is implemented throughout the CO-OP. The Compliance Officer shall determine whether additional or specialized training may be required for those employees who perform services under the Government Contracts or in other particular areas and shall provide for any such additional or specialized training.
A. New Employee and Annual Training Requirements
New Directors and employees initially will receive an orientation program and at least two hours of training on the Code, the Compliance Program, and applicable laws and regulations (HIPAA), including those dealing with any areas identified by the Compliance Officer as areas of heightened concern. All Directors and employees will receive at least one hour of additional training annually to refresh and update them on the requirements of, and the importance of complying with, the Code, the Compliance Program and applicable laws and regulations, including those dealing with any areas identified by the Compliance Officer as areas of heightened concern. Training may be conducted using instructor-led, computer-based or other alternate means of delivery.
The Compliance Officer shall interact with management at all levels on a regular basis to explain the significance of the Code and to determine if additional training is needed. The Compliance Officer will encourage management to engage their employees in group or individual discussions regarding the Code to determine what additional training may be needed.
B. Availability of the Code
The Code (including updates and revisions thereafter whenever the Code is modified) will be made available to all Directors and employees upon election to the Board or upon employment as the case may be.
Through one or more certifications, all Directors and employees will certify that
he or she:
(i) has read or will read and will comply with the Code;14 Revised 09/10/13
(ii) is unaware of any undisclosed violations of the Code; and
(iii) has disclosed any violations of which he or she had knowledge.
The Compliance Officer may also utilize a certification or any other reasonable method for ascertaining information regarding Directors or employees that may be necessary to operate an effective compliance program, such as, whether they have been convicted of a crime regarding dishonesty or breach of trust, regarding conflict of interest and disclosure, etc. The completed certifications will be reviewed and retained according to the CO-OP’s policies on employee screening and record retention.
IV. COMPLIANCE ISSUES — OPEN COMMUNICATION AND REPORTING
The Compliance Officer shall ensure that a CO-OP-wide system exists that allows and encourages employees to raise questions about the application or meaning of the Code and the Compliance Program and to report or disclose possible violations.
The Compliance Officer shall provide information about the resources available to assist employees in resolving any questions or concerns. Further, the Code shall contain a description of who employees may contact if they do not want to raise questions or disclose or report violations to their supervisory management. The Code shall explain the extent to which reports of wrongdoing will be kept confidential.
The CO-OP shall adopt policies and procedures to ensure that employees who raise these matters are treated with respect and are not subject to retaliation. A copy of the CO-OP’s Policy prohibiting retaliation is attached hereto as Appendix B.
A confidential, written record shall be maintained reflecting each communication concerning a possible violation of this Compliance Program. Whenever a possible material violation of the Code is disclosed, the Compliance Officer shall be notified. In each such instance, the Compliance Officer shall undertake or cause to be undertaken a prompt and thorough investigation appropriate to the circumstances. If the possible violation materially affects the CO-OP’s books and records, or if it may expose the CO- OP to criminal liability or substantial civil liability, the Compliance Officer shall consult with legal counsel with respect to the matter and shall notify the CEO and the Chair of the Board Audit & Compliance Committee.
When an investigation is initiated, steps shall be taken to ensure the retention of relevant documents. Routine document destruction procedures shall be suspended insofar as they may affect documents relevant to the potential violation and related investigation. Employees who may possess relevant documents shall be instructed to15 Revised 09/10/13 retain them or to turn them over to the investigative team. A record shall be maintained of all employees to whom such a request is made and of all documents retained for purposes of the investigation.
V. RESPONDING TO ALLEGATIONS
If the Compliance Officer has reasonable grounds to believe that any misconduct may constitute a material violation of criminal or civil law or in regards to the CO-OP’s performance under any Government Contract, the Compliance Officer shall initiate an internal investigation, promptly notify the CEO, the Board and Legal Counsel of such alleged misconduct, and shall timely report to the appropriate authorities. Other aspects of the Compliance Officer’s duties with respect to allegations of misconduct are set forth in Section II, above.
VI. AUDITING TO MONITOR COMPLIANCE — AUDIT AND PERFORMANCE REVIEW
The Controller/CFO or internal auditor (collectively “IA”) shall provide the tools, skills and process design necessary to support line management implementation of controls into all the operational areas in the CO-OP. IA is an independent appraisal function within the CO-OP established to examine and evaluate CO-OP activities as a service to management. IA is authorized to access all records, personnel and physical properties relevant to the performance of audits. IA directly reports to the CEO.
IA audits, reviews, verifies, monitors, tests and validates financial and operational controls as required for efficient management of the CO-OP’s system of internal controls and achievement of the organization’s strategic goals. In executing these functions, IA uses all necessary techniques, including sampling, to ensure that reasonable internal control policies, procedures and corporate standards exist, that line management properly monitors such controls, and that a CO-OP-wide network of internal controls properly operates to capture, monitor, summarize and report both internal control weaknesses and internal control strengths. IA reports all significant findings to the Board Audit & Compliance Committee. IA plans its functions based on an annual control risk assessment performed in conjunction with the Compliance Officer and Corporate Compliance Committee, recognizing independent auditors’ concerns, legitimate compliance issues, findings from internal audits and reviews, control weaknesses identified by line management, changes in the regulatory, economic or market environment and any other sources IA, the Compliance Officer and the Corporate Compliance Committee deem reasonable. The audit plan and the compliance audit plan are developed based on the results of this risk assessment. IA meets with the Board16 Revised 09/10/13 Audit & Compliance Committee annually to review the audit plan and reports progress and results to the Committee throughout the year.
IA executes its functions within all areas of the CO-OP. The operational areas and other IA functions addressed in the audit plan include but are not limited to, the following:
- Projects and audits of financial and accounting practices and related controls.
- Projects and audits of operational processes and controls.
- Projects and audits of information systems controls, information security, business continuation and disaster recovery.
- Coordination of external audits performed by members, customers, and state and federal agencies.
- Government program controls and government program and regulatory compliance activities.
- Quality validation audits of internal measurements of key performance indicators.
- Certification of reporting for the CO-OP’s financial statements, performance under the CO-OP’s Government Contracts, and any member/customer performance guarantees.
VII. EMPLOYMENT AND CONTRACTING DECISIONS
All job applications shall contain a statement that prospective employees understand that they are required, in the event of their employment, to abide by all rules and regulations of the CO-OP including the Code. The commitment of each employee to abide by the Code and fulfill his or her responsibilities under the Compliance Program will be a condition of employment at the CO-OP. Each job applicant shall be screened to determine, to the extent practicable, whether he or she (i) has a history of criminal conduct and the nature of any such conduct, (ii) is charged with a criminal offense involving government business and the nature of any such offense, (iii) is listed by a federal agency as debarred, (iv) is proposed for debarment or suspension, (v) is otherwise excluded from federal program participation, or (vi) has been the subject of any disciplinary action related to any license required with respect to such applicant’s potential job duties or functions with the CO- OP. This inquiry shall include at least a review of the OIG’s List of Excluded Individuals and Entities and of the General Services Administration’s List of Parties Excluded from Federal Procurement Programs and may from time to time, as determined by the17 Revised 09/10/13 Compliance Officer, include screening for other criteria or of other lists. Any applicant who demonstrates such a history may not be hired.
The CO-OP shall not vest an employee with authority to act on behalf of the CO- OP when that employee has demonstrated an inability to act in an honest and ethical manner nor shall the CO-OP employ personnel in positions with substantial authority that the CO-OP knew or should have reasonably known has engaged in illegal activities or other conduct inconsistent with an effective compliance program.
Should an employee be convicted of any criminal offense, debarred or excluded from Federal health care program participation, or have been found to have engaged in illegal activities or other conduct inconsistent with an effective compliance program, the CO-OP shall, at its sole discretion, upon discovery and confirmation of that fact, terminate that person’s employment, subject to and consistent with the CO-OP’s employment policies and procedures.
It is the policy of the CO-OP to prohibit the hiring or continued employment of individuals who have been convicted of a government program criminal offense or who are listed as debarred or excluded, from federal health care program participators. In addition, pending the resolution of any criminal charges or proposed debarment or exclusion, such individual will be removed from direct responsibility for or involvement with any federal health care program or other Government Contract. With regard to a current employee, if resolution of the matter results in conviction, debarment or exclusion, the CO-OP shall, upon discovery and confirmation of that fact, terminate that person’s employment, subject to and consistent with the CO-OP’s employment policies and procedures.
B. Vendors, Contractors, Consultants and Others
The CO-OP will not knowingly form a contract with, purchase from, or enter into any substantial business relationship with, for the purpose of fulfilling its obligations under any contract, any individual or entity charged with a criminal offense, listed by a federal agency as debarred, proposed for debarment or suspended, otherwise excluded from federal program participation, or who have engaged in illegal activities or other conduct inconsistent with an effective compliance program unless, in the judgment of the Compliance Officer in consultation with the Corporate Compliance Committee, there is a compelling reason to do so.
The CO-OP will make reasonable inquiry into the status of any vendor, contractor, consultant, or other such third party. This inquiry will include at least a18 Revised 09/10/13 review of the OIG’s List of Excluded Individuals and Entities and the General Services Administration’s List of Parties Excluded from Federal Procurement Programs and may from time to time, as determined by the Compliance Officer, include screening for other criteria or of other lists.
Should any vendor, contractor, consultant or other third party be convicted of any offense, debarred or excluded from Federal health care program participation, or have been found to have engaged in illegal activities or other conduct inconsistent with an effective compliance program, the CO-OP shall, at its sole discretion, upon discovery and confirmation of that fact, terminate its relationship with such vendor, contractor, consultant or other third party. In addition, pending resolution of any criminal charges, proposed debarment, or exclusion, such vendor, contractor or other third party will be removed from direct responsibility from or involvement with any federal health care program or other Government Contract. If resolution of the matter results in conviction, debarment, or exclusion, the CO-OP shall, upon discovery and confirmation of that fact, cease to do business with that party unless the CO-OP has otherwise received a waiver or permission from the government to continue its business relationship with such vendor, contractor, or other third party.
Vendors will be required to agree to comply with the CO-OP’s Code of Business Ethics and Conduct as stated in each vendor’s contract.
VIII. DISCIPLINARY STANDARDS
Disciplinary action will be taken on a fair and equitable basis. Such sanctions will range from oral warnings to suspension, termination, or financial penalties. While some disciplinary action can be handled by department managers, others may have to be resolved by a senior manager. Disciplinary action may be appropriate where a responsible employee’s failure to detect a violation is attributable to his or her negligence, deliberate indifference, or reckless conduct.
It is a violation of the Code for any employee of the CO-OP to:
- engage in any conduct prohibited by the Code;
- fail to report, through the channels identified in the Code misconduct of which the employee is aware;
- fail to cooperate with CO-OP officials engaged in an investigation of possible misconduct; or
- fail to enforce the Code, if the employee has responsibility for enforcing the Code.19 Revised 09/10/13
Any employee who violates the Code will be subject to appropriate disciplinary action, ranging from a warning to discharge and/or referral for criminal prosecution or civil action. MHC Compliance Program 1
Effective July 2013
EMPLOYEE ACKNOWLEDGMENT FORM
I hereby acknowledge that I have received a copy of MHC’s Compliance Program, including the Code of Conduct, which provides guidelines on the organizations compliance program, associated policies and procedures, and programs ensuring organizational and individual compliance. I understand that the procedures, practices, policies, and benefits described there supersede all prior policies and procedures, and may be modified or discontinued from time to time and that MHC will try to inform me of any changes as they occur.
I understand that I should consult with my supervisor or the organizations Compliance Officer, Larry Turney, if I have any questions that are not answered in Compliance Program Document.
I accept responsibility for familiarizing myself with the information, seeking clarification of its terms or guidance, where necessary, and complying with the content.
EMPLOYEE NAME (PRINTED)
This form will be retained in the Employee’s Personnel File.1
Mountain Health Cooperative
Non-Retaliation Policy and Procedure
To protect employees and other workforce members who report or cooperate in investigations of actual or suspected violations of the law, of the CO-OP’s Code of Business Ethics and Conduct, and/or the CO-OP’s policies and procedures (“violation”) from retaliation or attempted retaliation by other employees or workforce members, CO-OP leadership, and/or CO-OP Directors.
The CO-OP prohibits any form of retaliation or attempted retaliation against an employee or other workforce member who in good faith reports or cooperates in an investigation of any violation.
This policy protects any employee who in good faith reports a violation regardless of whether the report is made to the CO-OP leadership or to a regulatory or law enforcement agency, and protects any employee who in good faith cooperates in any investigation of a violation regardless of whether the investigation is conducted by the CO-OP, a third party or by a regulatory or law enforcement agency. Retaliation or attempted retaliation by other employees or workforce members, CO-OP leadership, and/or CO-OP Directors against such employee or workforce member will subject the individual or individuals involved in the retaliation or attempted retaliation to discipline.
Any employee or workforce member who observes or experiences retaliation or attempted retaliation should promptly report his or her concerns to the Compliance Officer. If for any reason it is not practical to report concerns to the Compliance Officer, the employee or workforce member should report his or her concerns to his or her leadership or to another person in leadership at the CO-OP.
As appropriate to the situation, the Compliance Officer, or the Compliance Officer’s designee, will conduct a prompt, thorough and impartial investigation. The CO-OP will take prompt and appropriate disciplinary action if it is determined that retaliation or attempted retaliation occurred.
An employee or workforce member may file a complaint of retaliation or attempted retaliation with a government agency if the complaint implicates or concerns an unlawful or allegedly unlawful discriminatory practice under state or federal law within the jurisdiction of such state or federal agency.
The employee or workforce member may contact the Mountain Human Rights Commission or the federal Equal Employee Opportunity Commission to determine whether a state or federal agency has jurisdiction over a complaint and for the specific filing period and requirements applicable to the complaint.