DEVELOPMENTAL SERVICES INC WHAT IS CORPORATE COMPLIANCE BY DEVELOPMENTAL SERVICES INC

Expectations from Training What is corporate compliance Discussion of DSI philosophy on fraud, abuse, waste Importance of a corporate compliance policy Corporate Compliance Office Information Basis for filing a complaint

“Compliance” is merely the act of complying with or conforming to the expectations of a third party and is frequently used in conjunction with regulatory reviews, licensing audits, etc. Generally speaking, the term “compliance” is used to describe the act of complying with or acting in accordance with a set of standards or expectations mandated by an outside entity.

“Corporate compliance” is those collective acts or actions that an organization takes to meet the expectations of the U.S. Sentencing Guidelines as articulated in the Federal Sentencing Reform Act of 1984. Specifically, corporate compliance is the sum of all actions, policies, procedures, reviews, audits, prevention strategies, corrective actions, modifications, staff training efforts, reporting systems, etc. that are developed and implemented by an organization and its employees to prevent and detect illegal or unethical activity and/or fraud, waste, and abuse. From “Introduction to Corporate Compliance: A Strategy for Effective Design and Successful Implementation

The Federal Sentencing Reform Act At the root of corporate compliance is The Sentencing Reform Act of 1984 (Title II of the Comprehensive Crime Control Act, 28 U.S.C., 994). The Act went into effect in 1987 and created the United States Sentencing Commission. The Commission has very broad powers to establish sentencing policies and procedures that federal judges must adhere to when passing down judicial sentences. The intent was to assure uniform sentencing from one federal jurisdiction to another. These guidelines are not law, but should be thought of as law because they have the same force and effect.

Why a Separate Corporate Compliance Program? Many organizations do not understand the need for a separate Corporate Compliance Program. Many human service organizations feel they exist to “serve people and to improve the quality of their lives”. Many feel that members of leadership, management, and staff are committed to “doing the right thing” in the interest of the people served.

The sentencing guidelines require that DSI to have in place a program to limit damage. There must be mechanisms developed to prevent fraud, waste, and abuse. Simply retaining an attorney is not sufficient under the guidelines.

More significantly, an organization cannot divest itself of legal liability simple by requiring its employees to “do the right thing” and/or by having them sign a statement during new employee orientation that obligates them to act in a way that will not violate any law, regulation, or organization policy.

DSI’s Corporate Compliance Program promotes high standards of conducting the organization’s business in a clearly ethical manner. Integrity is and must continue to be, the basis of all our business activities. The Corporate Compliance Program is used to further DSI’s mission, vision and values.

The purpose of the DSI Corporate Compliance Program includes continuing effort to improve quality, performance and define the scope of conduct expected of DSI’s employees. It also provides a statement of certain key policies of DSI for conducting its business legally, ethically and with integrity.

DSI is committed to establishing and observing high standards and ethical conduct in the delivery of services characterized by strict conformance with the highest standards of accountability for administration, business, marketing, financial management and the provision of consumer services.

DSI’s Code of Conduct details that all employees are responsible to ensure that their behavior and activity is consistent with the agency’s policies as well as applicable federal, state, local laws and regulations including Medicaid and Medicare requirements.

How to File a Report DSI expects all employees to abide by the principles in the Code of Conduct. As a result, all employees are expected to report any activity or practice that may violate applicable rules to their supervisor. If an employee feels that an activity is in violation of waste, fraud or abuse, it is their responsibility to file a report with the Corporate Compliance Officer.

The Corporate Compliance Officer at DSI is Linda Clouse The Corporate Compliance Officer at DSI is Linda Clouse. A report can be made by an employee by the internal e-mail system, submission of a written statement through the internal mail, US mail, hand delivery or the employee can submit a verbal report through a personal conversation or the voicemail system.

No-Reprisal Reporting System DSI has a No-Reprisal Reporting System. This system protects those employees who report wrongdoing and beyond. DSI has a corporate commitment to maintain an atmosphere that promotes prompt and immediate reporting and hold accountable those who knowingly fail to report fraud, waste, and/or abuse.

False Claim Act A false claim may take many forms: overcharging for a product, failing to perform a service, delivering less than the promised amount of goods or services, underpaying money owed to the government, and charging for one thing but delivering another. These are just a few examples of false claims.

The False Claim Act allows for a private individual or whistleblower with knowledge of past or present fraud committed against the US federal government to bring suit on its behalf. It is known as Qui Tam. The private individual, known as a “relator”, has information that the name of the defendant has knowingly submitted or caused the submission of false or fraudulent claims to the United States. The relator need not have been personally harmed by the defendant’s conduct.

When deciding if a potential False Claims Act is meritorious, a potential relator should consider a number of things: Should have actual knowledge of the fraud Evidence of the fraud, which cannot come from any publicly disclosed source Identify the “who, what, when, where” Federal money must be involved Fraud cannot involve a state defrauding the Federal government

The company/entity that submitted the False Claim to the government must have done so knowingly Case needs to be filed within six years of the violation The governments own waste and mismanagement is not subject to the False Claims Act

If the potential false claim is deficient under one or more of the above considerations, there is good chance the relator does not have a case. If the fraud appears to stand up under the claims then the relator can proceed. However, if the fraud appears to stand up under the previous mentioned considerations then the following should be considered:

The fraud needs to rise to a sizeable level and there has to be a reasonable expectation that the entity engaging in the fraud will be able to pay back the stolen money and the associated fines. Access the quality of the information related to the fraud. Specific knowledge of the fraud and how it works is required. The more documentation available, the more likely a private attorney and the Federal government will be interested in the case. The relator should be prepared to show how the fraud works and explain the evidence.

Any DSI employee should feel free to report any type of fraud, abuse, and/or waste. It is the policy of DSI that no employee shall be punished solely on the basis that they reported what was reasonable believed to be an act of wrongdoing or violations or suspected violations of the Code of Ethics.

However, an employee will be subject to disciplinary actions if DSI reasonable concludes that the report of wrongdoing was knowingly fabricated by the employee or exaggerated or minimized information either to injure someone else or to protect the reporting party or others.

An employee whose report of misconduct contains admissions of personal wrongdoing will not, however, be guaranteed protection from disciplinary action. The weight to be given the self-confession will depend on all facts known to DSI at the time it makes its disciplinary decisions.

In determining what, if any, disciplinary action may be taken against an employee, DSI will take into account an employee’s own admission of wrongdoing, provided the reporting employee’s conduct was not previously known to DSI or its discovery was not imminent and that the admission was complete and truthful.

Linda Clouse, Corporate Compliance Officer 1-812-376-9404, ext 234 1-800-745-7686 lclouse@dsiservices.org