1. Program Description
The ALIAH compliance program embodies its commitment to conducting business in the manner
proscribed by the applicable laws, rules, regulations, and other directives of the federal, state, and local
governments and agencies. An expression of this commitment is the code of conduct (“Code”) described
herein which is applicable to all individuals, including ALIAH managers, members, officers, directors,
employees, volunteers, and independent contractors working for or providing services to ALIAH (“staff
members”).
This Code is intended to provide general guidelines to assist staff members in understanding and
appreciating the high standards with which ALIAH conducts its business. Although the Code of Conduct
can neither cover every situation in the daily conduct of our many varied activities nor substitute for
common sense, individual judgment, or personal integrity, it is the duty of every staff member to adhere,
without exception, to the principles set forth herein.
The Code includes information regarding the program and its implementation, and the investigation and
resolution process.
The Code identifies the Compliance Officer as the employee responsible for monitoring the program daily
and performing periodic audits of its policies and procedures and outlines the additional duties of the
position as pertains to the Code. How ALIAH shall respond to and investigate issues brought to its
attention, via employee reports or company audits are detailed within. How actual or potential issues will be
addressed in the present and what steps shall be taken to mitigate their impact in the future is also
contained in the Code. Policies regarding the appropriate methods for reporting issues to the overseeing
agencies, and procedures related to overpayments are also included.
Included in the Code are details of the training and education programs offered by ALIAH through which all
staff members can ensure they understand their responsibilities and duties under the Code, and the
professional standards which ALIAH expects all its employees to conduct themselves. Training curricula
will include information regarding compliance issues, expectations, and the compliance program operation.
Session will be conducted on a periodic basis, as dictated by necessity, and will be included in employee
orientations.
The Code articulates the expectations for reporting compliance issues and assisting in their resolution and
the procedures by which employees can fulfill these duties. Specifics of the reporting process – how
employees may make reports and to whom – are outlined as well. Further enumerated are the lines of
communication via which reports may be made and the protections afforded employees in this process.
Information regarding the disciplinary policies of the code is included as well.
The Code of Conduct shall be amended and updated as necessary. At such times ALIAH will notify all staff
members that changes have been made, and the policy shall be made available for all employees to review
if they wish. A staff member will be made available to assist any employee in accessing and understanding
the changes. However, the final responsibility to comply with the standards, policies and procedures
contained in this Code falls on everyone. As such all ALIAH staff members must take great care to
understand the Code and conduct and the high standards expected of them.
ALIAH encourages members, managers, officers, directors, employees, contractors, and agents to raise
questions or concerns, and seek clarification regarding these laws or related policy issues with the
Compliance Officer or designated party.
This compliance program is more fully described and can be found in its entirety in the ALIAH Compliance
Program Manual (“Compliance Manual”), available for review in the office of the Administrator or
Compliance Officer.
ALIAH expects that the Code of Conduct will be a part of the daily activities of its staff members. The Code
of Conduct is in addition to, and does not limit, specific policies and procedures of ALIAH staff members
must perform their duties in accordance with all such policies and procedures.
It is the duty of every manager, member, officer, director, employee, independent contractor, volunteer, and
agent to uphold the standards set forth in the Code of Conduct and to report violations by following the
reporting procedures outlined in the Compliance Manual. Alleged violations of the Code of Conduct or other
policies and procedures of ALIAH will be investigated by persons designated by, and pursuant to
procedures established by ALIAH. We will make efforts to maintain the confidentiality of the identity of any
individual who reports perceived or actual violations. However, confidentiality of identity cannot be
guaranteed.
It shall be a violation of the Code of Conduct to take any action in reprisal against anyone who reports
suspected violations of the Code of Conduct or other ALIAH policies and procedures, assists in the
investigation of a compliance issue or assists with remedial actions in good faith.
Failure to abide by the Code of Conduct or the guidelines for behavior which the Code of Conduct
represents may lead to disciplinary action. Disciplinary action, up to and including termination, will be
determined on a case-by-case basis. If ALIAH determines that a violation may have included criminal
violations of law or regulation, ALIAH will seek the advice of counsel and cooperate with law enforcement
authorities about the investigation and prosecution of the offender.
While the duty remains the responsibility of everyone, ALIAH shall implement programs necessary to foster
further awareness of applicable laws and regulations and to monitor and promote compliance of such laws
and regulations. Any questions about the legality or propriety of any actions undertaken by, or on the behalf
of ALIAH should be referred immediately to the Compliance Officer.
2. Application
It is the duty of ALIAH and its staff members to uphold all applicable Federal, State and Local laws, rules,
regulations, and standards (“laws and regulations”). Everyone must be aware of the legal requirements and
restrictions applicable to his or her respective position and duties. The ALIAH employees who conduct
employee orientations have been educated in the specifics of the laws so they can answer any questions
new hires may have. The Compliance Officer will be available in the event further assistance is required.
Training and educational sessions will be conducted as needed, but no less frequently than annually, to
ensure all employees are aware of their responsibilities under the law.
The following policies and procedures govern the application of this code of conduct.
Reporting Procedures:
It is the policy of ALIAH to provide all its members, managers, officers, directors, staff, contractors, and
agents with the means to report actual or perceived violations of ALIAH Code of Conduct, Compliance
Program, policies and procedures and applicable laws and regulations.
Anyone with knowledge of an event, occurrence or activity that appears to violate applicable laws and
regulations, ALIAH Code of Conduct or any of its policies or procedures should promptly communicate the
actual or perceived violation to the Compliance Officer. Reports can be made anonymously by calling the
compliance hotline at 917-672-9825.
In compliance with law, ALIAH policy prohibits retaliatory action, in any form, against any individual who
makes a report, in good faith, to the agency or any governmental official or agency. The Federal False
Claims Act, New York False Claims Act, and New York State Labor Law §740 specifically prohibit and
provide remedies for such retaliatory action. Improper retaliation includes actual or threatened discharge,
demotion, suspension, harassment, discrimination, or other adverse employment action. Activities
protected against retaliation by Federal and State law and regulation include disclosing or reporting – or
making a threat of such – to a supervisor, the agency or to a governmental official or agency an activity,
policy, or practice that is in violation of the law; testifying or providing information for a hearing,
investigation, or inquiry; initiating or assisting in any action or investigation; and/or objecting to or refusing
to participate in any such illegal activity.
ALIAH has a zero-tolerance policy regarding retaliation and will aggressively investigate such matters and
disciplinary action will be take when appropriate. ALIAH expects its staff members, managers, officers,
directors, employees, contractors, and agents to promptly report any possible instances of retaliatory action
immediately to the Administrator, the Compliance Officer or other designated party.
All members, managers, officers, directors, employees, contractors, and agents are required to promptly
report all known or suspected violations of ALIAH billing and claims submission policies to the
Administrator, Compliance Officer, immediate supervisor or other designated party, in writing or through the
anonymous telephone hotline at 917-672-9825.
If an issue does arise, it is the policy of ALIAH to promptly disclose all relevant information to any and all
appropriate agencies.
Investigation and Resolution Processes:
It is the policy of ALIAH to make a prompt and thorough inquiry into any report concerning activity which
may be contrary to applicable laws or regulations. Upon receipt of a report which suggests that improper
conduct has occurred, and investigation either under the direction and control of legal counsel or the
Compliance Officer shall be commenced. The investigative techniques used shall be implemented to
facilitate the correction of any practices not in compliance with applicable laws or regulations.
Billing and Claims Reimbursement:
It is the policy of ALIAH to comply with all relevant billing and claim reimbursement rules, regulations, and
requirements. All personnel involved in coding, billing and claims submissions must maintain high ethical
standards and must know and adhere to all requirements for the health care industry, including all rules and
regulations pertaining to coding, billing, claims submission and reimbursement, including, among others,
Medicare, and Medicaid regulations. All billing personnel are expected to attend training and education
sessions. Billing personnel will be regulatory monitored to ensure that they are not engaging in any activity
which may be fraudulent or abusive under the Medicare and Medicaid regulations. Billing department
personnel and billing consultants will not offer any financial incentive to submit claims regardless of whether
they meet applicable coverage criteria for reimbursement or accurately represent the services rendered.
All Staff Members are required to promptly report all known or suspected violations of billing policies to their
immediate supervisor, Compliance Officer or Administrator, or other designated party.
ALIAH and its staff members have a duty to create and maintain records and documentation in accordance
with legal, professional, and ethical standards. Any individuals whose job duties involve billing procedures,
whether it be a part of their specific job description or in an executive role, shall ensure that all filings for
reimbursement for care are reasonable, necessary, and appropriate that services are provided by properly
qualified persons, and that services are billed correctly and supported by adequate documentation.
All claims for reimbursement to government and to private insurance payers must be true and accurate and
conform to all applicable laws and regulations.
Activities That May Violate the Law:
The following is a non-exhaustive list of examples of improper billing and claims activities:
• Billing for services or supplies that were not provided;
• Submitting a claim containing known false information or omitting material information;
• Filing a claim for services not medically necessary, or, if medically necessary, not to the extent
rendered;
• Altering claim forms to increase payments;
• Arranging to get paid twice for the same service by billing two payers (i.e. duplicated billing);
• Revising a claim for a service that is not covered so it will be covered;
• Misrepresenting the services performed, the fee for the services, the date of the services, or the
identity of the patient;
• Falsifying records to appear to meet conditions of participation or conditions of coverage;
• Omitting material information when making a claim or when submitting a written statement in
support of such claim;
• Scheming with another person to manipulate claims and increase payments (e.g. upcoding);
• Using the adjustment payment process to generate fraudulent payments;
• Billing services over a period of days when all treatment occurred over one visit;
• Improperly completing or obtaining certificates of medical necessity (CMN);
• Providing incomplete, false, or misleading information about ownership of an agency;
• Repeatedly charging patients more than the permitted amounts or repeatedly violation a
participation agreement or assignment agreement;
• Excessive charges for services or supplies;
• Improper billing practices, including submission of bills to Medicare instead of third-party payers
which are primary insurers for Medicare beneficiaries;
• Increasing charges to Medicare beneficiaries but not to other patients;
• False or misleading documentation regarding services provided; and
• Billing for home health services without meeting the program requirements.
Fraud and Abuse:
ALIAH has adopted Policies and Procedures for preventing and detecting fraud, waste, and abuse of the
Federal health care programs, including Medicare and Medicaid. All members, managers, officers,
directors, employees, contractors, and agents must strictly follow these policies. These policies and
procedures are available for review upon request. To review these policies and procedures, contact the
Compliance Officer.
In accordance with the requirements of relevant false claims laws, and to further ensure the accuracy and
appropriateness of claims submitted, ALIAH staff members, managers, officers, directors, employees,
contractors, and agents must strictly adhere to the following:
• The filing of claims for services not rendered is strictly prohibited. All documentation must be
reviewed and checked for accuracy by clinical staff prior to direct submission to Medicaid and/or
Medicare. Furthermore, billing staff must review the completeness and check for inconsistencies in
the documentation supporting the bill prior to submitting a claim. Diagnosis and procedure codes
reported on claims must be based on the medical record and other documentation and must
comply with appropriate coding guidelines. Coding must accurately describe the services ordered
by the physician and performed by the agency;
• The filing of claims and services rendered that were not medically necessary. Documentation
submitted by the staff must record the activity leading to the record entry, the identity of the
individual providing the service, and any information needed to support medical necessity and
other reimbursement coverage criteria. All clinical and billing staff shall communicate effectively to
ensure that documentation is consistent;
• Detect and prevent the submission of any claim which contains false information;
• Detect and prevent any claim for inadequate or substandard services. Clinicians must review
services rendered and supporting documentation to determine that the level of services provided is
adequate to support a claim for payment.
All documentation utilized to support claims for reimbursement shall be periodically reviewed by the billing
staff in conjunction with clinical personnel, if the claims are submitted directly to Medicare and/or Medicaid,
and the Compliance Officer or other designated party, to assess adherence to these standards. The
agency will maintain a process for pre- and post-submission review of claims to ensure that claims
submitted for reimbursement accurately reflect medically necessary services provided are supported by
sufficient documentation and are in conformity with any applicable coverage criteria for reimbursement.
ALIAH expects its staff members to refrain from any conduct which may violate applicable federal and state
laws and regulations, with special emphasis on those related to fraud and/or abuse.
These laws generally prohibit:
• The transfer of anything of value to induce the referral of patients or any government program
business (i.e., Medicare, Medicaid and other federal or state health care programs); and
• The making of false representations or the submission of false, fraudulent, or misleading claims to
any government entity or third-party payer, including claims for services not rendered, claims which
characterize the service differently than the service actually rendered, or claims which do not
otherwise comply with applicable program or contractual requirements.
More specific guidance with respect to laws and regulations applicable to fraud and abuse can be found in
the ALIAH Compliance Manual. A compendium of applicable federal and state laws applicable to the fraud
and abuse area will be included in the orientation package and will be available to all staff members by
contacting the HR department or the Compliance Officer.
Retention of Records:
It is the policy of ALIAH that all employees, contracted health professionals, agents and others associated
with the agency maintain and preserve all documents, including compliance, business, and medical
records, and secure them against loss, destruction, unauthorized access, unauthorized reproduction,
corruption, or damage. ALIAH will also comply with regulations concerning document retention periods.
The primary components of ALIAH record maintenance, access and retention policies and procedures
include, but are not limited to, the following:
• Records will only be accessible by authorized personnel on a need-to-know basis or legally
authorized individuals, and in strict conformance with applicable federal, state, and local laws and
regulations, including those relating to privacy and confidentiality.
• Patient medical records may only be accessed by authorized individuals and personnel. Questions
as to whether medical records should be released and/or distributed should be directed to the
agency’s Privacy Officer and/or Compliance Officer as they arise.
• Records will be stored in a systemized manner that preserves confidentiality and takes into
consideration environmental elements. Security of electronic records shall be in compliance with
HIPAA regulations.
3. Administration
The Compliance Officer shall be accountable for the Compliance Program; its content, implementation and
application, the response to – and investigation of – reports, the ongoing monitoring, periodic reviews and
updating of the policies contained therein and its lawfulness, are responsibilities attached to that position.
The Compliance Officer is further tasked with the duty to report compliance issues to the appropriate
governing bodies and maintaining compliance to the applicable laws.
The monitoring of the compliance policy shall include the following daily tasks:
• Frequent checking of the compliance hotline voicemails;
• Observation of the ALIAH working environment to uncover conditions which may foster or facilitate
the occurrence of violations; and
• Assessing the efficiency of agency responses to and investigations and the resolution of, reports;
ALIAH shall conduct periodic reviews designed to address relevant compliance issues; reviews will
generally be conducted internally but will be referred to external investigative bodies when deemed
necessary. Reviews shall be conducted in four stages:
• Past reviews shall be examined to evaluate the efficiency and timeliness of agency responses.
Further assessments shall be conducted to uncover the root causes of occurrences. Self-
evaluations shall be conducted to identify future risk areas;
• Procedures and policies shall be amended to address issues uncovered in the prior steps; and
• Upon its completion, the auditing process itself will be evaluated, and augmented as needed.
Attention shall be paid to identifying and addressing potential conflicts of interest among the
Compliance Staff which may affect their ability to effectively conduct future audits.
4. Training and Education
All ALIAH employees will receive comprehensive training and education regarding compliance issues,
expectations, and the compliance program operation. The compliance program will be explained in depth to
all incoming employees as part of their orientation. Current ALIAH staff including members, managers,
officers, directors, employees, contractors, agents, and other health care practitioners shall be required to
participate in a minimum of one (1) hour of basic compliance training and education annually. Attendance
at all sessions is mandatory and failure to participate will result in disciplinary action, up to and including
termination. Individuals involved in specialty fields such as coding, claims development and billing will
require additional compliance training and education addressing documentation, claims, billing, and fraud
and abuse issues. Additional training attendance may be required as part of an employee performance
improvement measure or action plan. In addition to periodic training and in-service programs, ALIAH will
notify its staff members whenever compliance standards change, and any relevant documentation will be
made available to all.
5. Professional and Ethical Standards
As professionals, all staff members have a duty to support ALIAH goals to provide nursing and other home
care services of the highest quality that respond to the needs of our patients. The services provided must
be reasonable and necessary for the care of each patient, and such care must be provided by properly
qualified individuals. All such care must be properly documented as required by law and regulation, payer
requirements, professional standards and the policies and procedures of ALIAH.
6. Confidentiality
ALIAH and its staff members are in possession of, or have access to, a wide variety of confidential and
sensitive information. Pursuant to the relevant laws, statutes, rules, and regulations, among them the
provisions of HIPAA regulations as mandated by Federal Law, dissemination of any confidential
information, patient information especially, to any unauthorized persons is strictly forbidden.
It is the duty of ALIAH and its staff members to protect the privacy rights of the patients. ALIAH and its staff
members shall maintain the confidentiality of patient medical records and information, as well as proprietary
information, by actively protecting and safeguarding such information in a manner designed to prevent the
unauthorized disclosure of such information.
If there are any questions or concerns concerning the disclosure of information, the question or concern
should be referred to an individual’s supervisor, the Administrator, the Compliance Officer, or the Privacy
Officer.
7. Business Practices
ALIAH business practices must be conducted with honesty and integrity and in a manner, that upholds the
reputation with patients, payers, vendors, and competitors. ALIAH expect its staff members to be loyal to
the organizations interests. Staff members should not use their position to profit personally or to assist
others in profiting in any way at the expense of ALIAH. Staff members must refrain from activities which
create conflicts of interest with ALIAH or give the appearance of impropriety.
Staff members involved in business transactions or behalf of ALIAH shall not offer or pay, nor solicit or
receive any gifts, favors or other improper inducements in exchange for influence or assistance in a
transaction or the referral of business. If there is any doubt or concern about whether specific conduct or
activities are ethical or otherwise appropriate, the doubt or concern should be referred immediately to an
individual’s supervisor, the Administrator, or the Compliance Officer.
When ALIAH decides to enter into an agreement or arrangement with another healthcare entity or
practitioner to provide services, that decision must be free of any improper influence. Thus, if you or any
immediate family member is already an employee, consultant, owner, contractor or even a passive investor
of an entity that (i) engages in any business or maintains any relationship with ALIAH (ii) provides to, or
receives from ALIAH, any patient referrals, or (iii) competes with ALIAH a “Conflict of Interest Disclosure
Statement Form” and submit it to the Compliance Officer. If you or your family member intends to become
such an employee, consultant, owner, contractor, or an investor, you must first obtain certain permission
from the Administrator or Compliance Officer by completing a “Conflict of Interest Disclosure Statement
Form.” In this way, ALIAH can be assured that our business relationships are free from improper
influences.
8.Conflicts of Interest
It is the policy of ALIAH that all Staff Members avoid all activities that conflict with their responsibilities and
obligations to ALIAH and its Patients.
The policies and procedures relating to conflicts of interest include, but are not limited to, the following:
• Staff Members must not have an interest in or serve as director, officer, manager, or member of
any entity in competition with ALIAH without permission.
• Any members, manager, officer, director, employee, contractor, or agent who performs work or
renders services for any competitor of ALIAH or for any organization which does business with or
seeks to do business with ALIAH outside of the normal course of his or her employment or other
engagement with ALIAH shall notify the Corporate Compliance Officer or Administrator.
• Business with any ALIAH vendor, supplier, contractor, or agency, or any of their officers or
employees that is not conducted on behalf of ALIAH is prohibited, unless previously authorized by
the Compliance Officer or Administrator.
• Staff Members shall not permit their names to be used in any fashion that would tend to indicate a
business connection with any organization which does business with or seeks to do business with
ALIAH without the prior approval of the Compliance Officer or Administrator.
• ALIAH shall not be represented by a member, manager, officer, director, employee, contractor, or
agent in any transaction in which he or she or an immediate family member has a personal
financial interest.
• Staff members should not discuss any confidential information with anyone outside of ALIAH. This
confidential information includes, but is not limited to, personnel data, patient lists, clinical
information, financial data, research date, techniques, computer software, and information with a
copyright, financial results, or business dealings.
• Staff Members shall not accept any gifts, including discounts, from prospective or current suppliers
and/or contractors.
• Staff Members shall not engage in any activities or outside interests that influence their ability to
make objective decisions during their job responsibilities.
• Staff Members are expected to disclose potential conflicts of interest involving themselves or their
immediate family members (spouse, parents, brothers, sister, and children) to the Compliance
Officer or Administrator using the agency’s “Conflict of Interest Disclosure Statement” form.
9. Employment Practices
ALIAH is committed to providing equal employment opportunities for all persons, without regard to race,
color, creed, religion, sexual orientation, national origin, age, sex, marital status, handicap, or disability.
ALIAH is committed to providing patient care and a workplace environment which emphasizes the dignity
and respect of every individual. In that regard, harassment and/or other types of prohibited discrimination in
any form or context will not be tolerated.
Violence in the workplace will not be tolerated and such behavior will result in immediate disciplinary action,
which may include termination.
ALIAH is committed to providing a healthy and safe workplace. ALIAH and its staff members will comply
with federal, state, and local laws and regulations that promote the protection of health and safety. Staff
members are expected to report workplace injuries or any situation presenting a danger of injury.
Employee and Other Association with the Agency Screening:
It is the policy of ALIAH to ensure that its members, managers, officers, directors, employees; agents and
independent contractors are properly screened in accordance with agency procedures, and in compliance
with applicable laws and regulations, prior to employment or engagement with ALIAH and periodically
during their tenure with ALIAH Offers of employment or engagement, as well as continued employment
and engagement, shall be contingent upon satisfactory screening.
Individual Excluded from Federal and State Health Care Benefits Programs:
It is the policy of ALIAH not to enter into employment, contractual or business arrangements, in any
capacity, with individuals or entities that are barred or excluded from participating in federal or state health
care benefit programs. This shall be accomplished through screening programs, which include reviewing
the U.S Office of Inspector General’s (OJG) List of Excluded Individuals/Entities (LEIE), the Office of
Medicaid Inspector General’s Providers Not Allowed to Bill list and other applicable sources of such
information prior to hiring, engaging or otherwise transacting business with any person or entity, and by
conducting such review periodically after employing, contracting with or otherwise engaging any individual
or entity.
10. Employee Compliance Verification;
ALIAH verifies employee compliance as follows:
• Home Health Aide Training Certificates are verified through examining and the home care registry;
• Social Security Numbers are verified with the Social Security Administration;
• Employees must complete an application including work history to the best of their ability to do so;
• Employees must have verified letters of reference preferable with a work reference;
• Employees will be checked through the OMIG website;
• Employees must have a physical exam with a toxicology screen, Rubeola and Rubella titers and a
PPD before beginning work;
• Employees must complete an orientation before beginning work;
• Employees must complete six hours (PCA) or twelve hours (HHA) of in-service a year;
• Employees must submit proof of an annual physical and PPD;
• Employees must have a photo ID
Please note that nothing in this Code of Conduct is intended to nor shall be construed as providing
any additional employment or contract right to staff members or other persons.