The Agency provides high-quality Applied Behavioral Analysis (“ABA”) services to Individuals Served and is committed to conducting its operations in accordance with applicable federal, state, and local laws, regulations, payer requirements, and other binding governmental directives (collectively, “Laws and Regulations”). This commitment applies to all individuals and entities acting for or on behalf of the Agency, including owners, directors, officers, employees, contractors, subcontractors, agents, volunteers, and other persons who perform services for the Agency or represent the Agency in any capacity (collectively, “Affected Individuals”).
For clarity, “Individuals Served” means persons receiving services from the Agency (including patients, clients, students, members, or other program recipients), as applicable to the service setting, payer requirements, and governing law. Individuals Served are not Affected Individuals and are not subject to workforce obligations under this Code, except to the extent applicable law or contractual terms governing access, conduct, or safety impose obligations in a particular service setting.
The Agency is committed to delivering services that support the Individual Served’s well-being while maintaining the highest ethical, professional, and legal standards. These standards apply to the Agency’s interactions with Individuals Served, families and caregivers, the community, referral sources, other providers, vendors, government agencies, school districts and other service sites (as applicable), and all public and private payers from whom reimbursement is sought or received. Affected Individuals are expected to act in a manner consistent with these standards and to avoid conduct that undermines the integrity or reputation of the Agency.
The Agency will not tolerate unlawful or unethical conduct. The Agency expects Affected Individuals to act honestly, accurately, and fairly in all business and clinical dealings, including documentation, coding, and billing activities. To support these expectations, the Agency maintains this Code of Conduct and a Compliance and Ethics Program designed to prevent, detect, and address violations of Laws and Regulations and Agency policy, and to promote early identification and timely resolution of compliance concerns through training, monitoring, discipline (as appropriate), and corrective action.
Cooperation with the Compliance and Ethics Program is a condition of employment or engagement. All Affected Individuals will receive this Code and applicable compliance policies, will be required to complete training and acknowledgements as directed, and must promptly report suspected misconduct or compliance concerns through established reporting channels. Violations of this Code, the Compliance and Ethics Program, or related policies and procedures may result in corrective action and discipline, up to and including termination of employment or contract, consistent with applicable law and Agency policy.
I. CODE OF CONDUCT
This Code of Conduct sets forth general principles to guide Affected Individuals in meeting their obligation to comply with applicable Laws and Regulations and the Agency’s Compliance and Ethics Program. This Code is not intended to address every situation. Affected Individuals are expected to consult the Agency’s policies and procedures and seek guidance when questions arise.
Compliance with this Code is a condition of employment or engagement. Violations may result in disciplinary action, up to and including termination of employment or contract, consistent with the Agency’s policies and applicable law.
Nothing in this Code is intended to create, nor shall it be construed as creating, any employment or contractual rights for any person.
Definitions. Capitalized terms used in this Code have the meanings set forth in this Code, including in the “Commitment to Compliance and Ethics” section above. “Standards” means the standards of conduct described in Section II of this Code.
A. HONESTY AND LAWFUL CONDUCT. Affected Individuals must act honestly and lawfully in all business activities conducted for or on behalf of the Agency. No Affected Individual may engage in conduct that violates applicable Laws and Regulations or Agency policy, or that misrepresents facts in documentation, communications, or records. Affected Individuals must avoid conduct that could reasonably create the appearance of impropriety and must raise questions or concerns through the reporting channels described in this Code.
B. COOPERATION WITH THE COMPLIANCE AND ETHICS PROGRAM. The Compliance and Ethics Program is effective only when Affected Individuals cooperate fully. Affected Individuals must cooperate with compliance-related reviews, audits, monitoring activities, and investigations, including responding timely to requests for information and assisting in corrective actions. Interference with an audit, review, or investigation, including destruction or alteration of relevant records, is prohibited.
C. QUESTIONS AND CONCERNS. If you are unsure about the proper course of conduct, or if you believe this Code, Agency policy, payer requirements, or Laws and Regulations may have been violated, you are expected to seek guidance or report the concern promptly. You may contact the Compliance Officer in person, by telephone, or in writing. Reports may be made anonymously, where permitted.
The Agency will maintain confidentiality to the extent practicable and consistent with the need to investigate, remediate, and comply with legal and contractual obligations.
D. NON-RETALIATION AND NON-INTIMIDATION. Retaliation, intimidation, threats, discrimination, harassment, or reprisals against any person for good-faith reporting of a concern, requesting guidance, participating in an investigation, or assisting with audits or corrective actions is prohibited. Any person who engages in retaliation or intimidation will be subject to disciplinary action, up to and including termination of employment or contract.
II. CODE OF CONDUCT STANDARDS
The Code provides a high-level overview of the expectations that the Agency has for all its Affected Individuals. Because Affected Individuals will be responsible for complying with this Code, the Agency has adopted the following standards of conduct (“Standards”) that all Affected Individuals are expected to follow. These Standards outline and summarize the basic concepts underlying the Agency’s Code of Conduct and its compliance and ethics program. These Standards must be carefully reviewed and closely followed by all Agency Affected Individuals. Supplemental information relating to these Standards will be provided through periodic formal and informal training and educational programs. Additionally, many Standards are expanded in greater detail in the Agency’s compliance and ethics standards and policies.
A. COMPLIANCE WITH THE LAW AND HIGH ETHICAL BUSINESS STANDARDS
The Agency operates in a heavily regulated industry and is subject to a large number of federal and state civil and criminal laws and regulations. Violation of these laws and regulations can result in harm to the public, severe financial penalties, exclusion from participation in government health care programs and in some criminal fines and/or imprisonment. The Agency’s Code of Conduct and compliance and ethics program are designed to prevent and detect such violations. Accordingly, it is critical that all Affected Individuals comply with all applicable federal and state laws and regulations and with all policies and procedures that comprise the Compliance and Ethics Program.
While one of the objectives of the Agency’s Compliance and Ethics Program is to educate all the Agency Affected Individuals about the basic requirements of these laws and regulations, the Agency does not expect any of its Affected Individuals to become experts in these areas. For precisely this reason, where an individual is not sure whether a particular activity or practice violates the law (or any of the compliance and ethics program policies), the individual should not – under any circumstances – “guess” as to the correct answer. Instead, the individual should seek appropriate guidance from his or her supervisor or the Compliance Officer. The Agency Affected Individuals will not be penalized for asking compliance and/or ethics-related questions. To the contrary, the Agency is intent on creating a culture in which every individual is comfortable asking the questions necessary to ensure that he or she understands and performs his or her tasks and obligations in full.
The following is a list of legal compliance and ethics issues that can pertain to Affected Individuals. Specifically, Affected Individuals shall refrain from any illegal conduct including, but not limited to:
a. Fraud, Waste, and Abuse.
The Agency expects its Affected Individuals to refrain from conduct that may violate any federal and state laws relating to health care fraud and abuse. Each Affected Individual is expected to: (1) maintain honest and accurate records of services provided; (2) follow current and applicable laws, regulations, and guidelines to facilitate proper documentation of services; and (3) take necessary steps to prevent the submission of claims for payment and reimbursement of any kind that are fraudulent, abusive, inaccurate, or medically excessive or unnecessary.
b. Antitrust and Fair Competition.
Affected Individuals shall comply with applicable federal and state antitrust and competition laws. The Agency prohibits any agreement or coordination, formal or informal, written or oral, with any competitor that could restrain trade or reduce competition, including: (i) fixing, stabilizing, or coordinating fees, rates, reimbursement terms, discounts, or other pricing terms; (ii) allocating or dividing markets, territories, customers, referral sources, or service lines; (iii) bid-rigging or coordinating responses to payer, school district, or government contracting opportunities; or (iv) boycotting or refusing to deal with any supplier, payer, provider, or other third party.
Affected Individuals shall not share or solicit competitively sensitive information with competitors (including pricing, margins, compensation rates, capacity, strategic plans, or contracting strategy), whether directly or through third parties (e.g., consultants, trade associations, industry meetings, listservs, messaging groups, or informal conversations). If a competitor raises such topics, end the discussion promptly and report the incident to the Compliance Officer.
c. Licensure/Certification.
All Affected Individuals that require licenses or certifications from state or federal agencies must comply with all licensure and certification laws applicable to the Agency’s operations. Such Affected Individuals are expected to participate in educational “in-services” offered by the Agency and by various professional groups and associations, and to be familiar with the laws that affect their specific job duties.
d. Tax.
The Agency and its Affected Individuals will truthfully and accurately report payments to appropriate taxing authorities, and will file all tax returns and other information in a manner consistent with applicable laws.
e. Discrimination and Harassment.
The Agency prohibits discrimination, harassment, and retaliation and is committed to providing equal opportunity and a respectful service and work environment. The Agency treats Individuals Served, employees, applicants, vendors, contractors, and other business partners without regard to any characteristic protected by applicable law. Concerns must be reported promptly to a supervisor/manager or the Compliance Officer, consistent with the Agency’s applicable policies.
f. Lobbying/Political Activity.
Affected Individuals may personally participate in, and contribute to, political organizations or campaigns as individuals, not as representatives of the Agency. Affected Individuals may not make any agreement to contribute any money, property, or services at the Agency’s expense to any political candidate, party, organization, committee, or individual in violation of any applicable law. Any attempt to influence the decision-making process of governmental bodies or officials by an improper offer of any benefit is absolutely and completely prohibited.
g. Kickbacks, Inducement, and Self-Referrals.
The Agency and its Affected Individuals shall comply with all laws relating to kickbacks, inducements, and self-referrals. The Agency and its Affected Individuals shall not knowingly offer, pay, solicit, or receive bribes, kickbacks, or other improper remuneration in order to induce business reimbursable by any federal or state government program including, but not limited to, Medicare and/or Medicaid. All Affected Individuals are required to report any gifts or other gratuities, other than those of nominal value, received from any outside source that would stand to benefit from the referral of business to the Agency.
h. Exclusion Screening and Eligibility.
The Agency screens Affected Individuals and, as applicable, contractors and vendors against required federal and state exclusion and debarment databases, including the New York State OMIG Exclusion List, the HHS-OIG LEIE, and, where applicable, the GSA System for Award Management (SAM). Affected Individuals must (i) cooperate with screening and verification requests, (ii) promptly disclose any exclusion, suspension, debarment, license restriction, or similar action, and (iii) immediately escalate any potential match or notice to the Compliance Officer. The Agency may remove an individual from federally- or state-funded program work pending verification and resolution.
B. STANDARDS RELATING TO QUALITY OF CARE AND SERVICES
The Agency is committed to high-quality, medically necessary ABA services delivered in compliance with applicable laws, payer requirements, school-site rules, and professional standards. The Agency maintains quality assurance processes designed to support service integrity, safety of Individuals Served, and accurate clinical and billing documentation.
a. Quality of Care Principles and Individual Rights. In keeping with the Agency’s mission and values, the following principles apply:
i. All Individuals Served will receive services without discrimination based on race, color, religion, sex, national origin, disability, sexual orientation, source of payment, age, or any other characteristic protected by applicable law.
ii. All Individuals Served will receive the information necessary to provide informed consent for any proposed intervention, procedure, or treatment, including the material risks, potential benefits, and available alternatives, as applicable.
iii. All Individuals Served will receive considerate and respectful care in a clean and safe environment, free from unnecessary restraints.
iv. The Agency will protect and promote the rights of each Individual Served, including the right to respect, privacy, dignity, self-determination, reasonable continuity of care, and participation in decisions regarding their care and treatment, consistent with applicable law and payer requirements.
v. The Agency will conduct background checks, credentialing, and other screening, consistent with applicable federal and state requirements, for Affected Individuals involved in the delivery of services to Individuals Served, in accordance with the Agency’s Credentialing and Screening Policy.
vi. All Affected Individuals providing services will maintain the credentials, experience, training, and competency required to perform their assigned responsibilities, consistent with applicable licensure, certification, supervision, and scope-of-practice requirements.
vii. The Agency will promote a culture of safety, quality, and service integrity and will use reasonable measures to support high-quality ABA services for Individuals Served.
b. Mandatory Reporting.
As part of its commitment to providing high-quality services to Individuals Served, the Agency complies with applicable federal, state, and local mandatory reporting laws and requirements. The Agency will ensure required reports are made timely and will monitor compliance with reporting obligations through policies, procedures, and quality assurance controls.
c. Clinical Documentation Integrity.
Affected Individuals must document services accurately, contemporaneously, and consistently with authorization terms, supervision requirements, payer rules, and Agency documentation standards. Alteration, falsification, backdating, cloning, or creation of documentation that misrepresents services, time, location, provider identity, or medical necessity is prohibited.
C. STANDARDS RELATING TO BILLING AND CODING
a. Billing Generally.
The Agency is committed to conducting the coding, billing, and collection process with integrity pursuant to the applicable billing laws, regulations, and guidelines to facilitate the proper documentation, coding, and billing of claims. The Agency will therefore ensure that all billing conforms with all federal and state laws regarding the submission of claims. The Agency will accurately code and bill third party payors based upon medical necessity and supporting documentation. Periodic auditing and monitoring may be necessary to ensure full compliance and ethics by the Agency. All Affected Individuals responsible for billing will be trained in the appropriate rules governing billing and documentation and will follow all regulations governing billing procedures. The Agency takes all reasonable steps to ensure that its billing software reliably and accurately codes and bills all services according to the most recent federal and state laws and regulations. Policies and training of coding and billing personnel shall focus particular attention to issues of medical necessity, appropriate diagnosis codes, prospective payment, consolidated billing, and individual Medicaid claims.
b. Compliance with Federal and State Laws Regarding the Submission of Claims.
All Affected Individuals shall comply with all applicable federal and state laws and regulations governing the submission of billing claims and related statements. A detailed description of (i) the federal False Claims Act; (ii) the federal Program Fraud Civil Remedies Act; (iii) state civil and criminal laws pertaining to false claims; and (iv) the whistleblower protections afforded under such laws is provided in the Agency’s Fraud, Waste, and Abuse Policy and Procedure.
D. STANDARDS RELATING TO BUSINESS PRACTICES
All Affected Individuals must conduct their business affairs with integrity, honesty, and fairness to avoid conflict between personal interests and the interest of the Agency, and Affected Individuals have a responsibility to obtain clarification from management on questionable issues that may arise. Affected Individuals shall forego any transaction or opportunity that can only be obtained by improper and illegal means, and will not make any unethical or illegal payments to induce the use of the Agency’s services. Specifically, Affected Individuals shall comply with the following standards:
a. Honest Communication. Affected Individuals are expected to be honest and truthful with regard to the performance of their responsibilities and in communications with the Agency’s attorneys, consultants, and auditors. Affected Individuals may not make false or misleading statements to any state or federal official, investigator, or person/entity doing business with the Agency. Affected Individuals shall not destroy or alter the Agency information or documents in anticipation of, or in response to, a request for documents by any applicable government agency or from any court.
b. Business Relationships. Affected Individuals shall not engage in any business practice intended to unlawfully obtain favorable treatment or business from any government entity or any other party in a position to provide such treatment or business. Affected Individuals shall not use confidential or proprietary information about the Agency for their own personal benefit or for the benefit of any other person or entity, except the Agency.
i. Disclosure of Financial Interest. Affected Individuals must disclose to the Compliance Officer any financial interest, ownership interest, or any other relationship that they or a member of their immediate family have with any of the Agency’s vendors or competitors.
ii. Disclosure of Personal Relationship. Affected Individuals must disclose personal relationships and business activities with any vendor or contractor that may be construed by an impartial observer as influencing any of the Affected Individuals’ performance or duties.
iii. No Use of Insider Information. The Agency and its Affected Individuals will not use insider information for any business activity conducted by or on behalf of the Agency. All business relations with vendors and contractors providing any services to the Agency will be conducted at arm’s length both in fact and in appearance, and in compliance with the Agency’s policies and procedures.
c. Unfair Competition and Deceptive Trade Practices. The Agency and its Affected Individuals shall not engage in unfair competition or deceptive trade practices, including misrepresentation of the Agency’s products or operations. Affected Individuals shall not make false or disparaging statements about competitors or their products or attempt to coerce suppliers or providers into purchasing products or services.
d. Financial Reporting. All financial reports, cost reports, accounting records, research reports, expense accounts, time sheets, and other documents must accurately and clearly represent the relevant facts or the true nature of a transaction.
e. Travel and Entertainment. It is the Agency’s policy that no Affected Individuals should suffer a financial loss or gain because of business travel and entertainment. That said, travel and entertainment expenses must be consistent with the Affected Individual’s job duties, and Affected Individuals are expected to exercise reasonable judgment in the use of the Agency’s assets.
f. Personal Use of Corporate Assets. All the Agency business shall be conducted, and the Agency assets property utilized, in a manner designed to further the Agency’s interest rather than the personal interest of an individual Affected Individual. Affected Individuals are prohibited from the unauthorized use or taking of the Agency’s equipment, supplies, materials or services and from converting the Agency assets to personal use.
g. Gifts from Individuals Served or Others. Affected Individuals may retain non-cash gifts of nominal value from vendors or Individuals Served, generally less than $50 in aggregate per calendar year, consistent with Agency policy. Cash and cash equivalents (including gift cards) are prohibited.
h. Gifts Influencing Decision-Making. Affected Individuals shall not accept gifts, favors, services, entertainment, or other things of value to the extent that decision-making or actions affecting the Agency might be influenced. Similarly, the offer or giving of money, services, or other things of value with the expectation of influencing the judgment or decision-making process of any purchaser, supplier, government official, or other person by the Agency is absolutely prohibited.
i. Gifts from Existing Vendors or Individuals Served. Affected Individuals may retain gifts from vendors or Individuals Served, which have a nominal value generally less than $50 in aggregate over each year. To the extent possible, these gifts should be shared with the Affected Individuals’ co-workers. Gifts of cash and cash equivalents (e.g. gift certificates) are never acceptable.
j. Vendor or Business Associate Sponsored Entertainment. Occasionally, at a vendor’s or business associate’s invitation, an Affected Individual may accept meals or refreshments, attend a local theater or sporting event, or similar entertainment, at the vendor’s or business associate’s expense, so long as the cost is of nominal value under the circumstances, generally less than $50 in aggregate over each year. In most circumstances, a regular business representative of the vendor or business associate should be in attendance with the employee or contractor. Affected Individuals should advise the Compliance Officer of vendors or business Affected Individuals that offer such invitations on a frequent basis, even if the Affected Individual does not accept such invitations.
k. Conflicts of Interest. Affected Individuals may not use their positions at the Agency to profit personally or to assist others in profiting in any way at the expense of the Agency. Affected Individuals shall not engage in any financial, business, or other activity which competes with the Agency’s business which may interfere or appear to interfere with the performance of their duties, or that involve the use of the Agency property, facilities, or resources, except to the extent consistent with the conflict of interest policies.
l. Services for Competitors or Vendors. No Affected Individual shall perform work or render services for any competitor of the Agency or for any organization with which the Agency does business or which seeks to do business with the Agency, without the approval of a member of the Governing Body. No Affected Individual shall be a director, officer, or consultant of an outside organization, nor permit his/her name to be used in any fashion that would tend to indicate a business connection with such organization without the prior approval of a member of the Governing Body.
m. Background Checks and Credentialing. The Agency conducts background checks, credentialing, license verification, and other screening for Affected Individuals, as applicable to role and access level, consistent with (i) applicable federal, state, and local requirements; (ii) payer, network, and school-site access requirements; and (iii) the Agency’s Credentialing and Screening Policy and related procedures.
n. Occupational Safety and Health Act. The Occupational Safety and Health Act (OSHA) requires employers to provide a work environment that meets certain safety and health standards. The Agency takes this responsibility seriously. We provide periodic education programs addressing the requirements of OSHA. Affected Individuals are required to comply with established agency policies and procedures designed to meet these guidelines. An Affected Individual who identifies a known or suspected workplace hazard must report it immediately to his/her supervisor.
o. Sexual and Other Forms of Harassment. The Agency is committed to maintaining a professional work environment that is free from sexual and other illegal harassment, which can include harassment based on race, color, religion, sex, sexual orientation, national origin, age, disability, or any other classification protected by law. Any illegal harassment of any individual by any Affected Individual (s) is prohibited and will not be tolerated. Sexual harassment consists of both direct and indirect actions that create a hostile work environment.
E. STANDARDS RELATING TO CONFIDENTIALITY
The Agency safeguards confidential information regarding its Individuals Served, such as individually identifiable health information, and confidential and proprietary information regarding the Agency’s business, such as Individual served lists, development plans, marketing strategy, financial data, proprietary research, and information about pending or contemplated business deals. Inappropriate disclosure of the Agency’s confidential business information, whether intentional or accidental, may adversely affect the Agency.
Affected Individuals shall not steal information belonging to another person or entity – including information belonging to the Agency or use any publication, document, computer program, information, or product in violation of a third party’s interest in such product. All Affected Individuals are responsible for ensuring that they do not improperly copy documents or computer programs in violation of applicable copyright laws or licensing agreements for their own use. Affected Individuals shall not use confidential business information obtained from competitors or pre-employment agreements, in violation of a covenant not to compete, or in any other manner likely to provide an unfair competitive advantage to the Agency.
Affected Individuals who learn confidential business information about the Agency or its Individuals Served shall not disclose that information to third parties, including family or friends, except with the prior written consent of the Agency, or as required by applicable law.
III. Education
The Agency will develop and implement a regular education and training program for all Affected Individuals. All Affected Individuals are expected to participate in educational programs and abide by policy requirements. Adherence to the Agency’s Compliance and Ethics Program will be a factor in evaluating the performance of a Affected Individual . The Agency will maintain records of all educational programs presented to Affected Individuals.
IV. Oversight By Compliance Officer
The Agency Compliance Officer will report to the Agency’s Governing Body (or an appropriate member of the Governing Body). The Compliance Officer shall review all material issues of interpretation of this Code of Conduct with the Governing Body or appropriate committee of the Governing Body.
V. Reporting of Violations
A. Illegal acts or improper conduct may subject the Agency to severe civil and criminal penalties, including large fines and being barred from certain types of federally funded insurance programs and businesses. It is, therefore, crucial that any illegal activity or violations of the Code be promptly brought to the attention of the Compliance Officer. In many cases, if the Agency discovers and reports illegal acts to the appropriate governmental authorities, the Agency may be subject to lesser penalties.
B. Any Affected Individual who believes or becomes aware of a violation of this Code, Agency policy, payer requirements, or Laws and Regulations must promptly report the concern to: (i) their supervisor/manager; (ii) the Compliance Officer; or (iii) the Compliance and Ethics Hotline at 800-610-2544.
C. Affected Individuals who do not report a violation of the Code or any known or suspected illegal activity will have violated this Code. Affected Individuals that have questions about whether particular acts or conduct may be illegal or violate the Code, have a duty to contact the Compliance Officer to get clarification.
D. High-level Affected Individuals to whom illegal activity or violations of this Code are reported to have a responsibility to ensure that such activity is properly investigated. Neglecting to properly investigate such reports shall be a violation of this Code. All Affected Individuals receiving any such reports are required to report such issues to the appropriate compliance and ethics personnel such as the Compliance Officer or his/her designee(s).
E. It is the Agency’s policy to promptly, thoroughly, and comprehensively investigate reports of illegal activity or violations of this Code. Affected Individuals must fully cooperate with these investigations and shall not take any action to prevent, hinder, or delay discovery and full investigation of illegal acts or violations of this Code.
F. Affected Individuals may report illegal acts or a violation of this Code anonymously. To the extent permitted by law, reasonable precautions will be taken to maintain the confidentiality of those individuals who report illegal activity or violations of this Code and of those individuals involved in the alleged improper activity, whether or not it turns out that improper acts occurred. Failure to abide by this confidentiality obligation shall be a violation of this Code.
G. No reprisals, intimidation, retaliation, or disciplinary action will be taken or permitted against Affected Individuals for good faith reporting of, or cooperating with the investigation of, illegal acts or violations of this Code.
VI. Disciplinary Action
Affected Individuals who violate this Code or commit illegal acts are subject to discipline up to and including dismissal. Affected Individuals who report their own illegal acts or improper conduct, however, will have such self-reporting taken into account when determining the appropriate disciplinary action.
VII. Conclusion
This Code of Conduct reflects standards that the Agency believes to be in the best interest of its Individuals Served, employees, contractors, vendors, and others with whom it does business. However, in addition to the specific directives set forth in this Code of Conduct, each Affected Individual’s own individual judgment is critical in determining the correct course of action for a particular situation. As each Affected Individual contemplates a situation, the Affected Individual should consider whether the proposed action or inaction is consistent with the Agency’s practices and whether it conforms to the letter and the spirit of this Code of Conduct. Additionally, whenever a Affected Individual sees a situation in which the purpose of this Code of Conduct does not appear to be served, the Affected Individual should bring the concern to the attention of the Compliance Officer.
The Agency thanks you for your cooperation with this Code of Conduct and for upholding the high standards of the Agency.
