YAI Network Compliance and Ethics Program
As part of the YAI Network’s ongoing commitment to embody and promote the highest ethical standards, we have an active Compliance & Ethics Program. This program furthers our mission of promoting opportunities of living, loving, working, and learning for people with disabilities. It promotes adherence to laws, regulation, and the agency’s internal policies. And it is also designed to prevent fraud, waste, and abuse in our delivery of services.
The Program covers the following essential areas, which are described in detail below. Additional information on this program can be found on our intranet website at the Compliance & Ethics section.
The YAI Network’s Code of Conduct lists the standards that all staff must follow. Our Written Policies and Procedures are based on applicable laws and regulations. They provide guidance and direction to all staff.
All YAI Network employees have the following responsibilities:
- to abide by the applicable laws, regulations, and the Code of Conduct at all times
- to support YAI’s compliance efforts
- to immediately report any known or suspected violations of either the YAI Network’s Code of Conduct or Written Policies and Procedures to one or more of the following:
- a supervisor
- YAI Compliance and Ethics Office
- the anonymous Compliance Hotline at 212.273.6161
- Chief Human Resources Officer
- We behave in ethical and legal ways.
- We provide the highest quality care and services.
- We comply with all rules and regulations.
- We only bill for services that are necessary.
- All billing and program records are accurate and truthful.
- We do not alter, destroy or change any agency records.
- Our business transactions are proper and legal.
- All information about the people we serve is confidential and only released upon conformance with appropriate procedures.
- We are proud of our open door policy. If we have any concerns they are reported to our supervisor, any other Network managerial staff, the Director of Human Resources or the Chief Quality, Compliance, & Ethics Officer without fear of retribution.
- We support and promote a work environment where staff can raise ethical concerns. Any staff member who in good faith raises a concern about wrongdoing is supported.
The Board of Directors has appointed a Chief Quality, Compliance, & Ethics Officer to oversee all aspects of the YAI Network’s Compliance and Ethics Program. The Chief Quality, Compliance, & Ethics Officer will implement the program and provide guidance to staff on compliance issues.
As part of the YAI Network’s Compliance and Ethics Program, all employees will receive mandatory, regular training concerning federal, state, and local laws and requirements as they relate to YAI’s operations. The training will also explain how to comply with the laws, each employee’s responsibility to report failures of compliance, and how to report non-compliance.
Federal, state and local governments provide the bulk of funding for YAI Network programs. Therefore, the YAI Network is subject to all federal and state laws regarding fraud, waste, and abuse in government-funded programs. Should the government find that the YAI Network has violated any of these laws; it can impose significant fines and penalties. In addition, such violations could also result in government’s refusing to fund YAI Network programs in the future.
Specifically, the Federal False Claims Act prohibits knowingly submitting a false claim to the government for payment. It also prohibits making or using a false record in connection with submitting such a claim. False claims include, among other things:
- Billing for services that are not medically necessary
- Billing for services that were not performed
- Billing more than once for the same service
- Upcoding claims
- Failing to report identified overpayments
- Submitting false or unverified financial reports, appeals or other information.
The YAI Network is committed to complying with all applicable federal and state laws and regulations. It is committed to preventing and detecting fraud, waste, and abuse in its practices. Our training and education programs are designed to apprise all employees and management of these rules. It is the duty of all YAI Network staff to support the agency’s commitment to fraud detection and prevention by reporting any known or perceived improprieties directly to their supervisors, to the Chief Compliance Officer, the Vice President of Human Resources and Diversity, or to the anonymous Compliance Hotline. The YAI Network will not allow retaliation against any employee for reporting any known or perceived improprieties under any circumstances.
If an employee believes that YAI is not responding appropriately to a report of known or perceived improprieties, the Federal False Claims Act allows any person to report this to the federal or state government. As a matter of both law and internal policy, YAI is prohibited from taking any adverse actions against persons who notify the government of actual or potential violations.
The YAI Network’s intranet site contains more detailed information regarding the Federal False Claims Act, the Federal Program Fraud Civil Remedies Act, and New York State law relating to civil or criminal penalties for false claims. It also explains the rights of employees under these laws.
A cornerstone of our Compliance and Ethics Program is our Open Door Policy. Our Open Door Policy mandates that any staff member has the right to address any issue of concern to any manager with whom he or she feels comfortable without fear of reprisal. This policy is designed to create an organizational climate where all staff are encouraged and empowered to discuss and report such issues as compliance.
Any employee, who witnesses or is aware of behavior that is inconsistent with the Code of Conduct, or with any laws and regulations governing the operations of the YAI Network, must report this behavior to his or her supervisor. If the employee is not comfortable making such a report to his or her supervisor, the employee must report it to another manager with whom he or she does feel comfortable. The manager may be the Chief Quality, Compliance, & Ethics Officer, the Chief Human Resources Officer, or any other member of the managerial staff.
If an employee wishes to report such a problem or concern to management anonymously and confidentially, he or she may do so by calling our Compliance Hotline at 212.273.6161. This number is printed in the Compliance Manual, and is posted in all YAI Network program locations.
All YAI Network staff receives clear guidance and supervision as to the agency’s standards and expectations regarding compliance and ethics. Any YAI Network employee who violates the Code of Conduct, or fails to report either actual or suspected noncompliance as described above, will be subject to disciplinary action. This may include sanctions up to and including termination.
The YAI Network has developed internal systems to promote appropriate procedures. We also perform regular checks to ensure that our programs follow these procedures. In addition, our supervision model requires that all employees discuss compliance issues as part of standard managerial procedure.
Please contact your supervisor, the Chief Compliance Office or visit the YAI Intranet site to obtain full copies of the following policies.
- Written Policies and Procedures
Ensuring that our agency responds to all written requests in a consistent and appropriate manner.
GCP1.01 Response to Governmental Requests / Demands for Information
GCP1.02 Search Warrants GCP1.02 Subpoenas
- Compliance Program Oversight
Policies that ensure the compliance department fulfills its responsibilities.
GCP2.01 Compliance Office Confidentiality Policy
GCP2.02 Employee, Board, and Contractor Exclusion Screening
GCP2.03 Role and Responsibility of the Staff Compliance Committee
- Training and Education
Regular and effective training – including specialized education when it is appropriate – is essential to the maintenance of a culture of compliance.
GCP3.01 Employee, Independent Contractor, Officer and Board Member Compliance Training
- Confidential Reporting and Communications
Processes for reporting compliance issues.
GCP4.01 Reporting and Self Disclosure of Compliance Issues
- Enforcement of Compliance Standards
The disciplinary procedures that help enforce adherence to our policies.
GCP5.01 Enforcement and Discipline of Compliance Violations
- Auditing and Monitoring
How the agency oversees billing and other areas identified as risky.
GCP6.01 Agency Documentation Practices and Treatment of Documentation and Billing Errors
GCP6.02 Compliance Monitoring of Identified Areas of Risk
GCP6.03 Compliance Risk Assessment Process
GCP6.04 Internal Compliance Auditing and Monitoring
- Responding to Offenses
The steps we take to ensure that violations are identified and corrected.
GCP7.01 Investigation and Resolution of Compliance Issues
The protection we put in place to safegard those who report compliance matter.
GCP8.01 Reporting Compliance Concerns and Non-Retaliation