Policy and Procedure COM-MCR Medicare Approved Date: 11/05/2015. Policy Number: Disciplinary Standards/ Corrective Action Policy

Transcription

1 Title: Disciplinary Standards/ Corrective Action Policy Policy and Procedure Policy Number: COM-MCR Department: Compliance-Medicare Distribution: All Departments Originator: Cary Santamaria, Medicare Compliance Officer Original Issue Date: 1/1/2013 Last Reviewed By: Michelle Watson, Medicare Compliance Officer Effective Date: 1/1/2013 Last Reviewed Date: Last Revised By: Last Revised Date: Reference: 10/16/2015 Kendria Anderson, Medicare Program Auditor 8/28/2014 Supersedes: Product: N/A Medicare Approved Date: 11/05/2015 Chapter 9 and 21 Prescription Drug and Medicare Managed Care Manual, Compliance Program Guidelines, Section , Disciplinary Standards Approved By: Dana Gryniuk, General Counsel Signature: Approved By: Michelle Watson, Medicare Compliance Officer Signature: PURPOSE: To ensure that all employees of Simply Healthcare Plans ( SHP ) are aware of corrective/disciplinary measures to be taken upon non-compliance with SHP s Compliance Program or improper/illegal activities related to the Compliance Program. SHP has well-publicized disciplinary standards through the implementation of procedures, which encourage good faith participation in the Compliance Program by all affected individuals. RESPONSIBILITY: Medicare Compliance Officer Human Resource Department SHP Management 1 P age

2 DEFINITIONS:. POLICY: SHP will enforce the disciplinary standards of the organization in a timely, consistent, effective and appropriate manner. SHP requires all management to follow the procedures listed below when dealing with disciplinary issues. SHP strives to take a constructive approach to disciplinary matters to ensure that actions, which would interfere with operations or an Associate s job duties, are not continued. It is not possible to list all the forms of behavior that are considered unacceptable in the workplace. Accordingly, the following list of prohibited conduct is not intended to be comprehensive nor does it alter the nature of the at-will employment relationship between the Associate and the Company. However, it is representative of types of interactions that may result in disciplinary or corrective action, including but not limited to, oral warning, written warning, suspension or termination of employment. In order to assure seamless operations and provide the best possible work environment, the Company expects Associates to conduct themselves in a professional manner. This policy sets forth the Corrective Action Guidelines in the event an Associate demonstrates inappropriate behavior in the workplace. It is meant as a guide and does not provide a comprehensive list of all infractions that can lead to Corrective Action or immediate dismissal. Other infractions not listed may also result in action by management. Additionally, nothing in this policy alters the at-will employment relationship between Simply Healthcare Plans and its Associates. SHP retains the right to immediately terminate the employment of any persons with or without cause, at any time, and for any reason. SHP will not tolerate non-compliant, unethical or illegal behavior and will take the appropriate action against such behavior. SHP operates under the strict contractual obligations of the Centers for Medicare & Medicaid Services (CMS), State of Florida Agency for Health Care Administration (AHCA), and various other state regulatory agencies; thus, compliance is the core focus of our sum business operations. In order for SHP to maintain its commitment to this important value, the Corrective Action Guidelines are consistently and impartially applied to all Associates in violation of our set standards. Further, all SHP Associates are required to adhere to our Corporate Compliance Plan, the Code of Conduct and the Anti-Fraud Program.. PROCEDURE: IMMEDIATE DISMISSAL Certain violations are so serious that they usually result in immediate dismissal. It is not possible to list all forms of behavior that are considered to be unacceptable in the workplace, but the following are some examples of serious infractions. When such a violation occurs please see Termination procedures below. Falsification of employment records, employment information or other records; Recording the work time of another Associate, allowing any other Associate to record your 2 P age

3 work time, or allowing falsification of any time card, whether your own or another Associate s; Theft or the deliberate or careless damage of any SHP property or the property of any Associate or Client; Possessing, distributing, selling, transferring, or using, or being under the influence of alcohol or illegal drugs in the workplace; Provoking a fight or fighting during working hours on premises owned or occupied by SHP or while conducting SHP related business; Carrying firearms or any other dangerous weapons, at any time on premises owned or occupied by SHP or while conducting SHP related business; Engaging in criminal conduct whether or not related to job performance; Unreported absence of three consecutive scheduled workdays; Refusing to work assigned overtime; Committing fraudulent act or breach of trust in any circumstances; Disparagement of SHP to anyone, including but not limited to Clients, Vendors, or Business Activities; Violation of non-compete or confidentiality agreements; unauthorized disclosure of SHP or Client confidential or proprietary information, including but not limited to unauthorized access to, or use of SHP salary information, Human Resource or Legal information; Insubordination or the use of abusive or threatening language, including but not limited to failure or refusal to obey instruction of any supervisor or member of management; Involvement, engaging in, or assisting another to engage in, a competitive business, or the preparation to do the same while employed by SHP; Misuse of any SHP computer or information system including, but not limited to, unauthorized use, input, manipulation or falsification of data, regardless of personal gain or motive; Lying or willfully or knowingly omitting to tell the truth, during any SHP investigation or inquiry into a SHP matter; or obstruction of any sort of SHP investigation or inquiry; Egregious violation(s) of the HIPAA (Federal Health Insurance Portability and Accountability Act of 1996) Privacy Policies such as willful unauthorized disclosure/use of consumers demographic information, health insurance, confidentiality or protected health information; Egregious violation(s) of the Corporate Compliance Program including the Code of Conduct, Code of Business Ethics, Anti-Fraud program or any other components relating to the program. Corrective Action Listed below are examples of scenarios which could result in Corrective Action being taken with the Associate: Failure to meet job performance or standards; Excessive absenteeism or lateness; Poor or inappropriate attitude; Inappropriate work attire; Discourtesy to an internal or external Customer; Unauthorized use of SHP equipment, time, materials or facilities; Causing or creating, participating in a disruption of any kind during working hours or on premises owned or occupied by SHP; Participating in horseplay or practical jokes on Company time or on premises owned or occupied by SHP; 3 P age

4 Failing to notify the appropriate Manager when unable to report to work; Failing to observe working schedules, including break and lunch periods; Sleeping on the job; Failing to obtain permission to leave work during normal working hours; Working overtime without authorization; Abusing Paid Time Off Policy; Violating any safety, health, or security policy, rule or procedure of SHP; Violating or disregarding, in part or whole, any of SHP Policies and Procedures; Minor violation(s) of the HIPAA (Federal Health Insurance Portability and Accountability Act of 1996) Privacy Policies such as willful unauthorized disclosure/use of consumers demographic information, health insurance, confidentiality or protected health information; Minor violation(s) of the Corporate Compliance Program including the Code of Conduct, Code of Business Ethics, Anti-Fraud program or any other components relating to the program. Corrective Action Procedures Although employment may be terminated at will by either the Associate or SHP at any time, without following any formal system of Corrective Action or warning, SHP may exercise its discretion to utilize forms of Corrective Action that are less severe than termination. These include documented coaching/counseling, first warnings and final warnings. Because each situation is different, SHP s Corrective Actions will be based upon the facts and circumstances of each situation. All Corrective Actions taken should be coordinated with Human Resources. Documented Counseling SHP encourages open communication between Associates and Management. Managers should use ongoing counseling to reinforce positive behavior and counseling to open the channel of clear communication as soon as it is realized expectations are not being met. Counseling should be seen as developmental rather than punitive. Management should stress counseling is not part of the Corrective Action procedure, but that Corrective Action may result if the Associate does not change the job behavior. Counseling Forms must be forwarded to Human Resources within three (3) business days of delivery. First Written Warning A First Warning is an indication by the Manager to the Associate that the Associate is not fulfilling the responsibilities of the position to which they have been assigned or the Associate has violated a Policy or Procedure. A First Warning consists of a discussion with an Associate that clearly states a problem exists, clarifies the minimum expectations and outlines the consequences of not correcting the problem. All reasonable steps should be taken to afford the opportunity for the Associate to correct the deficiency or improve performance. The Manager should meet with the Associate to discuss the performance and identify the specific action plan. The First Warning must be documented with a Corrective Action Form and signed by the Associate and Manager, then forwarded to Human Resources for the Associate s personnel file. The following are a list of steps to be performed for a Corrective Action: 4 P age

5 1. Minimum work standards are not being met and or an infraction of performance or compliance policy has been committed. 2. Manager fills out the SHP Corrective Action Form and completes the Specific Action Plan for Associate. 3. Manager may review the Corrective Action Plan with the Human Resource Department. 4. Manager meets with Associate to review behavior, Corrective Action, and Specific Action Plan. 5. Corrective Action Form is forwarded to Human Resources within the three (3) business days of delivery. Associate, Manager, and Human Resource Representative signs the Corrective Action Form and a follow up meeting will be calendared to monitor and review progress. 6. Manager forwards original copy of the Corrective Action Form to Human Resources to be filed in Associate s Personnel File. 7. Manager ensures training and testing is completed as deemed necessary according to the behavior, Corrective Action and Specific Action Plan. 8. First Written Warning must be forwarded to Human Resources within three (3) days of delivery. Final Written Warning For offenses that are serious or when the First Warning has proven insufficient or ineffective, a Final Warning shall be administered. The Manager issues a Final Warning to the Associate if a previous problem is not corrected. The Final Warning describes the problem, specifies the improvement that is expected, and establishes that the improvement should be immediate and sustained. The Final Warning should also state that continued unsatisfactory performance will result in termination. The Final Warning must be documented with a Corrective Action Form, delivered by the Manager and a Human Resource Representative; signed by the Associate, and Human Resources for the Associate s personnel file. The following are a list of steps to be performed for Corrective Action: 1. Associate has repeatedly not met the minimum standards and/or has violated Company performance or compliance policy egregious enough to receive a Final Warning. 2. Manager fills out the SHP Corrective Action Form and Action Plan, (new form for a repeat offense). 3. Manager reviews Corrective Action Form and Action Plan with a Human Resource Representative. 4. Manager and Human Resource Representative meet with the Associate to review the Corrective Action Form and Action Plan. Associate is advised that if the behavior is not satisfactorily improved immediately with sustained results, termination will be pending. Associate, Manager, and Human Resource Representative signs the Corrective Action Form. 5. Original Corrective Action Form is placed in the Associate s Personnel file. 6. Manager will schedule a follow up meeting to monitor and review progress of Associate. Termination An Associate may be terminated after Corrective Action Plans have failed or when a first time incident occurs that is extremely serious. An Associate may be discharged at any time without regard to any of the progressive steps if they have committed an offense for which immediate termination is warranted or, if in SHP s sole judgment, the Associate s continued presence would be contrary to the safety of other Associates. No decision to terminate may be made without approval of the Human Resource Department and Executive Management beforehand. 5 P age

6 The Following are a list of steps to be performed for a termination: 1. Once the progressive discipline policy has failed or an offense egregious enough has been committed the Manager will notify Human Resources immediately. 2. Manager notifies their Department Head and meets with a member of Human Resources Management to determine the proper course of action. 3. If termination is deemed appropriate, the Human Resources Management will review the reason for termination with the General Counsel, for concurrence. 4. The Manager and Human Resources Management will meet with the Associate and explain the cause for termination and release him/her from employment effective immediately. 5. The Associate will be escorted off of SHP s premises. ATTACHMENTS: Compliance Plan-Exhibit 1 Code of Conduct-Exhibit 2 Employee Handbook-Exhibit 4 Revision Record Date Version Number Revised By Summary of Revisions 2/15/ Brenda Lezama Updated to reflect the current process 8/28/ Kendria Anderson Updated to reflect the current process, revise name of the policy and include applicable guidance 6 P age