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The Office of Privacy and Corporate Compliance is committed to providing Yale New Haven Health System, and all of its individual delivery networks, with respect to its vision, mission and values, with clear and ethical compliance direction relating to all federal and state health care program requirements and regulations.
The YNHHS Compliance Program is designed to prevent and detect violations of applicable law, Code of Conduct and company policies. While it is expected that employees, contractors and agents will comply with applicable laws, Code of Conduct and policies, the System understands that the implementation of the Compliance Program cannot eliminate all risk of improper conduct. In the event that the System becomes aware of possible violations of law or Code of Conduct or policies, the Office of Privacy and Corporate Compliance will investigate the matter and, where appropriate, recommend disciplinary action and implement corrective measures to prevent future violations.
Compliance is not a “policing” action, but a way to ensure everyone is “doing the right thing”. To support this, YNHHS’ Corporate Compliance Department works with departments all across the health system to carry out primary functions such as:
Once an issue is identified, the Compliance Department works with the applicable departments to investigate and resolve the issue. All issues are recorded and tracked for timely resolution.
We encourage you to call the Office of Corporate Compliance at 203-688-8416 or email us at [email protected] to discuss any potential compliance concerns. In addition, the Compliance Hotline is available to everyone 24 hours a day, seven days a week by calling 888-688-7744 or visiting www.ynhhscomplianceprogramhotline.com.
You can make a report either anonymously or by using you name. All reports received by either the Office of Privacy & Corporate or Hotline are appropriately investigated.
Dear Colleagues,
Yale New Haven Health System is a leader in providing safe, high-quality, comprehensive patient care. We are committed to excellent service in day-to-day interactions with our patients and their families, visitors, other staff members and the communities we serve.
We rely on our education, training and experience, but it’s our values – integrity, patient-centered care, respect, accountability and compassion – that guide us as individuals and as an organization in the work we do.
In our work, often we face new and difficult situations involving issues like patient confidentiality, conflicts of interest or financial reporting. To be best positioned to address these challenges, we all need a thorough understanding of our policies, and the rules and regulations that govern our work and our actions and decisions.
The Yale New Haven Health System Code of Conduct reflects our commitment to ethical business behavior, provides guidelines for making informed decisions, and presents an overview of the policies to which we must all adhere.
If you are unsure about an issue or concerned about a possible violation, your organization’s corporate compliance officer will provide guidance. Or, you may call the Compliance Hotline at 1-888-688-7744 or go to the Corporate Compliance/Privacy website. Thank you for your continued commitment to providing safe, high-quality care to the patients we are privileged to serve.
Sincerely,
Our Code of Conduct reflects our collective commitment and responsibility to uphold our organization’s reputation, practice ethical business behavior, meet rigorous professional standards, and comply with the laws, regulations and policies that govern our work.
The Yale New Haven Health System (YNHHS) Code of Conduct applies to every individual affiliated with YNHHS, whether employee, volunteer, member of the medical staff or Auxiliary at YNHHS and its Bridgeport, Greenwich, Lawrence + Memorial, Westerly, Yale New Haven and Northeast Medical Group delivery networks.
The YNHHS Code of Conduct provides:
We as individuals have a shared commitment to meeting applicable laws and industry standards and applying them to our day-to-day interactions.
The YNHHS Code of Conduct articulates our commitment to our values and ethical business behavior while reminding us that our overriding responsibility is
to use sound judgment and personal integrity.
It is the responsibility of each of us to understand and comply with all applicable organization policies and procedures and be able to locate them and review them periodically.
The purpose of the Compliance and Privacy Program is to provide the system with clear ethical and compliance direction. In addition, the Compliance and Privacy Program is designed to prevent and detect violations of applicable law, Code of Conduct, and company policies.
Our Corporate Compliance Program is designed to enhance our understanding of acceptable behavior and appropriate decision-making.
It is everyone’s duty to promptly report any activity that appears to violate the Code of Conduct or any laws, regulations, or organizational policies.
All YNHHS policies (including compliance and privacy) can be found on the YNHHS intranet.
If you wish to obtain guidance on ethics or compliance issues, or if you are unsure about reporting a suspected violation, you may take any of the following actions:
If you feel uncomfortable about your activities or those of others around you and are hesitant about making a report in person, call the 24-hour Compliance Hotline at 1-888-688-7744 or make a report on the Corporate Compliance/ Privacy website at: https://ynhh.ethicspoint.com/.
The hotline is outsourced to an independent company that has trained professional personnel available to speak with you. You are not required to identify yourself. The hotline is not set up for caller ID and cannot trace calls.
However, you may decide to identify yourself in order to provide information that may be helpful in an investigation.
Information you provide will remain confidential to the extent possible.
You will be given a case number and a call-back date. You may call back again on or after the call-back date to determine whether action has been taken, but the nature and outcome of an investigation are always confidential.
We will protect any employee who reports a concern in good faith. While you are accountable for your own wrong-doing, anyone who retaliates against you for reporting a concern in good faith will be subject to disciplinary action.
Report any retaliation or harassment immediately to your supervisor, another manager, the Compliance Office or the Compliance Hotline. Please see the YNHHS Non-Retaliation and Non-Retribution for Reporting policy for more information.
These are just a few of the concerns that might prompt you to call the hotline:
No employee, member of the medical staff, volunteer, or member of the Board of Trustees may solicit or encourage a gift or gratuity from a patient or visitor. When gifts of a personal nature are offered by patients or visitors, they should be discouraged.
The patient or visitor should be politely thanked, but told that employees, medical staff, volunteers and trustees are not permitted to accept gifts or gratuities. YNHHS personnel may never accept cash or cash equivalents, such as gift certificates or gift cards.
YNHHS personnel may not offer or receive gifts unless such gifts are of a nominal value and are in accordance with these guidelines. Refer to policy on intranet for details.
Under no circumstances may YNHHS personnel offer or receive a gift when the intent is to generate healthcare business. YNHHS personnel must disclose and, as appropriate, seek prior approval from their department manager when receiving or soliciting gifts as YNHHS personnel.
Employees and medical staff should request, use or disclose only the minimum amount of information necessary from patients’ records, and only for patient treatment, payment or healthcare operations (TPO). Employees should use caution to never disclose PHI to any non-covered individual through any form of communication – verbal, written, electronic mail, social media, etc.
Employees who publish or post content on user-generated media on the internet (including, but not limited to, social media sites, blogs, wikis, chat rooms, message boards, etc.) should exercise good judgment, respect and discretion, and follow YNHHS’ policy on “Social Networking and Online Communications”.
Employees’ right to access Protected Health Information (PHI)
Employees may not use work access privileges to view the records of family members, friends, colleagues or others. Employees are granted access to electronic medical records (EMRs) for treatment, payment, or operations (TPO) purposes only.
YNHHS does not employ, contract with or otherwise utilize the services of any individual or organization that has been debarred or excluded from, or is otherwise ineligible to participate in, any federal healthcare program.
All employees, contractors, agents and volunteers of YNHHS must immediately report to the delivery network Compliance & Privacy Officers or Chief Compliance & Privacy Officer any suspicion of fraud, waste or abuse in connection with the business of YNHHS. YNHHS engages in specific compliance efforts to detect and prevent fraud, waste and abuse.
YNHHS prohibits any acts of retribution, discrimination, harassment or retaliation against any employee who, in good faith, provides information or otherwise assists in an investigation or proceeding regarding any conduct which the employee reasonably believes to be in violation.
My mother-in-law is in the hospital and I’m a nurse working on another floor. Can I look up her lab results in Epic to see what is wrong and consult with her tonight? No. Family members, friends and co-workers are entitled to the same privacy as any other patient. You must obtain a release of information and request the records through Health Information Management (HIM) or MyChart proxy access.
May I post something that includes the YNHHS logo or has patient information on social media? If an employee chooses to be identified as related to the System, its hospitals or other entities, he/she must make it clear to the readers that the views expressed are the employee’s alone and that they do not necessarily reflect the views of the System. Employees must avoid making defamatory statements about the System or its employees, patients, clients, partners, affiliates and others, including competitors. Disclosing any protected or confidential information (e.g., patient/employee/business) on social media or online is prohibited.
What if a patient gives me a gift card to my favorite store? This would not be permitted. Thank the patient and direct him or her to your delivery network’s Development/Foundation office to make a charitable contribution.
I saw a co-worker photographing a celebrity in the hospital waiting room with his phone. I didn’t take the picture – do I need to report it? This is a breach of patient privacy and you are required to report it.
I noticed a few instances in which the physician’s office where I work was billing twice for services with a Medicare patient. Should I wait for someone to catch the error later? Billing and coding are high-risk areas and this may be considered a fraudulent claim. It should be reported immediately to your manager and/or the Compliance Department or Hotline.
Policy updated 2/27/2017
We work hard to ensure the privacy of patients and maintain the confidentiality their information and medical records. Like all accredited healthcare institutions, we follow a federal law called the Health Insurance Portability and Accountability Act (HIPAA), which is designed to protect the privacy and confidentiality of patient information. We insist that our staff observe patient confidentiality – respecting your right to privacy about your medical records and experience at our hospital.
View or download a fillable PDF.
For Bridgeport, Greenwich and Yale New Haven Hospitals:
Authorization for Access/Release of Information
For Lawrence + Memorial Hospital:
Authorization for Access/Release of Information
For Westerly Hospital:
Authorization for Access/Release of Information
(Policies revised 7/8/24, 7/19, 11/18, 11/19)
View or download the PDF.
Authorization for Access/Release of Information (Spanish)
(Policy revised 7/19)
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions, please contact our privacy office at the phone number at the bottom of this notice.
We understand that medical information about you is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care generated by any of the separate facilities and providers described below. We are required by law to:
We may use and disclose medical information about you without your prior authorization for treatment, such as sending medical information about you to a specialist as part of a referral (this includes psychiatric or HIV information if needed for purposes of your diagnosis and treatment); to obtain payment for treatment, such as sending billing information to your insurance company or Medicare; and to support our healthcare operations, such as comparing patient data to improve treatment methods or for professional education purposes (Note: only limited psychiatric or HIV information may be disclosed for billing purposes without your authorization). If you are treated in a specialized substance abuse program, your special authorization is required for most disclosures other than emergencies.
Other examples of such uses and disclosures include contacting you for appointment reminders and telling you about or recommending possible treatment options, alternatives, health-related benefits or services that may be of interest to you. We may also contact you to support our fundraising efforts. It is always your choice to opt out of receiving fundraising communications from us.
We may use or disclose medical information about you without your prior authorization for several other reasons. Subject to certain requirements, we may give our medical information about you, without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, medical examiners, funeral arrangements and organ donation, workers' compensation purposes, emergencies, national security and other specialized government functions, and for members of the Armed Forces as required by Military Command authorities. We also disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances, or in response to valid judicial or administrative orders or other legal process.
Under certain circumstances, we may use and disclose health information about you for research purposes, subject to a special approval process. We may also allow potential researchers to review information that may help them prepare for research, so long as the health information they review does not leave our facility, and so long as they agree to specific privacy protection. For more information on research and how to opt out of research use of your records see www.yalestudies.org or 1-877-978-8343.
If admitted as an inpatient, unless you tell us otherwise, we will list in the patient directory your name, location in the hospital, your general condition (good, fair, etc.) and your religious affiliation, and may release all but your religious affiliation to anyone who asks about you by name. Your religious affiliation may be disclosed only to clergy members, even if they do not ask for you by name.
We may disclose medical information about you to a friend or family member whom you designate or in appropriate circumstances, unless you request a restriction. We may also disclose information to disaster relief authorities so that your family can be notified of your location and condition.
In any other situation not covered by this notice, including the use or disclosure of psychotherapy notes, we will ask for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision.
Yale New Haven Health System (YNHHS) and Yale School of Medicine (YSM) facilities provide health care to our patients in partnership with other professionals and healthcare organizations. The information privacy practices in this notice will be followed by:
While each of these facilities and affiliates operates independently, they may share your health information for coordination of care, treatment, payment, and healthcare operations purposes.
We will notify you in the event that the confidentiality of your information has been breached.
In most cases, you have the right to look at or get a copy of medical information that we use to make decisions about your care. All requests for copies or access must be submitted in advance, in writing. If your request for inspection is granted, we will arrange for a convenient time and place for you to look at your record. If you request copies, we may charge a fee for the cost of copying, mailing, or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.
If you believe that information in your record is incorrect or that important information is missing, you have the right to request that we correct the records, by submitting a request in writing that provides your reason for requesting the amendment. We could deny your request to amend a record if the information is not maintained by us; or if we determine that your record is accurate. You may submit a written statement of disagreement with a decision by us not to amend a record.
You have the right to request a list accounting for any disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and healthcare operations, circumstances in which you have specifically authorized such disclosure and certain other exceptions. as required by law.
To request this list of disclosures, indicate the relevant period which must be within the past six years. You must submit your request in writing to the Medical Record or Billing Department as appropriate.
You may request, in writing, that we not use or disclose medical information about you for treatment, payment or healthcare operations or to persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will consider your request and work to accommodate it when possible, but we are not legally required to accept it unless all of the conditions below are met:
We will inform you of our decision on your request. All written requests or appeals should be submitted to our Privacy Office listed below.
You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you.
You may receive a paper copy of this Notice from us upon request, even if you have agreed to receive this notice electronically.
We may change our policies at any time. Changes will apply to medical information we already hold, as well as new information after the change occurs. Before we make a significant change in our policies, we will change our notice and post the new notice in waiting areas, exam rooms, and on our Web site at yalenewhavenhealth.org. You can receive a copy of the current notice at any time. The effective date is listed at the end. Copies of the current notice will be available each time you come to our facility for treatment. You will be asked to acknowledge in writing your receipt of this notice.
If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Office listed below.
If you are not satisfied with our response, you may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our Privacy Office can provide you the address. Under no circumstances will you be penalized or retaliated against for filing a complaint.
YNHHS Office of Privacy and Compliance
203-688-8416
Toll Free: 1-888-688-7744
[email protected]
Yale University HIPAA Privacy Office
203-432-5919
[email protected]
Yale New Haven Health System Acknowledgement of Receipt of Notice Of Privacy Practices
Printed Name of Patient:Patient's Medical Record Number:
Patient's Date of Birth:
Patient's Address:
Patient's Personal Representative & Relationship:
Signature:
Date:
If Applicable, Reason for Patient Refusal to Sign:
Version effective 9/10/2019
Este aviso describe cómo se puede utilizar y divulgar su información médica y de qué manera usted puede acceder a ella. Por favor lea este aviso con cuidado. Si tiene alguna pregunta, comuníquese con nuestra oficina de privacidad al número telefónico que aparece al final de este aviso.
Nuestro compromiso con usted:
Entendemos que su información médica es personal. Nos comprometemos a proteger su información médica. Para ofrecerle atención de calidad y cumplir con los requisitos legales, creamos un expediente de la atención y los servicios que recibe. Este aviso se aplica a todos estos expedientes médicos generados por cualquiera de nuestros centros y proveedores independientes mencionados a continuación. La ley nos exige:
De qué modo podemos usar y divulgar su información médica:
Podemos usar y divulgar información médica sobre usted sin su autorización previa por razones de tratamiento, como por ejemplo enviar su información médica a un especialista como parte de un remitido (incluyendo información psiquiátrica y sobre el VIH si fuera necesario para su diagnóstico y tratamiento); para obtener el pago de un tratamiento, por ejemplo enviar información de su estado de cuenta a la compañía de seguros o a Medicare; y para apoyar nuestros servicios de atención de salud, como por ejemplo comparar datos sobre los pacientes para mejorar los métodos de tratamiento o con fines educativos para profesionales (Nota: sólo se puede divulgar sin su autorización una cantidad limitada de información psiquiátrica o sobre el VIH con el fin de facturar los servicios médicos). Si usted recibe tratamiento en un programa especializado por abuso de substancias, se requerirá su autorización especial para la mayoría de las divulgaciones que no sean por una emergencia. Otros ejemplos de tales usos y divulgaciones incluyen comunicarse con usted para recordarle que tiene una cita y mencionarle o recomendarle posibles opciones de tratamiento, alternativas, beneficios o servicios relacionados con la salud que puedan serle de interés. También podríamos comunicarnos con usted para que apoye nuestros esfuerzos para recaudar fondos. En cualquier momento, usted puede optar por no recibir información sobre nuestras campañas para recaudar fondos.
Podemos usar o divulgar información médica sin su autorización previa por varias otras razones. Podemos divulgar sin autorización previa la información médica que tenemos sobre usted, siempre que se cumplan ciertos requisitos, por razones de salud pública, denuncias de abuso o negligencia, auditorías o inspecciones de vigilancia de la salud, evaluadores médicos, arreglos funerarios y donación de órganos, por razones de indemnizaciones laborales, emergencias, seguridad nacional y otras funciones gubernamentales especializadas y para miembros de las Fuerzas Armadas según lo exigen las autoridades de Comando Militar. También divulgamos información médica cuando la ley lo requiere, como por ejemplo en cumplimiento de una solicitud de la policía en circunstancias específicas, o en respuesta a órdenes judiciales o administrativas válidas u otros procesos legales.
Podemos usar y divulgar su información con fines de investigación científica, bajo ciertas circunstancias y siempre que se cumpla un proceso de autorización especial. También podríamos permitir que potenciales investigadores analicen la información que pueda ayudarlos a prepararse para una investigación, siempre que la información médica que analicen no salga de nuestras instalaciones, y siempre que acepten cumplir con mecanismos específicos de protección de la privacidad. Para obtener más información sobre las investigaciones científicas o sobre cómo evitar el uso de su expediente para investigaciones vea la página de internet www.yalestudies.org o llame al 1-877-978-8343.
Si lo ingresan al hospital, incluiremos en el directorio de pacientes su nombre, ubicación en el hospital, su estado de salud general (bueno, regular, etcétera) y su afiliación religiosa y podremos divulgar dicha información, excepto su afiliación religiosa a cualquiera que pregunte sobre usted por su nombre, a menos que nos solicite lo contrario. Su afiliación religiosa sólo puede ser divulgada a miembros del clero, aunque no pregunten por su nombre.
Podemos divulgar su información médica a un amigo o pariente que usted haya designado o en determinadas circunstancias, a menos que usted solicite una restricción. También podemos divulgar información a las autoridades que brindan asistencia en caso de desastre para poder notificar a su familia sobre su ubicación y estado de salud.
Otros usos de la información médica:
En cualquier otra situación que no esté contemplada en este aviso, incluyendo el uso o divulgación de las notas de las consultas de psicoterapia, solicitaremos su autorización por escrito antes de usar o divulgar información médica sobre su persona. Si usted elige autorizar el uso o la divulgación, puede revocarla más adelante notificándonos su decisión por escrito.
Las instalaciones de Yale New Haven Health System (YNHHS) (El Sistema de Servicios de Salud de Yale New Haven) y Yale University School of Medicine (YSM) (la Facultad de Medicina de la Universidad de Yale) brindan atención médica a nuestros pacientes, en colaboración con otros profesionales y otras organizaciones de atención de la salud. La información que contiene este aviso sobre las prácticas de privacidad será acatada por:
Derecho a que se le notifique si ha habido fuga de información:
Le notificaremos si ha ocurrido alguna fuga de su información confidencial.
Derecho a obtener y rectificar su historial:
En la mayoría de los casos, usted tiene derecho a ver u obtener una copia de la información médica que usamos para tomar decisiones sobre su cuidado. Todas las solicitudes de copias del expediente médico o las solicitudes para tener acceso al mismo se deben de presentar con anticipación y por escrito. Si se le concede su solicitud, programaremos la hora y el lugar convenientes para que pueda revisar su expediente. Si solicita copias, podríamos cobrarle una tarifa por el costo del copiado, envío u otros suministros relacionados. Si denegamos su solicitud de revisar u obtener una copia, puede presentar una solicitud por escrito para que se reconsidere dicha decisión.
Si usted opina que la información que aparece en su historial es incorrecta o que falta información importante, tiene derecho a que rectifiquemos su historial presentando una petición por escrito expresando la razón por la cual ha solicitado la enmienda. Podríamos denegar su solicitud de corrección si la información no está a nuestro cargo; o si determinamos que su registro es correcto. Si nuestra decisión es no enmendar su historial, puede presentar por escrito una declaración de desacuerdo.
Derecho a recibir un informe:
Usted tiene derecho a solicitar un informe de las divulgaciones que hayamos hecho de su información de salud, excepto cuando se usó o divulgó para tratamiento, pago, servicios de atención de salud, aquellas circunstancias para las cuales haya autorizado dicha divulgación y otras excepciones según lo exige la ley.
Para solicitar esta lista de divulgaciones, indique el período relevante, que debe estar comprendido dentro de los últimos seis años. Usted debe presentar la solicitud por escrito al Departamento de Archivos Médicos (Medical Records) o al Departamento de Facturación (Billing Department), según sea apropiado.
Derecho a solicitar restricciones:
Usted puede solicitar por escrito que no usemos o divulguemos su información médica para tratamiento, pago o servicios de cuidado de la salud, o a personas involucradas en su cuidado, excepto cuando usted lo autorice específicamente, cuando lo exija la ley o en una emergencia. Consideraremos su solicitud y trataremos de ajustarnos a la misma, cuando sea posible, pero no estamos obligados por ley a aceptarla, a menos de que se cumplan todas las condiciones que aparecen a continuación:
Le informaremos nuestra decisión sobre su solicitud. Todas las solicitudes y apelaciones escritas deben ser presentadas ante la Oficina de Privacidad indicada más adelante.
Solicitudes de comunicaciones confidenciales:
Usted tiene derecho a solicitar que su información médica le sea comunicada de forma confidencial como por ejemplo el envío de correspondencia a una dirección distinta a la de su hogar, notificándonos por escrito cuál es el modo específico o qué dirección debemos utilizar para comunicarnos con usted.
Derecho a solicitar una copia impresa de este aviso:
Usted puede recibir una copia impresa de este aviso si así lo solicita, aunque haya aceptado recibir este aviso por vía electrónica.
Cambios a este aviso:
Podemos cambiar nuestras políticas en cualquier momento. Los cambios serán aplicables tanto a la información médica que ya tengamos como a la nueva información que obtengamos después de ocurrido el cambio. Antes de realizar un cambio importante en nuestras políticas, cambiaremos nuestro aviso y lo colocaremos en las salas de espera, salas de examen médico y en nuestro sitio de Internet: yalenewhavenhealth.org. Usted puede recibir una copia del aviso vigente en cualquier momento. La fecha de vigencia aparece al final del mismo. Habrá copias del aviso vigente disponibles cada vez que usted visite nuestro centro para tratamiento. Se le pedirá que reconozca por escrito que recibió de este aviso.
Quejas:
Si a usted le preocupa que se hayan violado sus derechos de privacidad, o si está en desacuerdo con una decisión que hayamos tomado respecto al acceso a su historial, puede comunicarse con nuestra Oficina de Privacidad (indicada más adelante).
Si no queda satisfecho con nuestra respuesta, puede enviar una queja escrita al Departamento de Salud y Servicios Humanos de los Estados Unidos, Oficina de Derechos Civiles [U.S. Department of Health and Human Services Office of Civil Rights]. Nuestra Oficina de Privacidad puede proporcionarle la dirección. Bajo ninguna circunstancia será sancionado o sufrirá represalias por presentar una queja.
Nombre del paciente en letra de imprenta:
No de récord médico del paciente:
Fecha de nacimiento del paciente:
Dirección del paciente:
Representante personal del paciente y vínculo:
Firma:
Fecha:
Si corresponde, motivo por el que el paciente rehusó firmar:
It is the policy of the Yale New Haven Health System to provide healthcare services in a manner that complies with all applicable federal and state laws. Such compliance is critical to the Health System's commitment to operating pursuant to the highest business, professional and ethical standards. In compliance with the Federal Deficit Reduction Act of 2005, YNHHS maintains a vigorous Compliance and Privacy Program and has implemented a system-wide policy regarding the detection and prevention of fraud, waste, abuse and misconduct.
We encourage you to call the Office of Corporate Compliance at 203-688-8416 or email us at [email protected] to discuss any potential compliance concerns. In addition, the Compliance Hotline is available to everyone 24 hours a day, seven days a week by calling 888-688-7744 or by visiting www.ynhhscomplianceprogramhotline.com
You can make a report either anonymously or by using your name. All reports received by either the Office of Privacy amp; Corporate Compliance or the Hotline are appropriately investigated.
The purpose of this policy is to inform employees, contractors, volunteers and agents of Yale New Haven Health System (YNHHS) of the federal False Claims Act (referenced in this policy as "FCA") the Federal Program Fraud Civil Remedies Act, the Connecticut False Claims Act (“CFCA”), and all other state False Claims Acts; to provide general information regarding YNHHS’s efforts to combat fraud, waste, and abuse; and to describe the remedies and fines for violations that can result from certain types of fraudulent activities.
In addition, this policy conforms to the Deficit Reduction Act (DRA) “Employee Education Provision” intended to bolster Medicaid fraud and abuse enforcement with the following:
This policy applies to YNHHS, and each of its affiliated entities, its affiliated hospitals (Bridgeport Hospital, Greenwich Hospital, Yale New Haven Hospital, Lawrence + Memorial Hospital, Westerly Hospital, and any other hospital that affiliates with YNHHS), its affiliated providers (including but not limited to Northeast Medical Group and Visiting Nurse Association of Southeastern Connecticut), and each of their subsidiary entities
All employees, contractors, agents, and volunteers of YNHHS must not create any false or misleading documents or financial or electronic records for any purpose. No one may instruct you to so.
All employees, contractors, agents, and volunteers of YNHHS must immediately report any suspicion of fraud, waste, or abuse in connection with the business of YNHHS to the Office of Privacy and Corporate Compliance. YNHHS engages in specific compliance efforts to detect and prevent fraud, waste, and abuse, such as the Corporate Compliance Program. It is the policy of YNHHS that an employee, contractor, or agent of YNHHS who knowingly and intentionally submits a false claim will be reported to the necessary authorities by the Office of Privacy and Corporate Compliance.
The identification of fraud, waste or abuse involving a particular Medicare Advantage organization will be reported to the Medicare Advantage organization to the extent required by law or pursuant to contract. If not provided by the Medicare Advantage organization, the form and manner of such report shall be determined by the Office of Privacy and Corporate Compliance in consultation with the Legal and Risk Services Department.
If you would like more information on the Corporate Compliance Program and specific compliance policies or on how to report any concerns, please contact the Office of Privacy and Corporate Compliance (203-688-8416). Compliance Policies may also be accessed via the YNHHS Intranet.
The Federal False Claims Act (FCA) imposes civil penalties on people and companies who knowingly submit a false claim or statement to a federally-funded program or otherwise conspire to defraud the government in order to receive payment. Failure to report and return overpayments from Medicare and Medicaid within certain timeframes might also constitute a violation of the FCA. The FCA also protects people who make efforts to stop the suspected fraud.
The FCA is not confined to healthcare claims, but extends to any payment requested of the federal government or the federal government’s contractor, grantee, or other party, if the payment is to be spent or used on the government’s behalf or to advance a government program or interest and the government provides any portion of the payment or will reimburse the contractor, grantee, or other party. The FCA applies to billing and claims sent from YNHHS to any government payor program, including Medicare and Medicaid.
It is the policy of YNHHS that an employee, contractor, or agent of YNHHS who knowingly and intentionally submits a false claim will be reported to the necessary authorities. Anyone or any company that submits a false claim or statement to the government may be fined under the FCA between $10,957 and $21,916 for each such claim submitted, regardless of the size of the false claim, and the person or company could be required to pay an additional fine of three times the value of any charges. Where a person who violated the FCA reports the violation to the government under certain conditions, the FCA provides that the person shall be liable for not less than double damages.
Part of the FCA's purpose is to create an environment where employees and others feel safe reporting concerns about fraud. Any person, who lawfully attempts to stop any FCA violations or reports information about false claims or suspected false claims that are submitted by others, may not be retaliated against, demoted, suspended, threatened, or harassed for such actions. The FCA also protects individuals who assist in an investigation, provide testimony, or participate in the government's handling of a false claim. Individuals have the right to FCA whistle blower protection from retaliation in any form as to the result of their whistle blowing.
These protections include reinstatement without loss of seniority if fired, recovery of two times lost wages plus interest and recovery of attorney fees and other reasonable costs in connection with pursuing retaliation claim. Confidentiality will be maintained to the extent possible. The FCA’s provisions are generally enforced by the U.S. Department of Justice. The FCA provides that an individual may initiate a formal claim under certain circumstances. If any funds are recovered, a portion of the funds may be paid to the person who initiated the formal claim, at the discretion of a federal court. This amount, if awarded, generally is between 15% and 30% of the total damage amount.
If a person wishes to file a claim regarding fraud or suspected fraud related to a healthcare payment directly with the government, he or she must first present a formal complaint, along with all material evidence relating to the alleged fraud, to the authorities at the U.S. Department of Justice. The authorities have 60 days to investigate, during which time the complaint is kept confidential. Upon completion of the investigation, the government will decide either to pursue the case on its own or decline to proceed with the case. If the federal government declines the case, the individual may still proceed with the case on his or her own, but without the government's assistance, and at his or her own expense.
A private legal action under the FCA must be brought within six years from the date that the false claim was submitted to the government. (A government-initiated claim may be brought up to ten years after the false claim, depending on the circumstances.)
Persons or companies that commit fraud on the federal government, by false claim or statement, can be assessed monetary penalties in addition to the penalties of the False Claims Act because of a law called the Program Fraud Civil Remedies Act (referenced in this policy as "PFCRA"). Specifically, PFCRA penalties of $5,000 per false claim or statement apply if a person or company submits a claim to the federal government that: the person or company knows or has reason to know is false, fictitious, or fraudulent; includes or is supported by written statements containing false, fictitious, or fraudulent information; includes or is supported by written statements that omit a material fact, which causes the statements to be false, fictitious, or fraudulent and the person submitting the statement has a duty to include the omitted fact; or is for payment of property or services that are not provided as claimed.
The $5,000 penalty also applies if a person or company provides written back-up or materials relating to the claim in which the person or company asserts a material fact that is false, fictitious, or fraudulent; or omits a fact that the individual had a duty to include, the omission causes the statement to be false, fictitious, or fraudulent, and the statement contains a certification of accuracy.
In 2009, the Connecticut General Assembly enacted the Connecticut False Claims Act (“CFCA”). The CFCA is very similar to the FCA and prohibits any individual or entity from knowingly presenting or causing to be presented a false or fraudulent claim for payment or approval under the medical assistance programs administered by the Connecticut Department of Social Services or knowingly making or causing to be made a false statement in order to get such a claim approved, or knowingly concealing, avoiding, or decreasing any obligation to pay or transmit money or property to the state. Any individual or entity that violates this prohibition can be subjected to civil monetary penalties of $5,000 to $10,000 per violation as well as up to three times the damages sustained by the state as a result of the false claim.
The CFCA provisions are generally enforced by the Connecticut Attorney General. However, like the FCA, under certain circumstances, the CFCA permits private individuals to initiate civil actions and protects these individuals from workplace retaliation. If any funds are recovered, a portion of the funds may be paid to the person who initiated the formal claim, at the discretion of a court. This amount, if awarded, general is between 15% and 30% of the total damage amount. A legal action under the CFCA cannot be initiated more than six years after the date the violation occurs or more than three years after the date when a state official knew or should have reasonably known the violation, but in no event more than ten years after the date that the violation occurs.
In addition, there are also other Connecticut laws that prohibit fraudulent billing. It is a crime in Connecticut to fraudulently bill Medicaid or general assistance programs. All employees, contractors, and agents of YNHHS must immediately report suspicion of any criminal activity, including criminal fraud, to the System Compliance Operations Officer.
Anyone who provides services to a state Medicaid beneficiary and seeks or accepts payment for unnecessary or improper services is subject to possible imprisonment and/or criminal fines under state law. Depending upon the extent of the fraudulent services involved, such offenses carry potentially significant penalties, with a maximum of 20 years in prison and a maximum fine of $15,000.
Anyone who provides services to a recipient of Connecticut's general assistance program and seeks or accepts payment for unnecessary or improper services is also subject to civil and criminal penalties. Depending upon the amount of the fraudulent services involved, such offenses carry a minimum one-year prison sentence and a maximum of 20 years, as well as a maximum fine of $15,000. Any person who defrauds Connecticut's general assistance program is also excluded from participating in the program for a minimum of one year.
Connecticut law protects employees who report suspected violations of state or federal law, including reports of criminal fraud. An employer may not discharge, discipline, or otherwise penalize an employee for reporting a violation of the law, or suspected violation, as long as the employee does not know the information being reported is false.
Additionally, other state laws inclusive of New York, New Jersey, Massachusetts and Rhode Island will be reviewed as required for compliance purposes.
YNHHS is dedicated to creating an environment where employees and others feel safe reporting concerns about fraud. YNHHS shall not unlawfully retaliate against individuals who: lawfully attempt to stop fraudulent billing practices or violations of the FCA, CFCA, or any other federal or state law or regulation regarding false or fraudulent claims; report information about false claims or suspected false claims that are submitted by YNHHS; or assist in any investigation, provides testimony, or participate in the government’s handling of a false claim investigation.
Approved 4/17/2020
Yale New Haven Health System Supply Chain Management staff is focused on working with vendors to deliver high-quality supplies, services and equipment, at the lowest total cost.
All patients and visitors at Yale New Haven Health and its member organizations have the right to receive information in a language they understand, free of charge. YNHHS complies with the Department of Health and Human Services' Section 1557 rule of the Affordable Care Act — which sets guidelines about language assistance for people with limited English proficiency or those who are deaf or hard-of-hearing — and takes reasonable steps to provide meaningful access to people with limited English proficiency who may require assistance within the health system.
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Discrimination is against the law
Yale New Haven Health complies with applicable civil rights laws and does not discriminate against, exclude or treat people differently on the basis of race, color, national origin, age, disability or sex.
Yale New Haven Health:
If you need reasonable modifications, auxiliary aids and services or language assistance services, contact the Civil Rights/ADA coordinator in Patient Relations at 203-688-3430.
If you believe that Yale New Haven Health has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with: Civil Rights/ADA coordinator, Patient Relations, Yale New Haven Health, 20 York Street, New Haven, CT 06510; 203-688-3430; Fax 203-688-1667; [email protected]. You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Patient Relations can help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at:
Complaint forms are available at
www.hhs.gov/ocr/office/file/index.html
(Policy updated 10/24/2024)
