Purpose of our Code of Business Conduct
Our Code of Business Conduct provides guidance to directors, officers, physicians, and other employees of Pioneer Medical Center (PMC), as well as the general public and those with whom Pioneer Medical Center does business, regarding Pioneer Medical Center’s standards and rules of ethical business conduct. The Code of Business Conduct is an integral part of our overall Compliance Program, which we rely on to help comply with applicable laws and regulations.
The Code of Business Conduct reflects Pioneer Medical Center’s commitment to its stated Mission, Vision, and Values. Pioneer Medical Center has always valued and been committed to the highest standards of integrity, accountability and legality.
Conflicts of Interest and Outside Activities:
Pioneer Medical Center employees should avoid situations where their personal interests could conflict, or reasonably appear to conflict, with the interests of Pioneer Medical Center. An example of a conflict of interest is any opportunity for personal gain apart from the normal compensation provided through employment.
Personal Financial Gain – Employees should avoid outside financial interests that might influence their decisions or actions as Pioneer Medical Center employees. Such interests might include, among other things:
Outside Activities – Employees should avoid outside employment or activities that would have a negative impact on the performance of their job, conflict with their obligations to Pioneer Medical Center or negatively impact Pioneer Medical Center’s reputation in the community.
Pioneer Medical Center recognizes that some employees may have financial interests in organizations that do business with Pioneer Medical Center. Some employees will either work for other health care organizations in this community or have a spouse or close relative who does. The Code does not mean that an employee is prohibited from having outside interests, including financial ones, in other health care organizations or businesses that do business with Pioneer Medical Center. What it does mean is that employees who have outside financial interests that could conflict with Pioneer Medical Center’s interests must be especially vigilant in making certain those interests never affect their judgment or behavior in a way that is inconsistent with their responsibilities to patients, colleagues and Pioneer Medical Center. If you are in a situation where there is or could be the appearance of a conflict that might affect your judgment, you should discuss it with your manager, Compliance Officer or CEO.
Members of the Pioneer Medical Center governing boards and committees are subject to the conflict of interest policy required of tax exempt organizations by the IRS.
Avoidance of Fraud and Abuse:
Pioneer Medical Center is strongly committed to detecting and preventing fraud, waste, and abuse. To this end, PMC has adopted an active corporate compliance program and this Code of Business Conduct. The PMC compliance program requires compliance with both legal requirements and applicable ethical standards.
False Claims Act
The Federal False Claims Act and state false claims acts establish liability for any person who knowingly presents or causes to be presented a false or fraudulent claim for payment for the U.S. government or state or local government. False claims laws do this by making it possible for the government to bring civil actions to recover damages and penalties when false claims are submitted. These laws often permit “qui tam” or “whistleblower” actions, which are lawsuits brought by private parties on behalf of the government. The federal False Claims Act (“FCA”) provides, in pertinent part, that:
Any person who knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval; or who knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim or who conspires do the same … or who knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government, is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461note; Public Law 104–4101), plus 3 times the amount of damages which the Government sustains because of the act of that person. 31USC 3729.
Montana’s false claims act contains similar provisions. (MCA 17-8-403). Wyoming currently does not have a state false claims act.
To encourage individuals to come forward and report misconduct involving false claims, the federal and many state False Claims Acts include a “qui tam” or whistleblower provision. This provision allows individuals with knowledge of false claims to report concerns or file lawsuits on behalf of the government as well as themselves. Employees cannot be retaliated against for filing a whistleblower action.
All Pioneer Medical Center workforce members should be familiar with and comply with the requirements of the Pioneer Medical Center Corporate Compliance Program, which focuses on fraud and abuse and the False Claims Acts.
Avoidance of behavior that could constitute fraud or abuse is imperative. In Pioneer Medical Center’s relations with all payers, including Medicare and Medicaid, Pioneer Medical Center’s policy is to deal legally and honestly with all requirements, including those related to billing, documentation, coding, marketing, and self-referral prohibitions. Each employee should understand the laws and rules related to his or her area of responsibility and comply with those laws.
• Billing for services that were never performed, billing for duplicate services, or billing for substandard care are examples of potential fraud and abuse.
• Accepting gifts from vendors or giving anything of value to those who refer services to Pioneer Medical Center are also examples of potential violations of federal and state regulations.
• Pricing services below cost in order to induce business, inconsistent charging of services, and giving away free services can raise fraud and abuse concerns as well.
“Our lives begin to end the day we become silent about things that matter.”
– Martin Luther King, Jr., I Have a Dream: Writings and Speeches that Changed the World
Exclusion from Participation in Federal Health Care Programs:
Pioneer Medical Center is prohibited from employing or contracting with any individual or entity excluded by the Office of Inspector General (OIG) from participation in Federal health care programs. This responsibility requires screening of all current and prospective employees and contractors against the OIG’s List of Excluded Individuals and Entities.
If you, as a Pioneer Medical Center workforce member or contractor, have reason to believe you are included on the OIG’s List of Excluded Individuals and Entities, it is your responsibility to immediately report your status to Pioneer Medical Center.
Use of Pioneer Medical Center Funds and Assets:
Pioneer Medical Center’s assets are to be used solely for the benefit of the Pioneer Medical Center. Assets are much more than equipment, inventory, funds and office supplies. Assets also include medical records, email, internet and intranet connections, concepts, business strategies and plans, financial data, intellectual property rights and other information about Pioneer Medical Center’s activities. Workforce members or others may not use Pioneer Medical Center assets for personal gain. For example, workforce members are prohibited from using Pioneer Medical Center assets to promote their home business. This includes use of Pioneer Medical Center equipment, supplies, computers, postage, copiers, email, letterhead and use of the Pioneer Medical Center brand or brand name. If property no longer needed by Pioneer Medical Center is sold to workforce members, such sales must be documented and approved by an appropriate authority other than the employee making the purchase. Further information on property disposal, including specific procedures, can be found in our other administrative policies.
Marketing and Public Relations:
Pioneer Medical Center respects the rights and needs of our patients and the community to receive accurate, honest and helpful communications about health care. The marketing and public relations staff will ensure that all communications fairly and accurately reflect Pioneer Medical Center in all aspects. Communications will be responsive and sensitive to the diversity of people Pioneer Medical Center serves and will not promote unnecessary services or services that have not been shown to be efficacious. Pioneer Medical Center shall adhere to all laws governing the marketing of health care services.
Patient Rights and Responsibilities:
Pioneer Medical Center recognizes and respects the rights of each patient and is committed to assuring and protecting patient rights at all times. Pioneer Medical Center expects our patients, their family, and guests to respond and react in a reasonable and responsible manner.
Pioneer Medical Center assists our patients by providing information that includes Patient Rights and Responsibilities and safety information either upon hospital admission or at the patient’s initial clinic visit.
Please refer to Pioneer Medical Center’s Patient Rights and Responsibilities
for additional information.
Confidential Business Information and Trade Secrets:
All workforce members must safeguard Pioneer Medical Center’s confidential information and trade secrets. Workforce members must also refuse any improper access to confidential information and trade secrets of any other company, including our competitors.
Pioneer Medical Center’s basic confidential information and trade secret guidelines are:
• Any proprietary information about Pioneer Medical Center or our business partners should be disclosed with others within Pioneer Medical Center or externally only on a need-to-know basis. An example would be information regarding new services or building projects.
• Any disclosure of proprietary information to any outside persons should be done only in conjunction with appropriate trade secret or confidential information disclosure agreements.
• All workforce members must be cautious about inadvertently disclosing confidential information, trade secrets or patient information in either social conversations or in normal business relations.
Confidential and trade secret information includes any information that is not generally disclosed to the public, which is useful or helpful to Pioneer Medical Center and/or which would be useful or helpful to Pioneer Medical Center’s competitors. Common examples include financial data, planned new projects, information about areas where Pioneer Medical Center intends to expand, wage and salary data, employee information, capital investment plans, projected earnings, information about suppliers and customers and changes in management or policies of Pioneer Medical Center.
Patient Privacy:
Patient protected health information must be kept confidential in accordance with Pioneer Medical Center policies and applicable laws. Violations of Pioneer Medical Center patient privacy policies, federal privacy regulations, and state privacy laws must be reported to the Pioneer Medical Center Privacy Officer for resolution.
• Information regarding patients, visitors, or workforce members of Pioneer Medical Center is considered to be private protected health information. Even a patient’s office appointment or a phone call note regarding scheduling an appointment must be safeguarded. Workforce members, physicians, and vendors who do business with Pioneer Medical Center cannot share information that was obtained appropriately or incidentally while performing work on behalf of Pioneer Medical Center.
• Information in our computer systems is intended for the sole purpose of treating our patients or managing the business of Pioneer Medical Center. This information should not be shared with those who are not authorized to have access to the information or who do not have a need to know the information in order to perform work on behalf of Pioneer Medical Center.
• Even though your family members may seek services at Pioneer Medical Center, it is still their right to keep this information confidential from you and others. Do not assume that you have a right to access information related to your friends’ and family members’ care.
• It is not appropriate to access electronic or other protected patient information out of curiosity. Information should only be accessed for work-related purposes. Then, only the minimum amount of information necessary to perform work-related duties should be accessed.
Patients count on us. Conducting business with integrity enhances our quality of care.
Anti-kickback and Self-referral: Dealing with Referring Providers, Suppliers and Patients:
Pioneer Medical Center and its workforce members must comply with federal and state laws regarding relationships with referral sources, product and service suppliers, and patients. The following guidelines are intended to help all workforce members avoid fraud, abuse, and self-referral issues.
• “Kickbacks” and Rebates – Workforce members or their families must not offer, receive, solicit, or pay anything of value in exchange for the purchase or sale of goods or services at Pioneer Medical Center or for referrals. “Kickbacks or rebates” can take many forms and are not limited to direct cash payments or credits. In general, if a workforce member or family member stands to gain personally from a transaction, that transaction is suspect and should be discussed with the Corporate Compliance Officer or CEO. Such practices may not only be unethical but are, in many cases, illegal.
• Reciprocity - In many circumstances, Pioneer Medical Center purchases goods or services from a supplier who also buys goods or services from Pioneer Medical Center. This practice is normal and acceptable, but any form of pressure for reciprocity with that supplier is not. Pioneer Medical Center workforce members must never ask a supplier to buy or use Pioneer Medical Center products or services in order to become or continue to be a Pioneer Medical Center supplier. Any and all payments between parties in a position to refer to each other or generate business for each other must be at fair market value and meet other requirements as directed by legal counsel and Pioneer Medical Center policies.
• Gifts or Gratuities from Patients – Workforce members may not accept money or other items of value from patients.
• Financial Relationships with Referral Sources – Any arrangements that involve payment in cash or in kind between Pioneer Medical Center and a physician or other individual who may be in a position to refer to Pioneer Medical Center must be in writing and approved by the CEO.
• Gifts or Gratuities from Businesses – Workforce members may not accept gifts of money or other items of value from suppliers or other companies or individuals doing or seeking to do business with Pioneer Medical Center under any circumstances. Also, workforce members may not solicit or accept non-monetary gifts, gratuities or any other personal benefit or favor from such businesses. Workforce members and members of their immediate families may accept unsolicited, non-monetary gifts from a business or individual doing or seeking to do business with Pioneer Medical Center only if the gift is of nominal value or the gift is primarily of an advertising or promotional nature. Gifts of greater value may be accepted if protocol, courtesy or other special circumstances exist. The Corporate Compliance Officer, in collaboration with the Human Resources and CEO, will determine if gifts may be kept, if they should be returned, or if they become Pioneer Medical Center’s property. Workforce members are required to disclose all such gifts to the Corporate Compliance department.
• Entertainment by Businesses – Workforce members may not encourage or solicit entertainment from any individual or company with whom Pioneer Medical Center does business. Offering or accepting entertainment, which is not a reasonable adjunct to a business relationship, but is primarily intended to gain favor or influence, should be avoided.
• Payment to Agents, Representatives, or Outside Consultants –
Agreements with agents, sales representatives or outside consultants must be reasonable in amount, not excessive in light of trade practices and reasonably equal to the value of the services rendered. These arrangements should be in writing and reviewed by the CEO prior to the beginning of services.
• Payments to Government Employees – No payments of money, gifts, services, entertainment or anything of value may be offered or made available in any amount, directly or indirectly, to any government official or employee.
• Other Improper Payments – The use of Pioneer Medical Center funds or assets for any unlawful or unethical purpose is prohibited. Any payment that is improper when made by a Pioneer Medical Center workforce member is likewise improper if made by a commission agent, consultant or other third party on behalf of Pioneer Medical Center if the Pioneer Medical Center workforce members know or have reason to know that a payment will be made. The making of any payment to a third party for any purpose other than that disclosed on the payment documentation is prohibited.
• Business Travel – Pioneer Medical Center workforce members who travel at the expense of a vendor must report this travel in advance for approval according to Pioneer Medical Center’s travel approval process. Pioneer Medical Center workforce members should not choose travel locations for personal preference and should not solicit vendors to pay for travel that is not necessary for conducting Pioneer Medical Center business.
All Pioneer Medical Center workforce members who obtain information that reasonably leads to the belief or suspicion that there has been a violation of law or of Pioneer Medical Center’s compliance program are required to promptly report the issue to the Pioneer Medical Center Corporate Compliance Officer and to provide requested information related to the suspected incident. All workforce members are also expected to cooperate with the Corporate Compliance Officer in any audit or investigation related to compliance matters. Pioneer Medical Center strictly prohibits any form of retaliatory conduct or action against any employee or workforce member who reports any compliance violation or concern.
“Always do what is right. It will gratify half of mankind and astound the other.”
- Mark Twain
Expert Testimony:
Physicians and other health care providers are prohibited from serving as expert witnesses if their testimony could conflict with the interests of Pioneer Medical Center or if payment for expert witness testimony could appear to influence the physician’s or provider’s decision-making. Individuals must report this action to Pioneer Medical Center’s CEO prior to actually providing expert testimony.
Business and Financial Information:
Falsification of Records – It is illegal and unethical to falsify records. State and Federal law requires Pioneer Medical Center to assure that its financial and business records accurately reflect the true nature of the transactions represented. While in rare circumstances to protect the identity of a patient, Pioneer Medical Center may agree to use an alias instead of the patient’s true name, it is against Pioneer Medical Center policy, and possibly illegal, for any workforce members to knowingly cause our records to be inaccurate. Examples include making records appear as though payments were made to one person when, in fact, they were made to another; or submitting expense accounts which do not accurately reflect the true nature of the expense. False or artificial entries must never be made in Pioneer Medical Center records, or in any public record, for any reason. Permanent entries in Pioneer Medical Center records should not be altered in any way. No payment or receipt on behalf of Pioneer Medical Center may be approved or made with the intention or understanding that any part of the payment or receipt will be used for a purpose other than that described in the documents supporting the transaction. “Slush funds” or similar off-book accounts, where there is no accounting for receipts or expenditures on corporate books, are strictly prohibited. Workforce members must not create or participate in the creation of any records which are intended to mislead or to conceal anything that is improper.
Retention of Records – Disposal or destruction of Pioneer Medical Center’s records and files is not discretionary. Legal and regulatory practice requires the retention of certain records for various periods of time, particularly in the tax, workforce members, health and safety, environmental, contract and corporate areas. In addition, when litigation or a government investigation or audit is pending, relevant records must not be destroyed until the matter is closed. Destruction of records to avoid disclosure in a legal proceeding may constitute a criminal offense.
Refer to Pioneer Medical Center’s Documentation Retention Policy for additional information on retention periods and restrictions.
Political Activities and Contributions:
Pioneer Medical Center encourages all workforce members to vote and be informed about political issues and candidates. However, federal laws and many state laws restrict the use of corporate funds in connection with elections. Accordingly, it is against Pioneer Medical Center policy, and may also be illegal, for workforce members to:
• Include, directly or indirectly, any political contribution on your expense account or in any other way, which causes Pioneer Medical Center to reimburse you for that expense. In general, the cost of fundraising tickets for political functions is considered a political contribution. Therefore, including the cost of such a fundraising dinner on an expense account, even if business is discussed, is against Pioneer Medical Center policy and possibly illegal.
• Endorse individual candidates in any elections on behalf of Pioneer Medical Center.
• Use any Pioneer Medical Center property or facilities, or time of any Pioneer Medical Center workforce members, for any political activity. Examples of prohibited conduct include using secretarial time to send invitations for political fundraising events, using a Pioneer Medical Center telephone to make politically motivated solicitations, allowing any candidate to use any Pioneer Medical Center facility (such as meeting rooms) for political campaigning or loaning any Pioneer Medical Center property to anyone for use in connection with a political campaign. The political process has become highly regulated. Anyone who has any question about what is or is not proper should consult with the Compliance Officer or CEO before agreeing to do anything that could be construed as involving Pioneer Medical Center in any political activity at either the federal, state or local level.
Safety, Health and Environment:
Environmental health and safety management are substantially more than compliance. Pioneer Medical Center is committed to providing a safe and healthful environment for all persons associated with Pioneer Medical Center including patients, workforce members, volunteers, visitors, and members of the communities we serve. To ensure vibrant communities, Pioneer Medical Center is equally committed to preventing the deterioration of the environment and minimizing the impact of our operations on environmental resources. These commitments are consistent with the Pioneer Medical Center’s vision.
The goal of the Environmental Health and Safety Management Program and its component subparts is to provide a safe, functional, supportive, and effective environment. Pioneer Medical Center emphasizes an integrated approach, as well as education and training focusing on safety as the primary means of achieving this goal. This is crucial to providing quality care services and achieving quality outcomes. These commitments can only be met through the awareness and cooperation of all workforce members. Pioneer Medical Center workforce members have a responsibility to abide by safe operating procedures, to guard their own health as well as that of others and to maintain and utilize pollution control systems. These efforts directly contribute to and support our obligations and commitment to being a socially responsible health care organization.
In the United States, regulatory agencies exist under federal, state, or local jurisdiction to ensure compliance with laws and regulations affecting safety, health and environmental protection. It is Pioneer Medical Center’s policy to comply with both the letter and spirit of the laws and regulations imposed by these agencies and to attempt to develop a cooperative attitude with inspection and enforcement workforce members. In keeping with this spirit, workforce members must report conditions that they perceive to be unsafe, unhealthy, or hazardous to the environment. Contact the Pioneer Medical Center Safety Office for assistance with safety, health, or environmental issues.
Employee Relations:
Pioneer Medical Center is committed to the principles of Equal Employment Opportunity. All policies and processes are designed toward achieving fair and equitable treatment of all employees and job applicants. Employees are encouraged to discuss any concerns they have in this regard with their immediate supervisor and/or Human Resources. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, creed, religion, national origin, gender, gender identity, sexual orientation, age, marital status, genetic information or disability.
The Powers and Fiduciary Duties of Directors and Officers:
Officers, directors and members of the governing boards and committees occupy a fiduciary relationship to Pioneer Medical Center and are required to exercise the utmost good faith and to exercise their powers solely in Pioneer Medical Center’s interests. When accepting a position on a governing board, an individual agrees to give diligent attention to its concerns and to be faithful and honest in the discharge of his or her duties. Board members are not expected to be infallible, but should act in good faith. Officers, members of the board of directors and members of the leadership council are charged with the general responsibility to oversee the business conduct and ethical standards of Pioneer Medical Center.
Measuring Program Effectiveness:
Pioneer Medical Center is committed to assessing the effectiveness of our Compliance Program. Responsible executives monitor the staff responsible for implementing the program and facilitate external audits as necessary to review specific compliance risks or the effectiveness of the program itself. Through these audits or program reviews we identify ways to improve our program, implement best practices, and ensure that our Mission, Vision, Values and Who We are, are adhered to.
Resources for Guidance and Reporting Concerns:
No Code of Business Conduct can cover all circumstances or anticipate every situation. Consequently, workforce members encountering situations not addressed specifically by this Code of Business Conduct should apply the overall philosophy and concepts of this Code to the situation – always following the path of honesty and integrity.
If questions still exist or if any employee wants to report or discuss a possible violation, he or she should use any of the following methods of communication:
It is the obligation of every Pioneer Medical Center employee to report honest concerns about potential violations of this Code. Pioneer Medical Center makes every effort to maintain, within the limits of the law, the confidentiality of the identity of any individual who reports concerns or possible misconduct. There will be no retribution for anyone who reports a concern in good faith. Anyone who deliberately makes false accusation with the purpose of harming or retaliating against another colleague is subject to discipline.
Conclusion:
This Code attempts to make Pioneer Medical Center’s expectations as clear as is reasonably possible for workforce members and others who do business with Pioneer Medical Center. Where an internal or external investigation identifies a violation, Pioneer Medical Center is committed to initiating a corrective action, including making prompt restitution of any overpayment amounts, notifying government agencies, taking disciplinary action, and implementing systemic changes to prevent a similar violation from recurring in the future.
Everyone at Pioneer Medical Center, and those with whom Pioneer Medical Center does business, are expected to comply with the standards contained in this Code, report possible violations to the Corporate Compliance Officer or Chief Executive Officer and assist in investigating any allegations of wrongdoing.