Code of Excellence: Our commitment to ethics and ... - Priority Health

Code of ExcellenceOur Commitment to Ethics and Integrity

To All Spectrum Health Employees, Physicians and Partners:Spectrum Health has become Michigan’s pre-eminent health system for a reason: We have values that guide all we do—compassion, accountability, integrity, respect, teamwork and excellence.Our mission—to improve the health of the communities we serve—demands the highest professional and ethical standardsfrom each one of us.Our Code of Excellence provides a reference for the way we conduct business at Spectrum Health. The Code’s values andpolicies can help every employee, every day, make the best decisions possible and provide exceptional experiences topatients, families and members.Spectrum Health’s reputation as a health care enterprise of integrity is one of our greatest assets. Our Code of Excellence willhelp us reach our goal of becoming the national leader for health.Sincerely,Richard C. BreonPresident & CEOCode of Excellence 2

Our Code of Excellence at a GlanceLiving by the Code4 8 12Excellence in Our Actions• We understand our responsibilities• We know what is required of us• We take responsibility for our work and actions• We understand the importance ofprofessionalism in our appearance and conduct• We seek guidance when we have questions• We raise concerns so that they can be addressed• We always do the right thing• We do not retaliate against others for doing theright thingExcellence in Our Reputation• We avoid conflicts of interest• We maintain professional qualifications• We uphold professional standards of conductExcellence in Our Relationships• We serve others respectfully• We protect the privacy and confidentiality ofpatients, residents and members and customers• We respect the rights of patients, residents andmembers and customers• We promote equal opportunities for a diversityof backgrounds, skills and perspectives• We protect information belonging to othermembers of our team• We provide a work environment free ofharassment• We follow good business practices withcontractors and suppliers• We are honest and accurate in ourmarketing materials• We uphold fair practices with our competitors• We protect the security of patient-member andbusiness-sensitive information18 22 24Excellence in Our Operations• We follow good business practices to avoidfraud, waste and abuse• We ensure that claims are coded, billed andprocessed accurately• We protect information from misuse orimproper access or disclosure• We record business information honestly,accurately, completely, timely and clearly• We monitor and audit activitiesExcellence in Our Environment• We protect the health and safety of others• We keep an alcohol and drug-free workenvironment• We properly handle and dispose of toxicand hazardous waste• We protect the environmentCode of ExcellenceAcknowledgement• We sign an acknowledgment that demonstratesour commitment to our Code of ExcellenceAppendix 26This Code of Excellence has been approved by the Spectrum Health System Board of Directors.For more information about the Code of Excellence, contact the organizational integrity and compliance department at 616.486.2430.Code of Excellence 3

Spotlighting …Excellence in Our Actions• We understand our responsibilities• We know what is required of us• We take responsibility for our work and actions• We understand the importance of professionalism in our appearance and conduct• We seek guidance when we have questions• We raise concerns so that they can be addressed• We always do the right thing• We do not retaliate against others for doing the right thingThe promise we make:To encourage and make it safe to speak up, disagree, share concerns, makesuggestions, question decisions, admit mistakes or near misses, and try new waysof doing things.To take time daily to praise people, listen carefully to their needs anddemonstrate our commitment.Code of Excellence 4

The reputation for excellence at Spectrum Health isbuilt on the hard work and responsible conduct of thethousands who have worked with and for us over manyyears. Each service we perform for a patient,* resident,member or customer, each contact we make with avendor or other outside party, each interaction we havewith a colleague is an opportunity to strengthen theexcellence of our actions.This Code of Excellence applies to Spectrum Healthemployees, physicians, providers, agents, contractors,independent contractors, sub-contractors, students,vendors and volunteers.*This code uses the term “patient” to apply also toresidents of Spectrum Health’s long-term care facilitiesand customers of Spectrum Health services.Being ResponsibleEach of us is expected to:• Promote the mission and values of Spectrum Health• Comply with all laws, regulations and applicableSpectrum Health policies and procedures• Seek guidance when unsure of the right course of action• Raise concerns and instances of actual or potentialethical or compliance issues• Provide assistance to management as requested, suchas participating in investigations related to potentialissues or wrongdoingIf we manage or supervise Spectrum Health staff andothers, we are expected to:• Set the right example regarding responsible conduct forthose who report to us as well as all others.• Ensure that employees attend educational sessions thathelp them understand their responsibilities, includingthose pertaining to ethics and compliance• Help create and maintain a culture within our workgroup that values responsible conduct and encouragesemployees to seek guidance and report concerns• Ensure that employees reporting to us comply with thiscode and related laws, rules and policies• Never sacrifice ethical and compliant behavior in thepursuit of business objectivesEnsuring Regulatory ComplianceHealth care and business operations in general aregoverned by various federal, state and local laws andregulations. These rules cover a wide array of activities,from how we deliver services to how we market and bill forthose services and conduct our daily work responsibilities.Everyone is expected to be knowledgeable about and followthese rules. Spectrum Health and responsible individualsmay be subject to significant penalties for violating them.Asking QuestionsIf you are unsure about what to do in a given situation,help is available. Pursuing the answer to a question ingood faith is always the right thing to do. Discussingthe matter with a manager up line, human resources,the legal department or integrity and compliancedepartments is encouraged. These are people who canhelp determine the most appropriate action.Using ResourcesA wealth of resources exists to assist with questionsand concerns:• Supervisor/Manager—Our principal resource is oursupervisors/managers. They are most familiar with ourwork duties and responsibilities.• Other members of the management team—Themanagement team, including the executive team and thelegal department, can provide guidance.• Human resources—Get help with all types of employeerelations issues, including fair employment, respectfultreatment and employee privacy issues.• Your entity’s integrity and compliance department.You can also contact the Integrity Help Line at877.319.0266 or spectrumhealth.alertline.com/gcs/welcome. This resource is available 24 hours a day,seven days a week. Calls are handled by a companyoutside of Spectrum Health that then refers theconfidential report to the integrity and compliancedepartment for follow-up or investigation. All contactsare treated confidentially, to the limit allowed by law.If you prefer, you can make an anonymous report.Providing as much information as possible will helpSpectrum Health review the validity of the report andinvestigate any potential misconduct.Code of Excellence 5

Spectrum Health Integrity Help Line 877.319.0266Priority Health Providers and Members Integrity and Compliance 800.560.7013Emailorganizationalintegrity@spectrumhealth.orgWebsitespectrumhealth.alertline.com/gcs/welcomeTo obtain the name and contact information of your entity’s integrity and compliance officer, visit the InSite directory on the organizationalintegrity and compliance department page.Spectrum Health contractors, medical staff physiciansand other members of the Spectrum Health team mayreport concerns and suspected misconduct to theIntegrity Help Line. These reports may also be madeanonymously.PoliciesPolicies are available for review on InSite in the QuickLinks section by selecting Policies and Procedures.Information regarding policy development is availableunder the Tools and Services tab under PolicyAdministration.Raising ConcernsWhen we raise concerns in good faith (with a sincerebelief in the truth of our report) about actual or potentialproblems or improper practices, we have an opportunityto improve everyone’s work environment. Concernsmay include actions of managers, colleagues, affiliatedphysicians, subcontractors, suppliers, contractors orothers who affect Spectrum Health operations. Managershelp resolve concerns or take them to someone who can.If it is too uncomfortable to speak to a manager, contacthuman resources, your legal department or your entity’sintegrity and compliance department, or call theIntegrity Help Line at 877.319.0266. You can alsoreport a concern through the Integrity Help Line website,spectrumhealth.alertline.com/gcs/welcome.If for some reason you are not satisfied with theinvestigation or the resolution of a matter that youreported, you should make a second report througha different channel. Taking this extra step will helpensure that your concern is understood and thoroughlyinvestigated.Reporting your own misconduct, while not absolvingyou of responsibility, will be considered in addressingthe matter. While reporting concerns is encouraged,intentionally filing false reports will be considered causefor discipline, up to and including termination.Ensuring Non-retaliationRetaliation against anyone seeking help or raising a concernof suspected misconduct in good faith is not permitted.Spectrum Health will discipline anyone found to haveengaged in retaliatory actions, including harassment. Ifyou think that you have been retaliated against or suspectretaliation against someone else, you should report thismatter to the integrity and compliance officer or theIntegrity Help Line. All instances will be investigated, anddisciplinary action will be taken as appropriate. See thenon-retaliation policy on InSite for more information.Code of Excellence 6

Q. My boss and co-worker are friends outsideof work, and it is really hard to report concernsbecause of that. When I found my co-worker lookingin personnel files, I voiced my concerns to myboss about this issue. I think my boss is retaliatingagainst me, because a few days later, my job dutieschanged. What do I do?A. We always recommend that you try to talk withyour manager first, but if you are too uncomfortable,we urge you to contact any of the following to helpresolve the concern: Human resources, your entity’sintegrity and compliance department, the systemorganizational integrity and compliance department,or the Integrity Help Line at 877.319.0266 orspectrumhealth.alertline.com/gcs/welcome. We takeour commitment to our Code very seriously, and thatincludes providing a retaliation-free workplace.Q. If I report a concern, will I get in trouble?A. No. You will not be reprimanded or subject todiscipline if you suspect and report in good faiththat something is wrong. As a Spectrum Healthteam member, you have a duty to report any knownor suspected compliance or ethical concerns. If youhave knowledge of a problem and fail to speak up,you have not met your obligation under this Code.Correcting ProblemsSpectrum Health will conduct an investigation ofsuspected errors and reported misconduct. If an issueis verified, we will take corrective action, including:• Identifying the root cause of the issue and makingchanges to help avoid future occurrences• Informing applicable government authorities• Making restitution to affected parties• Reporting and returning overpayments without delay,generally within 60 days (in collaboration with theintegrity and compliance department)• Disciplining violators if a blatant or intentional violationof rules has taken placeIndividuals with a specific need to know will be advisedof the investigation’s outcome. If appropriate disciplinaryactions for responsible individuals are required, they mayinclude suspension, restitution or, in more extreme cases,termination and referral for government investigation. Seethe Performance Correction and Internal Review policy onInSite for more information.This Code of Excellence is not an employment contract.It does not contain all requirements; for additional guidance,consult related policies. We expect to periodicallymodify this code so that it remains relevant to SpectrumHealth activities. The most recent version of the code isposted on InSite under Policies and Procedures.Waivers and ExceptionsWaivers or exceptions to this Code of Excellence areuncommon. Any waivers always will be in keeping withthe spirit of the code’s standards. Exceptions to this coderequire the written approval of the President & CEO ofSpectrum Health System, or his/her designee.Code of Excellence 7

Spotlighting …Excellence in Our Reputation• We avoid conflicts of interest• We maintain professional qualifications• We uphold professional standards of conductThe promise we make:Excellence is not an endpoint or a way of distinguishing ourselvesas better than someone or something else. It is a journey, amindset and a process. It is a set of beliefs without limits thatguide us to be the best we can be. We take responsibility for ourwork and our work areas. We collaborate with others and weresolve concerns.Code of Excellence 8

Over many years, the employees and partners ofSpectrum Health have worked together to serve ourdiverse communities. Our combined efforts have earnedus a reputation for commitment to patient and memberhealth through quality service. We have earned thisreputation by our dedication to professional competenceand our loyalty to the Spectrum Health mission. We willsustain our excellent reputation through ongoing vigilancein the services we provide.Conflicts of InterestWe are committed to managing potential conflicts beforethey arise. Preventing and/or managing conflicts of interestprovides patients and others who depend on SpectrumHealth the excellent health care and business environmentthey deserve. Conflicts of interest are unavoidable in somesituations. Conflicts can be managed through full disclosureand lack of involvement in Spectrum Health decisionsrelated to the conflict of interest. These conflicts aredescribed below and in more detail in applicableSpectrum Health policies.A conflict of interest occurs when a personal interestactually interferes, or may be perceived to interfere,with our ability to make decisions that are in the bestinterests of Spectrum Health, our patients and members.A personal interest also may become a conflict of interestwhen it benefits a competitor of Spectrum Health ordisrupts our work responsibilities.Conflicts may arise that involve you or a member of yourfamily. Examples include, but are not limited to:Outside personal activities—A relationship with anotherorganization, such as a Spectrum Health supplier,customer, provider, business partner or competitor.Outside professional activities—Professional activitiesoutside your Spectrum Health role if these activitiesinvolve using your professional expertise for anotherorganization/service or cause, such as:• Employment/service with or consulting for acompetitor/supplier• Acceptance of sponsorship by a supplier• Unauthorized attendance at a supplier education meeting• Unauthorized participation in vendor surveys• Service on a supplier panel• Service as a board member for an organization thatmay create a potential conflict of interestQ. My spouse manages a training and consultingfirm. Can he or she submit a proposal to mydepartment at Spectrum Health to become a vendor?A. Generally yes, but before any proposal issubmitted, report this relationship to your managerand by completing a Conflict of Interest Disclosure(see below section entitled “Disclosure of PotentialConflicts of Interest”). This report will resultin a management plan that removes you fromparticipating in any discussions or decisions relatedto the proposal.If you think a situation might create a conflict ofinterest, ask yourself the following questions:• Would others think this might affect how I do my job?• Could it affect any decision I might make at work?• Will I or someone in my family gain anythingfrom my relationship with the third party doingbusiness with Spectrum Health?• Do I feel under any obligation because of myrelationship with the third party doing businesswith Spectrum Health?• Would I be embarrassed if anyone inside or outsideSpectrum Health knew about the situation?• How might the situation look to customers orsuppliers? Would they question whether theyhave been treated fairly?• Does the relationship benefit a competitor of anySpectrum Health entity?If the answer to any of the above questions is yes oreven perhaps, you may have a conflict of interest todisclose and discuss with others.Financial interests in Spectrum Health’s businesspartners or competitors, especially when there is apotential to benefit financially at the expense ofSpectrum HealthBusiness opportunities that you learn about in yourwork for Spectrum Health or that may compete with anySpectrum Health businessFamily and friends—Relationships with family membersor close friends, such as personally recruiting, workingwith or conducting Spectrum Health business with them,or serving them as patients or membersSolicitation—Soliciting colleagues or others while at workfor outside business or other personal interestsCode of Excellence 9

Distribution—Distributing or posting materials for anoutside organization or causePolitical activities and contributions—Participation orintervention in any election campaign in support of or inopposition to a candidate for local, state or national publicoffice, in a manner that is perceived as being on behalf ofSpectrum Health or in any employee’s official capacity.Lobbying activities regarding public policy positions alsoshould be done in consultation with the Spectrum HealthGovernment Affairs department or community relations.Disclosure of Potential Conflictsof InterestIf you or your manager feels that you have a potentialconflict of interest, fill out a Conflict of Interest Disclosureto report the relationship.Step 1: Remove yourself from participating in anydiscussions or decisions in the matter until submissionand review have been completed.Step 2: Contact Spectrum Health’s conflicts of interestcoordinator by sending an email to conflictsofinterest@spectrumhealth.org or calling 616.391.8165. Submit yourcontact information and you will receive instruction andaccess to the questionnaire process.Step 3: You will receive an email with a link to the currentconflicts of interest questionnaire to be completed uponreceipt.Step 4: Once submitted, the matter will be reviewed byyour entity’s conflict of interest committee in consultationwith integrity and compliance and/or legal departments.If you face a potential conflict, you need to discuss thematter with a manager, the legal department or theorganizational integrity and compliance department.They can help you determine whether the situationshould be disclosed and, when appropriate, how tomanage it so that it does not become an actual conflict.All gifts, business courtesies and entertainment must belegal and part of ordinary business. We may never give orreceive cash. We are permitted to accept nominal, noncashgifts such as cards, candy or flowers. When patients,members, or their families, vendors or business partnersoffer a more substantial gift, we can refer them to theSpectrum Health Foundation. Other gifts and businesscourtesies may be acceptable if they meet SpectrumHealth policy. Managers should be immediately informedwhenever we are offered or we receive a gift that webelieve may violate our standards.Items given or received as gifts and business courtesiesmay need to be logged into the Gift Tracking databaseand include actual or estimated values. Refer to theGifts and Business Courtesies policy on InSite beforeaccepting or giving gifts.Search Spectrum Health policies for key words such asservice shortfalls, patient transportation assistance, lodgingassistance, free screenings and other free items offeredto patients, as these types of services are many timesentirely appropriate, with the correct safeguards in place.For more information contact integrity and complianceat 616.486.2430 or email organizationalintegrity@spectrumhealth.org.You must never promise, offer, provide or accept anythingof value if it can be perceived as a bribe, kickback orpayment intended to directly influence your judgment.An example of this could be using Spectrum Health’sservices or purchasing a vendor’s product. Somethingof value also can include non-monetary benefits, suchas in-kind services or favors. This includes providinganything to a government or political official or employeewith the intent to influence. You must never ask, solicit orsuggest to others that you would like to receive a businesscourtesy, gratuity or anything else of value.For information regarding approved and prohibited politicalactivities, see the Advocacy and Government Affairs policyon InSite.Gifts and Business CourtesiesAt times, you may exchange appropriate gifts and businesscourtesies with physicians, contractors, members, customersand suppliers/vendors. When this is done properly, thesegifts and business courtesies are acceptable. When doneimproperly, the exchange of gifts may put Spectrum Health’sreputation and legal interests at risk.Code of Excellence 10

Qualifications and ProfessionalStandardsWe serve our patients and members best when weare competent in our jobs. We maintain the higheststandards in accordance with various federal, state andlocal laws and regulations regarding health care. Wemaintain current certificates of need, licenses, permitsand accreditations. We also are expected to maintainprofessional standards applicable to our positions and tocomply with respective professional standards of conduct.Disclosure of Exclusion FromParticipationAny person (employee, medical staff, volunteer, student,contractor, vendor etc.) excluded from participatingin federally funded programs (Medicare/Medicaid/CHAMPUS, etc.) due to sanctions, loss of license,criminal activity etc., must immediately inform theorganizational integrity and compliance departmentof such exclusion by calling 616.486.2741 or emailingorganizationalintegrity@spectrumhealth.org.Code of Excellence 11

Spotlighting …Excellence in Our Relationships• We serve others respectfully• We protect the privacy and confidentiality of patients, residents, members and customers• We respect the rights of patients, residents, members and customers• We promote equal opportunities for a diversity of backgrounds, skills and perspectives• We protect information belonging to other members of our team• We provide a work environment free of harassment• We follow good business practices with contractors and suppliers/vendors• We are honest and accurate in our marketing materials• We uphold fair practices with our competitors• We protect the security of patient-member and business-sensitive informationCode of Excellence 12

Spectrum Health Values• Accountability• Compassion• Excellence• Integrity• Respect• TeamworkThe U.S. Health Insurance Portability and AccountabilityAct (HIPAA) places heavy restrictions on how healthcare organizations handle patient and member data,commonly called protected health information (PHI).When working or coming in contact with patient andmember data, we are responsible for knowing SpectrumHealth’s policies on how HIPAA applies. It is importantthat we follow these rules and related procedures.Our business is about people—our patients, members;physicians and other health care providers with whomwe collaborate; suppliers and other business partners;our surrounding communities; and our employees. Strongrelationships mean a strong Spectrum Health. We must allremain committed to excellence in our relationships.Serving Our Patients, Members,Families and CommunitiesOur mission is to improve the health of the communitieswe serve. In this effort, we treat everyone with respectand dignity. We do not discriminate based on race, color,gender, national origin, handicap, age, HIV status, maritalstatus, sexual or gender orientation, religious beliefs orsources of payment for care. Clinical care is always basedon a patient’s identified health care needs, not ona patient’s source of payment for that care.We strive to demonstrate quality in all clinical and nonclinicalcare and other health care operations. No jobis too big or too small. All aspects of what we do areinterdependent and affect the quality of care we provideto our community. Any possible failures in following thepolicies and procedures of Spectrum Health should becommunicated to the appropriate manager so that we canmaintain quality services.We strive to assure patients that they will be Involved inall aspects of their care. We obtain and confirm a patient’sinformed consent for treatment. As applicable, eachpatient or patient representative is provided with a clearexplanation of care, including:• Diagnosis• Treatment plan• Right to refuse or accept care• Care decision dilemmas• Estimates of treatment costs• Risks and benefits associated with availabletreatment optionsEnsuring Confidentiality and PrivacyWe are committed to ensuring and protecting theconfidentiality and privacy of our patients, membersand their representatives. Spectrum Health collectsinformation about a patient’s and member’s medicalcondition, history, medication and family illnesses toprovide the best possible care and health plan. Werespect the sensitive nature of this information anddo not release or discuss patient-specific informationwith others unless it is necessary to serve the patient,or as required by law, and with the patient’s permissionwhether during or after employment at Spectrum Health.Spectrum Health also provides an opportunity for patientsand members to resolve confidentiality complaints. If apatient or member clearly expresses a concern that hisor her privacy has been violated, we communicate theconcern to the appropriate integrity and compliance orprivacy area.We are expected to be knowledgeable about and complywith HIPAA privacy regulations. Our HIPAA policies andprocedures are available on InSite under Policies andProcedures, Departments, Privacy.Q. Does HIPAA apply to looking up my child’s orhusband’s lab results or claims using my work accessto Cerner, Epic or Facets? Can I look up my own labresults or claims?A. You may not look up your own or any familymember’s confidential medical information usingyour work access. You may access this informationvia appropriate methods, such as MyHealth, or byfilling out an authorization form available from healthinformation management or customer service.Social MediaWorking in the health care environment makes itunacceptable to share any information that involves apatient by word or image through social media. Doingso can lead to disciplinary action up to and includingtermination. See the Social Media policy on InSite formore information.Code of Excellence 13

Respecting Patient and MemberRights and ResponsibilitiesSpectrum Health accepts patients in compliance withapplicable laws. We provide the appropriate diagnosticand treatment services to all patients with emergentconditions, regardless of their ability to pay for health care.Spectrum Health makes Rights and Responsibilitiesinformation available to all patients in several forms.Each patient care area has Rights and Responsibilitiesposters with key information in both English and Spanish.Brochures and the Patient Handbook are available in bothlanguages with complete information. This information canalso be found on InSite under Policies and Procedures.Priority Health members have rights and responsibilities.Priority Health makes rights and responsibilitiesinformation available to all members in memberhandbooks and other appropriate documents. In addition,this information is also available at priorityhealth.com.Nurturing Relationships WithContractors and Suppliers/VendorsWe work with contractors and current and prospectivesuppliers to achieve the best outcomes for our patientsand members and to advance our mutual interests. Inworking with these parties, we are expected to act in arespectful, fair and reasonable manner, consistent with allapplicable laws and good business practices. We promotecompetitive bidding, when practical.We are expected to follow Spectrum Health policies,procedures and good business practices in sourceselection, negotiation and determination of contractawards and the administration of all purchasing activities.Our selection of subcontractors and suppliers is made onthe basis of objective criteria, including quality, technicalexcellence, price, delivery, adherence to schedules,service, maintenance of adequate sources of supply anda supplier’s ability to meet our needs—not on personalrelationships and friendships.Care must be taken when exchanging gifts and businesscourtesies with contractors and suppliers. Please see“Gifts and Business Courtesies” in the “Conflicts ofInterest” section on page 10.Building Relationships With ColleaguesExcellence in serving our community depends on how wellwe work together as colleagues. The more that we cantrust and rely upon each other, the better we can meet ourcommitment to improving the health of the communitieswe serve.We all must conduct ourselves in a manner thatensures the orderly and efficient operation ofbusiness and creates a safe and harmonious workenvironment. We follow these guidelines:• Behave in a manner consistent with SpectrumHealth Values• Demonstrate accountability• Keep commitments, communicate honestly anddirectly, and exemplify high ethical standards• Provide the highest-quality customer service• Strive for excellence in every situation• Treat others with dignity, respect, courtesyand care• Work cooperatively with others as part of a teamStrengthening Relationships WithPhysicians and Physician GroupsEspecially in the context of our Delivery System entities,Spectrum Health’s relationships with physicians andphysician groups must meet strict regulatory standards,including the provision of anything of value to physicians,their relatives, their group or their staff. This includespayment for services rendered, use of space, equipmentand staff time, and any other item that is provided byeither party. The legal department or integrity andcompliance can provide consultation prior to enteringinto such relationships.Key things to remember when interacting withphysicians:• Various laws and regulations, including the StarkLaw, regulate the way we work and interact withphysicians, physician groups and their staff that areemployed and/or not employed by Spectrum Health.• Any business arrangement between a SpectrumHealth Delivery System entity and physicians mustbe evaluated by legal counsel and/or the integrityand compliance department prior to commencingthe arrangement in order to ensure compliance withnumerous laws and regulations, such as providerbasedrules, tax-exempt status and other laws.Code of Excellence 14

Embracing Inclusion and DiversityA work environment thrives when it embraces peoplefrom a multitude of backgrounds, with differing skillsand a variety of perspectives. At Spectrum Health, wemake the effort to get to know, listen to and appreciatecolleagues and their contributions to Spectrum Health’smission. Diverse perspectives improve our effectiveness.We support diversity initiatives that foster anenvironment in which all are valued.Providing Equal EmploymentOpportunitiesOur employees provide Spectrum Health with a widecomplement of talents, contributing to workplace excellence.Spectrum Health is committed to providing an equalopportunity work environment where everyone is treatedwith fairness, dignity and respect. See the Equal EmploymentOpportunity policy on InSite for more information.As an affirmative action employer, we follow all laws,regulations and policies related to non-discrimination basedon age, race, gender, pregnancy, marital status, height,weight, color, religion, national origin, disability, childbirth,sexual orientation, U.S. military status, status as a disabledor Vietnam-era veteran or other legally protected category.This applies to all decisions regarding recruiting, hiring,compensation, evaluations, promotions, transfers, staffreductions, corrective action and terminations. SpectrumHealth makes reasonable accommodations for knownphysical and mental limitations of otherwise qualifiedindividuals with disabilities. See the Accommodations policyon InSite for more information.Maintaining Respectful TreatmentMutual respect allows all Spectrum Health employeesto do our best work in pursuit of our common mission.We expect our employees to be respectful of others;employees rightly should expect the same respectfrom colleagues. We do not tolerate harassment ofany employee, vendor, patient, member or visitor. Wenever engage in any degrading jokes, slurs, intimidation,derogatory comments or other inappropriate conduct,nor do we tolerate others who do so.Spectrum Health also prohibits any form of sexualharassment, including unwelcome sexual advancesor requests for sexual favors related to employmentdecisions. We do not engage in or tolerate verbal orphysical conduct of a sexual nature that may interferewith work performance or create an intimidating, hostileor offensive work environment. See the Harassment FreeWorkplace policy on InSite for more information.Types of harassment include:• Abuse• Conduct of a sexual, racial or other nature thatinterferes with an individual’s work performanceor creates an intimidating, hostile or offensivework environment• Display of offensive material• Offensive jokes• Threat of dismissal or loss of promotions basedon sex, race, age, color, national origin, disability,religion or sexual orientation• Threatened or actual violence• Unwanted physical contactPreventing Workplace ViolenceSpectrum Health will not tolerate any form of violence in theworkplace. This includes any threatened or actual violence,stalking, fighting, or injuring or attempting to injure others.In our commitment to a safe workplace, no firearms, otherweapons, explosive devices or other dangerous materials arepermitted on Spectrum Health premises.If any form of harassment or violence is observed orexperienced, it must be reported to a manager, humanresources or the integrity and compliance department.See the Harassment Free Workplace policy on InSite.Practicing Ethical Marketing andCommunicationsSpectrum Health’s communications to the market mustdemonstrate the same sense of responsibility that our internalcommunications do. To convey our dedication to excellencein service, we are committed to responsible marketing.Marketing and communications include:• Advertising• Community events and seminars• Data collection• Direct mail• Public relations• Publications• Web communicationsIn marketing and communications, we practice confidentiality,honesty, accuracy and decency. We do not exploit thesuffering of others in marketing materials. Permission mustalways be obtained from patients, family members, visitors,staff, contractors and physicians prior to the use of pictures,video, general information or identifying information in publicrelations activities.Code of Excellence 15

Participating in Fair CompetitionAntitrust laws are intended to promote fair and vigorouscompetition. These rules encourage us and other healthcare systems to continually strive to better serve ourpatients, members, customers and community. Whilewe compete to win patients and members, we alwaysdo so fairly. Fair competition rules cover a broad rangeof interactions with competitor health care systems,customers and suppliers that may otherwise reducecompetition.As Spectrum Health employees, we avoid discussions oragreements with employees or representatives of otherhealth care systems about costs, price setting, terms withsuppliers or customers, allocation of market share amongcompetitors, strategies or marketing plans.Likewise, Spectrum Health representatives are prohibitedfrom discussing or sharing with Priority Health currentand potential pricing, payment and contractingarrangement and strategies with other health plans.We must always consult with the legal departmentbefore providing any information in response to an oralor written inquiry concerning an antitrust matter. Also,it is important to avoid any conversation with a supplierthat may suggest an attempt to limit competition amongsuppliers. An example of this might be unilaterallyrefusing to do business with a certain supplier.If a competitor raises an inappropriate subject, you must:• End the conversation immediately• Request that your refusal to participate in theconversation be documented in the meeting minutes, ifyou are in a meeting• Notify legal counsel or the integrity and compliancedepartmentSpectrum Health employees must avoid discussingsensitive topics with competitors or suppliers, unless thediscussion is consistent with the advice of legal counsel.In addition, no one on behalf of Priority Health shalldiscuss or share with Spectrum Health representativesany Priority Health information related to its negotiatedrates with other providers, potential provider pricingstrategies or any of Priority Health’s individual strategiesregarding managed care contracting or dealings withother providers, or Priority Health’s strategic plans orplanned competitive initiatives with other providers.Code of Excellence 16

Handling outside inquiriesSpectrum Health wants to ensure that we provide truthful,accurate information to the news media, general public andothers who have an interest in our activities. We provideinformation to outside parties only if we are authorized to doso. If we receive a request from an outside party for SpectrumHealth business information, we need to check with thecommunications department before fulfilling the request.We can also refer the request directly to the communicationsdepartment. All inquiries from the news media should bedirected to the communications department.At Spectrum Health, we take seriously our responsibilityto the public through regulatory oversight. All regulatorycompliance inquiries should be coordinated with your entity’sintegrity and compliance department and legal counsel. Wemust provide complete, factual and accurate information aspart of regulatory requests, surveys and inspections. Duringsurveys and inspections, we are courteous and cooperative.We will provide governmental or external auditors withthe information to which they are entitled during a review,inspection or audit. We never fail to provide accurateinformation, and we must not obstruct, mislead or delayto provide information or records as requested. We mustnever conceal, destroy or alter documents, or make falseor misleading statements. We must not attempt to causeanother person to fail to provide accurate information orobstruct, mislead or delay the communication of informationor obstruct, mislead or delay the communication ofinformation or records relating to a possible violation.See also: “Ensuring Regulatory Compliance” on page 5.Code of Excellence 17

Spotlighting …Excellence in Our Operations• We follow good business practices to avoid fraud, waste and abuse• We ensure that claims are coded, billed and processed accurately• We protect information from misuse or improper access or disclosure• We record business information honestly, accurately, completely, timely and clearly• We monitor and audit activitiesThe promises we make:We contribute all we can to improving decisions, policies and actions by fullyexpressing opinions and disagreements, regardless of the level or position of theperson we need to address. We freely and promptly share information with thosewho need it.To hold people accountable to mutually agreed-upon goals and objectives,whenever we have a concern with the performance or behavior of others, wetake action to make sure the problem is addressed; first, by speaking directly andrespectfully with the person involved, and then if unsuccessful, by engaging thechain of command to resolve outstanding issues.As a nonprofit health care system, Spectrum Health has limited resources. We arecommitted to using our resources wisely. The health of our patients and membersdepends upon us being responsible guardians of our operations. Excellence inservice demands excellence in resources.Code of Excellence 18

Payment for ServicesSpectrum Health’s standard is to bill patients and thirdpartypayers only for medically necessary services. AllSpectrum Health entities are prohibited from “knowingly”presenting (or causing to be presented) a false orfraudulent claim for payment. Knowingly means havingactual knowledge of the false claim, acting in deliberateignorance of the truth, falsity of the information, or acting inreckless disregard of the truth or falsity of the information.We are also prohibited from knowingly making orusing (or causing to be made or used) a false recordor statement to get a false or fraudulent claim paid.Spectrum Health verifies that claims are submittedonly for services actually rendered. Our services arecoded and billed appropriately. We strive to ensure andmaintain complete and accurate documentation of thesemedical services and aim to collect the full amount ofco-payments and other deductibles where required bypayer agreements. Any overpayment from a governmenthealth care program must be reported and returnedwithout delay (usually within 60 days).Spectrum Health promotes patient and memberunderstanding of the cost of care and billing procedures.We attempt to answer questions and resolve disputesrelated to billing to the patient’s and payer’s satisfaction.Q. We are really driven by making budget andstaying on target. Sometimes that means we takeshortcuts to get the work done, but I think we maybe unintentionally breaking the rules. What shouldI do?A. Health care has many laws and regulations toensure that the highest quality of care is providedand that we are paid appropriately for theseservices. If you think there may be a problem, askingthe question is the right thing to do. You can goto your manager, speak with any member of themanagement team, call the organizational integrityand compliance department at 616.486.2430, orcontact the Integrity Help Line at 877.319.0266 orspectrumhealth.alertline.com/gcs/welcome.Q. We recently changed our work processes in thelab. During this time, we may have double-enteredsome of the charges. What do I do?A. Inform your manager of your concernimmediately. Timing is important, because if thereis an error, resolving it quickly will reduce potentialpenalties. You may be asked to coordinate withyour manager and the integrity and compliancedepartment to validate whether the charges wereactually entered twice.Q. I keep seeing physician claims that have nodocumentation to support the coding and charges.What do I do?A. Discuss your concerns with your managerand site billing specialist. We may need to offereducation or review the documentation further.Integrity and compliance is a resource as well.Q. We perform many procedures, but it seems thatsome of the patients do not need them. I’m not adoctor, but this does not feel right. What do I do?A. All the services that we provide must bemedically necessary. This is not only a requirementfor us to be paid, but is crucial to protect ourpatients and members from harm. If you suspectthat patients or members are receiving care that isnot necessary, contact your manager or integrityand compliance immediately.Code of Excellence 19

Conducting Scientific andClinical ResearchWe follow high ethical and legal standards in any researchperformed at Spectrum Health and by Spectrum Healthprofessionals in any setting. All such research must bepre-approved by the institutional review board (IRB).In keeping with good clinical practice and regulations,we ensure that Spectrum Health provides protectionsfor human subjects, including the use of the informedconsent process, where required. Participation in researchis voluntary, and a patient’s right of refusal is honored andrespected and does not impact or compromise accessto services. Spectrum Health also follows policies andregulations regarding animals used in research.In performing any aspect of research at Spectrum Health,we strive to maintain the highest ethical standards in allwritten and oral communications regarding research.We also comply with applicable state, federal and localresearch policies, regulations and guidelines. We adhereto research authorship, attribution and other intellectualproperty standards and related Spectrum Health policies.Spectrum Health does not tolerate research misconduct.Research misconduct includes, but is not limited to,falsifying, plagiarism or copying results from other studieswithout performing the research. Spectrum Health willfollow our misconduct policy and act promptly to addressand resolve any and all allegations.As in all accounting and financial record keeping, we mustsubmit only true, accurate and complete costs related toresearch grants and studies.Using Sensitive InformationHow we use business and proprietary informationimpacts our relationships with patients, members,suppliers and colleagues and the success of SpectrumHealth. When we use information entrusted to uscarefully and responsibly, we safeguard our assetsand reputation, and strengthen our relationships.Handling Business InformationConfidential and Other Non-public InformationWe must safeguard business and proprietary informationfrom improper disclosure, keep it stored in a safe location,share it only with colleagues and others who are authorizedto have it and dispose of it only according to applicableSpectrum Health procedures. See the Professional Conductpolicy on InSite for more information.Likewise, business partner/vendor information should behandled as carefully as all system information. When weaccept others’ business information, we must understandrestrictions regarding its use. Confidential informationshould be viewed or provided to others only with alegitimate business reason, and, if providing confidentialinformation to others, we must ensure that they understandand agree to maintain its confidentiality.Confidential information includes:• Patient and member information• Business practices• Customer lists• Clinical information• Contract terms• Employee data• Employee lists• Financial data• Information pertaining to affiliations• Marketing strategies and techniques• Pricing and cost data• Proprietary computer software• Research data• Strategic plans• Trade secretsRespecting Intellectual PropertyIntellectual property includes information protected bycopyrights, trademarks, service marks or patents andshould be safeguarded by using the appropriate symbol.The legal department should be notified if SpectrumHealth’s intellectual property is being used inappropriatelyor without permission.A trade secret is another form of intellectual property. Itsimproper disclosure could cause its owner financial harm.Spectrum Health’s trade secrets must be stored in a safelocation. Trade secrets cannot be shared with others whoare not specifically authorized to receive them. Likewise, wedo not accept others’ trade secrets without permission.Protecting Technology andCommunicationsAs technology improves the quality of the health careand other services that we deliver, it becomes increasinglyimportant that we protect Spectrum Health’s vitalelectronic media and other communication systems. Ourcommunication systems are intended for business use.Communications systems include:• Computers and computer system access• EmailCode of Excellence 20

• Internet access• Pagers• Mobile phones and personal digital assistants such assmartphones and tablets• Telephones• Voice mailConfidential information should only be sent throughemail (or via the Internet) when it Is encrypted or securedIn a manner acceptable to the information security officer.We enjoy limited personal use of these systems in accordancewith Spectrum Health policy. These communicationsare not private and may be monitored by SpectrumHealth as part of any normal communications monitoringprocedures. Abuse of this privilege may lead to its lossand further corrective action.Q. A new co-worker does not yet have access toa network application needed to perform theirduties. Can he or she borrow my password in orderto have access?A. No. All new employees must wait to be assignedtheir own password. Protecting a password is theresponsibility of its owner. You are accountable forall actions associated with it. It is your legally bindingelectronic signature. Keep tight control over yourpassword and change it when prompted to helpprotect all Spectrum Health data.Using Other Spectrum Health ResourcesSpectrum Health resources are used to advance ourmission and serve our patients, members and customers.These resources include funding, personnel, facilities,vehicles, equipment, supplies and pharmaceuticalproducts. Quality service requires effective use of theseresources. We use them responsibly, and ensure thatothers do, too. We share them or allow others access tothem only for legitimate business purposes and with theproper authorization.Procedures must be followed for disposing of anySpectrum Health property. We must be especially vigilantfor product diversion, such as with pharmaceuticalproducts. Also, we do not use Spectrum Health worktime to pursue outside activities.Keeping Accurate Records ofTransactionsKeeping accurate records of Spectrum Health businesstransactions builds our reputation of integrity. Entriesrecorded in Spectrum Health records must be accurate,complete, fair, timely and understandable. No part ofSpectrum Health records may be falsified or improperlyaltered. We must never create or approve a record thatis intended to mislead, conceal or improperly reflect thetrue intention of a transaction. Financial records mustfollow generally accepted accounting principles and otherapplicable standards.Records can relate to financial, operational, claims orregulatory transactions or other activities. They includedocumentation of business activities, transactions,payments, receipts, applications, agreements, bids,contracts, accounts and assets. Records may includepaper documents, such as letters and memos; computerbasedinformation, such as email or computer files on diskor USB; or any other medium that contains informationabout the organization or its business activities.We follow Spectrum Health standards, policies andprocedures related to record retention, destruction anddisclosure. Even inadvertent destruction or disclosurecan lead to stringent penalties for Spectrum Health andresponsible employees.Federal and state false claims acts and, specifically,Federal Fraud Civil Remedies Act impose heavy penaltiesfor improper recording of business transactions andrecord destruction regarding health care claims forpayment to the government, whether made intentionallyor unintentionally. Penalties may apply to SpectrumHealth or individual employees. Therefore, we mustunderstand the purpose of any business transaction thatwe make, assist with or approve.See also: “Handling Outside Inquiries” on page 17.MonitoringAn important step toward safeguarding resources is activeoversight of those resources. Managers are expected toregularly monitor their operations to ensure compliancewith laws and regulations and Spectrum Health policiesand procedures. Any concerns identified during monitoringactivities must be reported immediately to the entity’sintegrity and compliance department or the systemorganizational integrity and compliance department.The internal audit department supplements these activitieswith additional monitoring and auditing activities.Code of Excellence 21

Spotlighting …Excellence in Our Environment• We protect the health and safety of others• We keep an alcohol and drug-free work environment• We properly handle and dispose of toxic and hazardous waste• We protect the environmentCode of Excellence 22

A commitment to excellence means that we care aboutthe good health of not only our patients and members,but also our employees. At Spectrum Health, we maintaina workplace with the basic essentials for good health.We act in safe and healthy ways and do our jobs withclear minds. Our concern for good health extends to ourcommunity with a concern for how our operations affectthe environment.Prioritizing Health and SafetyAs a health system, a core priority for us is the healthand safety of our patients, members, visitors, employeesand other members of the Spectrum Health team. Wehave established policies and procedures to ensure thisobjective. We are all expected to know the health andsafety policies that apply specifically to our jobs and toSpectrum Health facilities overall. We must immediatelyreport to our supervisor or safety manager any seriousworkplace injury or any situation that presents a dangerof injury so that it can be corrected.See also: “Maintaining Respectful Treatment” on page 15.Preventing Substance Use and DiversionFor a safe and healthy workplace and in service to ourpatients and members, Spectrum Health takes seriouslythe use of any substance that may influence your ability towork. You may face immediate termination if you report towork under the influence of any illegal drug or alcohol, havean illegal drug in your system or use, possess or sell illegaldrugs while on Spectrum Health work time or property. Youare responsible for ensuring that any medication you takewill not impede job performance ability or judgment. If youare not sure about the effects of your medications on yourwork, it is your responsibility to discuss the matter with aphysician, a manager or human resources.Q. I often cover breaks for my co-worker, Susie. Herpatients often complain that they have pain, buttheir medication records show they have recentlyreceived pain medication. Susie appears to bevery sleepy and grouchy after her breaks. I thinkshe may be taking the drugs from the patients andusing them herself. What should I do?A. Talk with your charge nurse or manager rightaway. You can call the Integrity Help Line as well.For our patients’ sake, we need to ensure that Susieis not under the influence of drugs. Patients musthave their pain properly managed. Lastly, if Susie isdiverting the drugs, that would be considered theft.Environmental ProtectionOur commitment to our local communities and theirhealth and safety calls for us to safeguard the naturalenvironment. Each of us has the responsibility to takemeasures that demonstrate this commitment. Suchmeasures include:• Adhering to procedures for handling and disposingof medical and other waste, especially toxic andhazardous materials• Following all environmental protection policiesand procedures• Following our recycling practices• Reducing energy use and unnecessary wasteSpectrum Health may test employees, consistent withentity drug testing policies, to determine the presence ofdrugs, narcotics or alcohol. Some employees may haveaccess to prescription drugs, controlled substances andother medical supplies. Possession and use of manyof these substances are regulated, and they require aphysician’s order to administer. These items must behandled properly and only by authorized individualsto reduce risks to patients and employees. If you learnabout the diversion of these items from Spectrum Healthfacilities, or from another institution or organizationwhere Spectrum Health provides services, you mustimmediately report the incident to a manager, to integrityand compliance, via the risk management reportingsystem or the Integrity Help Line.Code of Excellence 23

Spotlighting …Code of ExcellenceAcknowledgementWe sign an acknowledgment that demonstrates our commitment to our Code of Excellence.Code of Excellence 24

CONFIDENTIALSpectrum Health System Code of ExcellenceCode of Excellence AcknowledgmentI acknowledge the following to demonstrate my commitment to our Code of Excellence:• I understand the Code of Excellence (“the Code”) is posted on PolicyTech on InSite.• I understand that it is my responsibility to review and be familiar with the Code’s contents and all related policies andprocedures.• I agree to comply with the standards contained in the Code and all related policies and procedures as part of my continuedemployment or association with Spectrum Health.• I am aware of my obligation to seek guidance when unsure of the proper course of action and report concerns andsuspected violations of the Code or other policies applicable to me.• I understand that I am not permitted to retaliate against another person for raising a concern or reporting a suspectedviolation.• I am aware that any breach of the Code or other policies applicable to me subjects me to performance correction up to andincluding termination of employment or other relationship with Spectrum Health.• I understand that I am not permitted to be excluded from participation in Medicare, Medicaid, or any healthcareprogram at a federal or state level and that it is my responsibility to immediately disclose to the integrity and compliancedepartment any current or future federal or state program exclusion or another event that makes me ineligible to performwork related directly to federal or state health care programs.• I understand that I am expected to inform my supervisor of potential conflicts of interest that I may encounter so that theymay be properly addressed.• I understand that it is my responsibility to disclose and eliminate any conflict of interest or to receive pre-approval for anypotential conflict of interest per policies and procedures.NameDateSignature Entity DOCTYPE: CONDUCT Send to MC162Code of Excellence 25

AppendixThe Prevention and Detection of Health Care Fraud, Waste and AbuseFederal and State LawsThe government has taken steps to prevent and detect fraud,waste and abuse in the U.S. health system. In accordancewith the Deficit Reduction Act of 2005, informationregarding the federal and state false claims laws and relatedqui tam/whistleblower provisions will be communicatedto all employees, agents and contractors. In addition,this information is shared through the distribution of theSpectrum Health Code of Excellence.A. The Federal False Claims ActThe federal False Claims Act (FCA) is a law that deals withfraud in any federally funded program or contract. Examplesof federal programs covered by the FCA are Medicare andMedicaid.1. General ProvisionsThe FCA establishes liability for any person who knowinglypresents or causes to be presented a false or fraudulent claimto the U.S. government for payment. A “claim” includes anyrequest or demand for money that is submitted to the U.S.government or its contractors. In addition, no person canknowingly and improperly avoid or decrease an obligation torepay the government. The term “knowingly” is defined as:1) Having actual knowledge of false information in the claim2) Acting in deliberate ignorance of truth or falsity of theinformation in a claim3) Acting in reckless disregard of the truth or falsity of theinformation in a claimThe FCA does not require proof of a specific intent to defraudthe U.S. government.Health care providers organizations or employees whoviolate the FCA may be subject to civil monetary penaltiesranging from $5,500 to $11,000 for each false claim thatis submitted. Penalties of up to three times the amount ofdamages also may be ordered. The provider, organizationand/or employee also may be excluded from participating infederal health care programs.Significant civil monetary penalties may also apply to healthcare organizations and/or employees who knowingly makesor causes to be made any false statements, omission ormisrepresentation of a material fact in the application, bid,contract to participate or enroll In a federally funded healthcare program or who knows of an overpayment and does notreport the overpayment without delay.2. FCA Qui Tam “Whistleblower” ProvisionsThe FCA allows any person with actual knowledge of anallegedly false claim to file a lawsuit on behalf of the U.S.government. Such persons are called “whistleblowers.”In order to file a qui tam suit, a whistleblower must meetseveral requirements as outlined below.The whistleblower must file his or her lawsuit on behalfof the government in federal district court. Once filed,the lawsuit is kept confidential or “under seal” while thegovernment investigates the allegations and decides howto proceed. If the government decides that the lawsuit hasmerit, it may intervene. In this case, the U.S. Department ofJustice will try the case. The government may decide not tointervene. In this case, the whistleblower can continue withthe lawsuit on his or her own.If the lawsuit is successful, the whistleblower may receivean award ranging from 15 percent to 30 percent of theamount recovered. The whistleblower also may be entitledto reasonable expenses, such as attorney fees. If a courtfinds that the whistleblower planned or initiated the falseclaims, the award may be decreased. If the whistleblower isconvicted of crimes related to the false claims, no award willbe given.The FCA contains important protections for whistleblowerswho file claims in good faith. Depending on the circumstances,these protections may not apply to whistleblowers whofile frivolous claims, file claims in bad faith or were directlyinvolved in certain aspects of these claims. Retaliatory conductagainst an employee who files an FCA lawsuit, or tries tostop or prevent an FCA violation, may entitle the employee toadditional relief, including reinstatement of employment, backpay and compensation for costs or damages.B. The Program Fraud Civil Remedies ActThe program Fraud Civil Remedies Act of 1986 provides foradministrative remedies against any person who makes, orcauses to be made, a false claim or written statement tocertain federal agencies, including the Department of Healthand Human Services. The Program Fraud Civil Remedies Actaddresses lower dollar fraud and generally applies to claimsof $150,000 or less.C. The Michigan Medicaid False Claims ActThe Michigan Medicaid False Claims Act (MMFCA) is astate law that is designed to prevent fraud, kickbacks andconspiracies in the Michigan Medicaid program (MedicalAssistance Program).1. General ProvisionsThe MMFCA establishes liability for any person whoknowingly presents or causes to be presented a false orfraudulent claim for payment to Michigan’s Medicaidprogram. A “claim” means an attempt to cause the MichiganDepartment of Social Services to make a payment. The term“knowingly” is defined as:1) Being aware that his or her conduct is substantially certainto cause the payment of a Medicaid benefit; and2) Not including errors or mistakes, unless there is apersistent tendency to cause inaccuracies.Code of Excellence 26

Health care providers, organizations or employees whoviolate the MMFCA may be subject to both criminal and civilpenalties. Violation of the MMFCA is a felony punishable byfour years or less in prison, or a fine of $50,000 or less, orboth. Civil monetary penalties are equal to the full amountreceived plus triple damages. The provider organizationor employee may be excluded from participating in theMichigan Medicaid program.2. MMFCA Qui Tam “Whistleblower” ProvisionsThe MMFCA allows any person to file a civil lawsuit torecover losses to the state of Michigan. Such personsare called “whistleblowers.” In order to file a qui tam suit,a whistleblower must meet several requirements asoutlined below.The whistleblower must file his or her lawsuit. A suit filedunder the MMFCA will be dismissed unless the attorneygeneral is notified and has an opportunity to oppose thedismissal. If the government decides that the lawsuit hasmerit, it may intervene. In this case, the attorney generalwill prosecute the case. The whistleblower has the rightto continue as a party to the action, subject to certainlimitations. The government may decide not to intervene. Inthis case, the whistleblower can continue with the lawsuit onhis or her own.If the lawsuit is successful, the whistleblower may receive anaward ranging from 15 percent to 30 percent of the amountrecovered. If a court finds that the whistleblower activelyparticipated in the false claims, the award may be decreased.If the whistleblower is convicted of crimes related to the falseclaims, no award will be given. If the court finds that the actionbrought by the whistleblower was frivolous, the court may finethe whistleblower up to $10,000.The MMFCA contains important protections forwhistleblowers who file claims in good faith. Dependingon the circumstances, these protections may not apply towhistleblowers who file frivolous claims, file claims in badfaith or were directly involved in certain aspects of the claim.Retaliatory conduct against an employee who either filesunder the MMFCA or cooperates in an MMFCA lawsuitmay entitle the employee to additional relief, includingreinstatement of employment, back pay and compensationfor costs or damages.D. The American Recovery and Reinvestment Act of 2009Section 1553 of the American Recovery and ReinvestmentAct of 2009 (ARRA) is a federal law that is designed toprevent the misuse of stimulus package funds.1. General ProvisionsSection 1553 of the ARRA extends “whistleblower”protections to employees who reasonably believe they arebeing retaliated against for reporting misuse of ARRA fundsby a non-federal employer.2. ARRA “Whistleblower” ProvisionsARRA prohibits retaliation against a non-federal employeewho discloses information that the employee reasonablybelieves constitutes evidence of:1) Gross mismanagement of a contract or grant relating tostimulus funds;2) Gross waste of stimulus funds;3) Substantial and specific danger to public health or safetyrelated to implementation of stimulus funds;4) Abuse of authority related to implementation or use ofstimulus funds; or5) Violation of law, rule or regulation related to a contract orgrant relating to stimulus funds.The above allegations must have been reported to at leastone of the following to be granted possible protection: aperson with supervisory authority over the employee (oranother employee of the employer who has the authority toinvestigate, discover or terminate misconduct); an Officeof Inspector General, the Recovery Accountability andTransparency Board, the Comptroller General, a member ofCongress, a state or federal regulatory or law enforcementagency, a court or grand jury, or a federal agency head or his/her representatives. Such disclosures may be made duringthe course of the employee’s duties.Retaliatory conduct against a person protected under theARRA provisions may result in a federal agency order forreinstatement, back pay, employment benefits, compensatorydamages and/or attorney fees.E. Anti-Kickback StatuteAs required by the Anti-Kickback Statute, all employeesare prohibited from knowingly or willfully offering, paying,soliciting or receiving remuneration (the transfer of anythingof value, directly or indirectly, overtly or covertly, in cash orin kind) in order to induce and reward business payable (orreimbursable) under the Medicare or other federal healthcare programs. An Anti-Kickback Statue violation may beestablished without showing the individual had specificknowledge of laws or intent to violate the statute. Claims thatviolate the Anti-Kickback Statute may also violate the FalseClaims Act.F. Freedom of Information ActThe Freedom of Information Act makes informationcollected by government agencies available to the public. Itis important to note that Information provided to the Centersfor Medicare and Medicaid under the Part D program thatwould be considered proprietary in nature or that would tendto stifle the availability of discounts or rebates will not bereleased by CMS.Code of Excellence 27

100 Michigan Street, NEGrand Rapids, MI 49503616.486.2430spectrumhealth.orgX17205 FY14.6.23.D ©07.2014