Compliance

At Surgi-Care, we're committed to conducting our business in a way that puts patients first. As part of this commitment, our Compliance Department provides ongoing education to our employees, healthcare partners, and patients on industry best practices and the law. Below is a summary of some of the key industry standards and laws we adhere to.

Health Insurance Portability and Accountability Act

The Health Insurance Portability and Accountability Act ("HIPAA") was pased into law in 1996.  As its name implies, the main purpose of the law was to make health insurance "portable" by enabling Americans to take their healthcare coverage with them as they moved from job to job.  Since then, HIPAA has evolved into a complex set of privacy and security rules which govern how medical professionals protect patient's protected health information ("PHI").  Learn more about the Health Insurance Portability and Accountability Act>>   

Notice of Privacy Practices

As part of this law, healthcare records and other individually identifiable information transmitted or maintained by us must be kept strictly confidential.  Our Notice of Privacy Practices describes how medical information about our patients may be used and disclosed, and how patients can get access to this information in accordance with HIPAA.  View our Notice of Privacy Practices>> 

Patient Bill of Rights

We believe informed care equals better care.  At Surgi-Care, each patient receives a copy of our Patient Bill of Rights, so they can make better decisions about their medical treatment.  View our Patient Bill of Rights>> 

CMS Supplier Standards

Durable medical equipment, prosthetics, and orthotics suppliers must meet certain standards established by the Centers for Medicare and Medicaid (CMS) in order to obtain and retain Medicare billing privileges.  View the CMS Supplier Standards>>

AdvaMed Code of Ethics

The AdvaMed Code of Ethics is a code of standards created by the Advanced Medical Technology Association, a non-profit organization dedicated to the advancement of medical science and the improvement of patient care.  The main purpose of this Code is ensure medical decisions are based on the best interests of patients, by helping to facilitate ethical interactions between medical companies and healthcare professionals.  View the AdvaMed Code of Ethics>>

Community Health Accreditation Program

The Community Health Accreditation Program (CHAP) is an independent, not-for-profit, accrediting body for community-based health care organizations, such as Surgi-Care.  Created in 1965, CHAP was the first to recognize the need and value for accreditation in community-based care.  CHAP is the oldest national, community-based accrediting body with more than 5,000 agencies currently accredited nationwide.  Through "deeming authority" granted by the Centers for Medicare and Medicaid Services (CMS), CHAP has the regulatory authority to survey agencies providing home health, hospice, and home medical equipment services, to determine if they meet the Medicare Conditions of Participation and CMS Quality Standards.  CHAP's purpose is to define and advance the highest standards of community-based care.

Surgi-Care has been a CHAP accredited organization for over 10 years.  CHAP accreditation demonstrates that Surgi-Care meets the industry's highest nationally recognized standards.  Rigorous evaluation by CHAP focuses on structure and function, quality of services and products, human and financial resources, and long term viability.  Through CHAP accreditation, Surgi-Care is also certified as a Medicare provider.

American Board for Certification in Orthotics, Prosthetics and Pedorthics

The American Board for Certification in Orthotics, Prosthetics and Pedorthics has been accrediting O&P organizations since 1948. To attain ABC accreditation, all patient care facilities must comply with certain business requirements as well as the appropriate ABC patient care standards.

ABC standards create a minimum expectation for the physical environment and organizational function of orthotic, prosthetic and pedorthic patient care providers as well as suppliers of other types of medical equipment. Standards are grouped into categories and include topics such as organizational process, patient care, performance management, product safety, facility safety, and supplier compliance. Each of these categories contains a set of standards unique to the specific type of accreditation an organization is seeking.

Surgi-Care has been an ABC accredited facility since 2005.

Laws to Prevent and Address Fraud and Abuse

The Anti-Kickback Statute, False Claims Act, and Whistleblower Act are laws created by the government to prevent and address fraud and abuse.  Violations of these laws may result in civil monetary penalties, exclusion from federal health care programs (i.e., Medicare and Medicaid), and criminal and civil liability.  The following section describes each of these laws in greater detail. Suspected violations of any of the following laws are to be reported immediately to our Compliance Officer by calling our Compliance Hotline at 781-290-1911, emailing the compliance officer at compliance@surgi-careinc.com, or sending a letter to the compliance officer at 71 First Ave., Waltham, MA 02451.

Anti-Kickback Statutes

The federal Anti-Kickback Statute ("AKS") makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal health care program (i.e., Medicare and Medicaid). If even one purpose of a payment or transfer of value is to induce a referral, it is considered a violation of the Anti-Kickback Statute.  Since many Surgi-Care products are reimbursable by Medicare or Medicaid, the AKS is applicable to our company.  In addition to corporate penalties, individuals who violate the AKS may be subject to fines, imprisonment, or both.  Additionally, many states have adopted similar Anti-Kickback Statutes.

False Claims Acts

The False Claims Act ("FCA") prohibits the knowing submission of false or fraudulent claims to the federal government.  Many states have also adopted FCAs or other laws that are similar to those found in the federal FCA.  Examples of false claims include, but are not limited to, filing a claim for services that were not rendered or were not medically necessary, submitting a claim containing information one knows to be false, or assisting a customer in submitting a false or fraudulent claim.

A person or entity found liable under the federal FCA is subject to civil monetary penalties ranging from $5,550 to $11,000 per false claim, plus three times the amount that the government paid for each false claim.  In addition to fines and penalties, courts can impose criminal penalties against individuals and organizations for willful violations of the FCA.  Many states have adopted their own False Claims laws with similar penalties which can be imposed in addition to federal FCA penalties. 

Government Whistleblower Protections and Company Non-Retaliation Policy

Whistleblower protections are federal and state laws established to encourage individuals to report suspected instances of fraud and abuse to the government, and to protect them from retaliation when they do.  In addition to making it illegal for companies to retaliate against individuals for reporting suspected instances of fraud and abuse, many whistleblower statutes provide a monetary reward to individuals if the reported entity or individual is found guilty.  This reward is generally a portion of the money recovered by the government as a result of the reported information.  Surgi-Care also has a Non-Retaliation Policy which protects individuals from harassment, punishment, or retaliation of any kind for reporting illegal or unethical acts to the company.