St. Joseph Health Services of Rhode Island
The Deficit Reduction Act of 2005, Section 6032, requires the Hospital and other entities that receive or make annual Medicaid payments of $5 million or more to establish and make available policies with detailed information about:
     • The federal False Claims Act and similar state laws
     • The right to be protected as a whistleblower
     • The Hospital's policies and procedures for detecting and preventing        fraud, waste, and abuse in state and federal healthcare programs.
     • Include a detailed discussion of the False Claims Acts, including the        rights of whistleblowers in the Employee Handbook

Contractors and Agents
Contractors and agents are defined as any contractor, subcontractor, or agent, or other person, who, on behalf of the Hospital, provides or authorizes providing health care items or services, performs billing or coding functions, or is involved in the monitoring of health care provided by the Hospital.

Per a memorandum dated December 13, 2006 from the Director of the Center for Medicare and Medicaid Services, this written policy must be disseminated to contractors and agents who must adopt this policy.

Federal False Claims Laws
The federal False Claims Act (31 U.S.C. § 3729), is a law that covers fraud involving federal contracts or federal health care programs, including the Medicare and Medicaid programs. The law allows private citizens ("qui tam relators" or "whistleblowers") who have evidence of fraud to initiate a lawsuit on behalf of the federal government If the lawsuit is successful, the whistleblower may receive an amount ranging from 15 to 30 percent of the amount recovered, plus reasonable expenses such as attorney's fees.

The law covers a wide variety of conduct that leads to the submission of fraudulent claims, including:

State False Claims Laws
The Deficit Reduction Act provides a financial incentive for states to pass their own false claims legislation and entitles states with laws as strict as or tougher than the federal False Claims Act to a 10 percent increase in their share of Medicaid recoveries.

On July 24, 2008, The Office of Inspector General (OIG), for the Department of Health & Human Services, notified the State of Rhode Island that it has reviewed and determined that the "State False Claim Act", R.I. Gen. Laws §§ 9-1.1-1 through 9-1.1-8, effective February 15, 2008, meets the requirements of section 6031(b) of the Deficit Reduction Act.

Federal Whistleblower Laws
In 1986, Congress added anti-retaliation protections to the False Claims Act (31 U.S.C. Sec. 3730(h))

The law provides protection against retaliation for any employee who is discharged, demoted, suspended, threatened, harassed, or discriminated against in the terms and conditions of employment for the employees legal actions involving investigation, initiation, testimony, or assistance in an action filed or to be filed under the False Claims Act.
The protection against retaliation extends to whistleblowers whose allegations could legitimately support a False Claims Act case even if the case is never filed. The statute of limitations is six years in most jurisdictions.

The whistleblower plaintiff is entitled to all relief necessary to remain whole, including reinstatement with seniority, double back pay, interest, special damages sustained as a result of discriminatory treatment, and attorneys' fees and costs.

There are many other federal laws protecting whistleblowers or otherwise designed to protect workers from retaliation or other illegal treatment. However, the laws vary as to the proper procedure or intake agency for filing a complaint or charge. Some statutes do not permit a whistleblower to go directly to court but require an administrative pursuit. Some statutes designate a federal agency such as the Department of Labor/OSHA and others designate the EEOC as the intake office for claims. Some of the protection laws have statute of limitations as short as 30 days from the date of the alleged retaliation, so whistleblowers are cautioned not to delay filing a claim with the appropriate government official.

State Whistleblower Protection Laws
The Rhode Island Whistleblowers' Protection Act (R.I. General Law § 28-50-1 to § 28-50-9) protects employees from discharge, threat, or discrimination against compensation, terms, conditions, location, or employment privileges because an employee reports or is about to report a violation, or is requested to participate in an investigation, hearing, inquiry, or court action. If the employee knows or has reason to know that the report is false, there is no protection under this law.

Rhode Island's "State False Claim Act" provides relief, through action in the appropriate superior court, for any employee who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment because of lawful acts done by the employee in furtherance of an action under the Act. Relieve includes reinstatement with the same seniority status the employee would have had but for the discrimination, two (2) times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys' fees.

Policies and Procedures
The Hospital's Corporate Compliance Program was approved in January 1998 by the Board of Trustees to insure St. Joseph Health Services of Rhode Island conducts its operations and provides services in a manner consistent with its Mission Statement, charitable purposes, and in compliance with all federal and state laws and regulations.

As established in the Code of Conduct Policy, No. 05-950-07, It is mandatory for any employee or member of the professional staff who becomes aware of an apparent violation, actual or threatened, of any St. Joseph policy, applicable law, regulation, or standard of conduct to report the situation to their immediate supervisor, or if appropriate, to the anonymous and confidential Network Hotline (1-877-888-0002). The Hospital has a strict Non-Retaliation Policy, No. 10-950-08, and will not take any adverse action against any employee or member of any professional staff of St. Joseph who reports, in good faith, any apparent violation, actual or threatened of any St. Joseph policy, applicable law, regulation, or standard of conduct.

The Hospital has various policies and procedures for detecting and preventing fraud, waste, and abuse. These policies are available on the Hospital's intranet or by leaving a message at 401-456-3623. The policies include: