SECTION 1557 of ACA: NON-DISCRIMINATION NOTICE
Caldwell Memorial Hospital (& all affiliated Clinics) complies with applicable Federal civil rights laws and does not discrimination on the basis of race, color, national origin, age, disability, or sex. Caldwell Memorial Hospital (& all affiliated Clinics) does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Caldwell Memorial Hospital (& all affiliated Clinics):
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
If you need these services, contact Caldwell Memorial Hospital Director of Nursing at 318-649-6111 ext. 144.
If you believe that Caldwell Memorial Hospital (& all affiliated Clinics) has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
Administrator, PO Box 899, Columbia, LA 71418, or call (318) 649-6111.
You can file a grievance in person or by mail or phone. Help is available if needed.
You can also file a civil rights compliant with the U.S. Department of Health and Human Services, Office of Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Ave, SW, Room 509F, HHH Building, Washington, D.C. 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Compliant forms are available at http://www.hhs.gov/ocr/office/file/index.html
Pricing Transparency:
You have reached the federally-required section of our website that contains the charges for the services we provide within our facility. While we provide this information to comply with federal regulations, healthcare billing is complex. It is extremely important for you, as the consumer, to understand that standard charges may not be a relevant starting point for estimating what costs you may incur during an episode of care, and the amount actually paid by a patient will depend on that patient’s insurance coverage, policy provisions and other factors. Everyone’s case is different based on that patient’s medical condition.
The charges displayed only include hospital charges and do not include charges that are billed separately by the physician or other professional fees. Furthermore, the actual amount paid by a patient will depend on that patient’s insurance coverage, as benefit plans vary greatly.
IF YOU HAVE COMMERCIAL INSURANCE:
IF YOU HAVE MEDICARE:
IF YOU HAVE MEDICAID:
IF YOU ARE UNINSURED:
By clicking and downloading the document below, I understand that the actual amount paid by a patient will depend on a number of factors, including the ones mentioned above.
Machine Readable Standard Charges File (CSV)
FALSE CLAIMS ACT DRA NOTICE
Deficit Reduction Act Notice
Designed to improve federal and state oversight and enforcement actions against fraud and abuse in the Medicaid program. It requires any entity receiving more than 5 million dollars in Medicaid funds per year must instruct their employees on the following issues: 1. The federal False Claims Act. 2. Any state civil or criminal penalties for false claims. 3. Whistleblower protections.
Federal False Claims Act, 31 USC § 3279
The False Claims Act is a federal statute that covers fraud involving any federally funded contract or program, including the Medicaid and Medicare programs. This act is commonly known as the “Lincoln Law” because it was first enacted to counter fraudulent activities involving military procurement during the Civil War. The act establishes liability for any person who knowingly presents or causes to be presented a false or fraudulent claim to the U.S. government for payment
The term “knowingly” is defined to mean that a person, with respect to information:
Claim
For purposes of the False Claims Act, a “claim” includes any request or demand for money that is submitted to the U.S. government or its contractors.
Liability
Health care providers and suppliers who violate the False Claims Act can be subject to the following:
What is a False Claims Violation?
Any conduct that leads to the submission of fraudulent claims to the government such as knowingly making false statements, falsifying records, double-billing for items or services, submitting bills or services never performed or items never furnished, or otherwise causing a false claim to be submitted.
Qui Tam “Whistleblower” Provisions
Encourages individuals to come forward and report misconduct involving false claims, the False Claims Act includes a “qui tam” or whistleblower provision. It allows any person with actual knowledge of allegedly false claims to the government Such persons are known as a “relators.” By way of example, the U.S. Department of Justice reports that the federal government obtained more than $1.4 billion in settlements and judgments for fraud committed against the government in 2004-2005.
Qui Tam Procedure
The relator must file his or her lawsuit on behalf of the government in a federal district court. The lawsuit will be file “under seal,” meaning that the lawsuit is kept confidential while the government reviews and investigates the allegations contained in the lawsuit and decides how to proceed.
Rights of Parties to Qui Tam Actions
If the government determines that the lawsuit has merit and decides to intervene, the prosecution of the lawsuit will be directed by the U.S. Department of Justice. If the government decides not to intervene, the whistleblower can continue with the lawsuit on his or her own.
Award to Qui Tam Whistleblowers
If the lawsuit is successful, and provided certain legal requirements are met, the qui tam relator may receive an award ranging from 15 to 30 percent of the amount recovered. The whistleblower may also be entitled to reasonable expenses including attorney’s fees and costs for bringing the lawsuit.
No Retaliation
In addition to a financial award, the False Claims Act entitles whistleblowers to additional relief, including employment reinstatement, back pay, and any other compensation arising from retaliatory conduct against a whistleblower for filing an action under the False Claims Act or committing other lawful acts, such as investigating a false claim or providing testimony for, or assistance in, a False Claim Act action.
Louisiana State Law
Under Louisiana state law, the definition of a false or fraudulent claim is slightly broader, At LSA R.S. 46.437.–, “8) “False or fraudulent claim” means a claim which the health care provider or his billing agent submits knowing the claim to be false, fictitious, untrue, or misleading in regard to any material information. “
Under state law, (12) “Knowing” or “knowingly” means that the person has actual knowledge of the information or acts in deliberate ignorance or reckless disregard of the truth or falsity of the information.
Just as with the federal whistleblower statute, under Louisiana state law, “a private person (“Qui Tam plaintiff) may institute a civil action (“Qui Tam Action”) in the courts of this state on behalf of the medical assistance programs and himself to seek recovery.
A person who is or was a public employee or public official or a person who is or was acting on behalf of the state shall not bring a qui tam action if the person has or had a duty or obligation to report, investigate, or pursue allegations of wrongdoing or misconduct by health care providers, or had access to the records of the state through the normal course and scope of his employment relative to activities of health care providers.
State Whistleblower Protection
No employer of a qui tam plaintiff shall discharge, demote, suspend, threaten, harass, or discriminate against a qui tam plaintiff at any time arising out of the fact that the qui tam plaintiff brought an action pursuant to this Subpart unless the court finds that the qui tam plaintiff has instituted or proceeded with an action that is frivolous, vexatious, or harassing.
No employee shall be discharged, demoted, suspended, threatened, harassed, or discriminated against in any manner in the terms and conditions of his employment because of any lawful act engaged in by the employee or on behalf of the employee in furtherance of any action taken pursuant to this Part in regard to a health care provider or other person from whom recovery is or could be sought. Such an employee may seek any and all relief for his injury to which he is entitled under state or federal law.
No individual shall be threatened, harassed, or discriminated against in any manner by a health care provider or other person because of any lawful act engaged in by the individual or on behalf of the individual in furtherance of any action taken pursuant to this Part in regard to a health care provider or other person from whom recovery is or could be sought except that a health care provider may arrange for a recipient to receive goods, services, or supplies from another health care provider if the recipient agrees and the arrangement is approved by the secretary. Such an individual may seek any and all relief for his injury to which he is entitled under state or federal law.
An employee of a private entity may bring his action for relief against his employer or the health care provider in the same court as the action or actions were brought pursuant to this Part or as part of an action brought pursuant to this Part.
Recovery awarded to a qui tam plaintiff
Generally, if the secretary or the attorney general intervenes in the action brought by a qui tam plaintiff, the qui tam plaintiff shall receive at least ten percent, but not more than twenty percent, of recovery, exclusive of the civil monetary penalty provided in R.S. 46:439.6(C). In making a determination of award to the qui tam plaintiff the court shall consider the extent to which the qui tam plaintiff substantially contributed to investigations and proceedings related to the qui tam action.
Rewards for fraud and abuse information
State law provides that there may be a reward of up to two thousand dollars to an individual who submits information to the secretary which results in recovery pursuant to the provisions of this Part, provided such individual is not himself subject to recovery under this Part.
Louisiana State False Claims Penalties
A MESSAGE TO VENDORS, CONTRACTORS & BUSINESS ASSOCIATES
FEDERAL AND STATE FALSE CLAIMS LAWS
It is the policy of Caldwell Memorial Hospital and Clinics to obey federal and state laws, to implement and enforce procedures to detect and prevent fraud, waste, and abuse regarding payments to the Hospital from federal or state healthcare programs, and to provide protections for those who report actual or suspected wrongdoing.
What are some of the things that the Hospital is required to do to comply with the federal Deficit Reduction Act of 2005 & Louisiana’s Medical Assistance Programs Integrity Law? These laws require us to establish written policies and procedures about federal and state false claims laws and whistleblower protections and how we will take steps to detect and prevent healthcare fraud, waste, and abuse.
We have the required policies and procedures in place, and our policies are applicable to employees and to our business partners and independent contractors who furnish healthcare items and healthcare services to our patients or on our behalf. The Hospital’s corporate compliance plan establishes standards for conducting hospital business with excellence, integrity, and responsibility. It also provides guidelines which employees may use to prevent and detect any violation of the law. Because you do business with the Hospital, you are required to comply with the plan and related policies. You may also request a copy by calling the Administration Department at (318) 649-6111.
What is the False Claims Act? This federal law (31 U.S.C. §§ 3729-3733) establishes liability when any person or entity improperly receives from or avoids payment to the United States government. The Act authorizes federal prosecutors to file a civil action against any person or entity that “knowingly files” a false claim with a federal health care program, including Medicare or Medicaid, and applies to any person or entity that:
Anyone who knowingly submits a false or fraudulent claim to a Medicare, Medicaid or other federal healthcare program is liable to the federal government for three times the amount of the federal government’s damages plus penalties of $5,500 to $11,000 per false or fraudulent claim. The government may exclude “violators” from participating in Medicare, Medicaid, and other government programs, and any person or entity that makes an intentional submission of a false claim is subject to federal criminal enforcement.
Louisiana also has a false claims law which is called the “Medical Assistance Programs Integrity Law” (LSA-R.S. 46:437.1, et seq.), and it is very similar to the federal False Claims Act.
What are some examples of false claims? In healthcare, false claims may include things like: billing twice for the same service or billing for services not rendered; billing for medically unnecessary services; unbundling or billing separately for services that should be billed as one; creating false medical records to increase payments; failing to report and refund overpayments or credit balances; and giving and/or receiving unlawful inducements to healthcare providers for referrals for services.
What are whistleblower protections? Individuals who observe activities that may violate the law in some manner and who report their observations either to management or to governmental agencies are provided protections under certain laws, and these protections are “whistleblower” protections. Generally, whistleblowers are protected by the law from retaliation in any form.
What & how do I report? If you suspect instances of healthcare fraud, submission of false claims or other noncompliance with laws or the Hospital’s policies and procedures, you must report it. There are several options available to you:
You may contact the Hospital’s Administration Department at (318) 649-6111 and speak with the Chief Compliance Officer or the facility Administrator. (Confidentiality will be maintained, to the extent possible.)
You may contact the Office of Inspector General (US Department of Health and Human Services) at 1-800-HHS-TIPS (1-800-447-8477) or the Louisiana Medicaid Fraud Control Unit at 1-800-488-2917 for State help in reporting.
Patients should bring the following items:
For patients – it means being able to make informed choices when seeking care and reimbursement for care based on how personal health information may be used.
Most health plans and health care providers that are covered by the new Rule must comply with the new requirements by April 14, 2003.
The HIPAA Privacy Rule for the first time creates national standards to protect individuals’ medical records and other personal health information.
We do not provide ER services at our rural health clinics. However, walk-ins are welcome and same day appointments are available for you and your loved ones so you can be seen in a warm, comfortable setting without the hassle and wait of an emergency room visit.
We understand the worry and stress medical bills can place on a family or patients. We provide financial counseling services to help assist you with these issues.
A health record is created any time you see a health professional such as a doctor, nurse, dentist, chiropractor, or psychiatrist. You could find the following in your health record:
We accept most insurances, such as:
If you would like to know more information about our accepted insurance plans, give us a call at 649-6111.
We are proud to offer services at the following locations:
Under HIPAA, only you and your personal representative have the right to access your medical information. The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule.