To avoid any possible misunderstanding, AKSM wants you to know the material in this Manual is presented for information purposes only. It is not a contract (expressed or implied) guaranteeing employment for any specific duration. This manual is not a promise of treatment in any particular manner in any particular situation. This manual is intended as a guide to some of the company`s policies and procedures that are currently in effect. AKSM, at its option, may change, delete, suspend or discontinue any part(s) of the policies in this Manual at any time without prior notice. Any such action shall apply to existing, as well as future employees. AKSM, as the employer, always has the right to handle any situation as it deems appropriate, based on the particular circumstances of each case.

Although we hope that your employment relationship with AKSM will be long-term, either you or AKSM may terminate this relationship at any time, with or without cause, and with or without or notice for any reason or no reason at all.

The at-will employment policy may not be modified by any statements contained in this Manual or any other employee handbooks, employment applications, Company recruiting materials, Company memoranda, or other materials provided to applicants and employees in connection with their employment. None of these documents, whether singly or combined, are to create an expressed or implied contract concerning any terms or conditions of employment. Further, AKSM's at-will employment policy may not be modified by any oral statement. Oral promises to the contrary are of no force and effect. An employee's at-will status can only be modified by a separately executed agreement signed by the C.E.O. of AKSM and the employee.

All employment and compensation with AKSM Service Corporation, LLC. or with any of its current or future subsidiaries, affiliates, successors or assigns (collectively, "AKSM") is "at will".

Completion of an "orientation period" does not in any manner affect the "at will" status of your employment.

During the orientation period and any time thereafter, an employee can be terminated, with or without cause, and with or without notice, at any time, for any reason or no reason at all, at the option of either AKSM or the employee, except as otherwise provided by law.

The success of AKSM depends upon the quality of the relationships between AKSM, our employees, our clients and the general public. Our client's impression of AKSM and their interest and willingness to utilize our services is greatly influenced by the people who serve them. You are AKSM's ambassador.

Here are several things you can do to help give our clients a good impression of AKSM:

• Act competently and deal with our clients in a courteous and respectful manner.
• Communicate pleasantly and respectfully with other employees.
• Take pride in your work and enjoy doing your very best.

AKSM Service Corp. retains and/or hires for employment three categories of employees. Those categories are full time, part time, and contingent. The definitions of these categories are as follows:

Full-Time Employees: Those persons scheduled 72 hours or greater per two-week pay period.

Part-Time Employees: Those persons scheduled less than 72 hours per two-week pay period.

Contingent Employees: Those persons who agree to work for AKSM on an "as needed" basis with no expectation of regularly scheduled employment.

At the time of hire, all employees are classified as "exempt", "non-exempt", or "commission only". This is necessary because, by law, employees in certain types of jobs are entitled to overtime pay for hours worked in excess of 40 hours per workweek. These employees are referred to as "non-exempt" in this Manual. This means that they are not exempt from (and therefore, should receive) overtime pay.

"Exempt" employees are those categories of employees that are allowed to be exempt from overtime pay provisions as provided by the Federal Fair Labor Standards Act (FSLA) and any applicable state laws. If you are an exempt employee, you will be advised that you are in this classification at the time you are hired, transferred, or promoted.

The American Kidney Stone Management, Ltd. and Innovative Medical Technologies, LLC companies (the "Companies") value the health, safety and well-being of their employees. To promote employee safety and health, the Companies have adopted the following policies to be followed in conjunction with the specific health and safety requirement policies adopted by the business lines.

The Companies' employees perform a variety of functions in different locations. All employees are responsible for complying with all health and safety work practices and policies applicable to their job duties and location. In addition, all employees are required to comply with the following:

• report any unsafe conditions to your supervisor or another member of management immediately (or you may make reports anonymously to the Compliance Hotline by calling 1-800-826-6762);
• follow the Companies' policy and procedures on incident reporting;
• report any work related injury or illness to your supervisor or Human Resources immediately;
• wear seat belts and follow the Companies' policy on cell phone usage at all times when operating a motor vehicle;
• keep aisles and exits clear;
• do not operate a motor vehicle or equipment when overly tired, ill or under the influence of any substance that may affect alertness or judgment;
• do not stand on chairs;
• do not stack items in an unstable manner or against doors;
• promptly clean up or report all spills;
• follow emergency and evacuation plans of any facility where duties are performed;
• follow safe chemical handling and storage policies;
• wear personal protective equipment when warranted for the job duties; and
• follow all applicable infection control policies.

The Director of Human Resources has overall responsibility for coordinating the Companies` health and safety plans.

The Companies' managers and supervisors are responsible for:

• implementing, communicating and maintaining the health and safety plans applicable to their business lines;
• training their employees on safe operation of equipment and applicable health and safety policies: at orientation, when new equipment is to be utilized, if previously unidentified hazards are recognized and at such other times as deemed appropriate; and
• correction of unsafe or unhealthy conditions, practices or procedures in a timely manner based on severity of the hazard and removing employees, if appropriate based on the type of hazard, from effected areas until the hazard is corrected.

The Companies believe that employee health and safety is everyone's responsibility. If you have a suggestion to enhance the Companies' health and safety plan and policies, please share your idea with your supervisor or another member of management.

Failure to comply with this policy may result in disciplinary action up to and including termination of employment.

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PURPOSE: To provide guidance and process of driver's time utilizing DOT regulations. This policy is to serve as guidance and therefore in no manner to be considered all inclusive of DOT Regulations or the updates which may be made to the DOT Regulation in the future.

OBJECTIVES: To ensure accurate use of time and parameters of regulations governing the employees driving a company truck over 10 thousand and one pounds. This policy does not apply to any of the various sized company vans utilized in the Guild or Genesis Divisions.

A pocket Department of Transportation book for reference will be issued to all employees required to drive company trucks weighing over 10 thousand and one pounds. It is expected that all drivers of company trucks adhere to all DOT regulations at all times. For any questions, please refer to the DOT guide along with consulting AKSM's Fleet Management.

Under current DOT regulations, AKSM's box trucks do not require a CDL (Commercial Drivers License) to operate. However, all drivers of these trucks are required to maintain a current DOT physical and abide by the Hours of Service Rules.

A Few Pertinent Rules Applicable to Short Haul Operations are:

1. 14 Hours of Consecutive time: Of these 14 hours, you are permitted to drive 11 hours. This is continuous from the starting time. Therefore, it is prudent that all routes be run efficiently. Once you have 14 hours of consecutive time, you are required to be off duty at least 10 hours.
2. Log Sheets: Log sheets are required if:
1. If you do not return to where the truck is domiciled in any one day, you are required to complete a daily log sheet.
2. If your assignment requires the driver goes outside the 150 mile air mile radius, it is required that the daily log sheet be completed.
3. The rules of the DOT mandate that a 10-hour break is required after completion of 14 consecutive hours of duty. This is where the planning of your route is most important. If you are not able to return to the place your vehicle is domiciled within the 14-hour rule, you must get a motel room and spend at least the required 10-hour break. Notification of your manager is required under these circumstances.
3. DOT Work Hours VS Hours Entered on Employee Time Sheet: This is two separate polices. For entering your time worked on your time card, all AKSM employees are to enter the exact time that they are performing duties for the company. There is to be no "carry over" of hours worked. However, if there is a time period during the day where NO AKSM duties are being performed, then those hours should not be marked as "worked hours". All hours from the beginning of the workday are to be counted in the DOT requirements. All DOT regulations will be maintained and all AKSM payroll policies will be followed.

Please contact your manager or the Corporate Fleet Office immediately for all questions and directions on how to handle any situation you may be unsure of. Additionally, you may also refer to your DOT handbook for additional guidance.

It is the responsibility of all employees to follow safety guidelines and applicable law with regard to usage of cellular mobile phones on Company time and/or business ("Company Business") whether driving a Company motor vehicle or a personal motor vehicle. Employees are required to ascertain the law applicable to cellular phone usage in each locale where the employee will be driving and to comply at all times with all applicable laws on cellular phone usage.

In locales where usage of cellular mobile phones while operating a motor vehicle is not prohibited or restricted:

• Employees are not permitted to read or respond to e-mails or text messages while operating a motor vehicle on Company Business even in locales where such activitiy is not prohibited by applicable law; and
• Employees must use every effort to refrain from using cellular mobile phones while operating a motor vehicle. If a cellular phone must be used during the operation of a motor vehicle, the vehicle must be equipped with and the driver must utilize hands-free equipment. When talking while in motion, reduce speed, drive in slower lane, and pay particular attention to driving conditions. Keep the coversation brief. Do not take notes or engage in complex thoughts while in motion. Stop the vehicle if you must take notes. Notify the other party that the call will be interrupted if traffic conditions change. Do not use cellular telephones in vehicles with manual transmissions while shifting. Do not use cellular phones while fueling your vehicle.

Failure to follow this policy may result in disciplinary action up to and including termination of employment.

AKSM is committed to providing a healthy, safe and productive work environment and quality service to its customers. In furtherance of this goal, AKSM has adopted this Drug and Alcohol Free Workplace Policy.

REQUIREMENTS AND PROHIBITED CONDUCT: When on Company Work, all employees must:

• not use, possess, or be under the influence of alcohol or an unauthorized drug. With management approval, employees may drink moderately at certain business related meetings or social gatherings;
• not sell, buy, transfer or distribute any unauthorized drugs;
• not use, possess, sell, buy, transfer or distribute drug paraphernalia;
• not have their ability to perform job duties impaired due to on or off duty use of alcohol, unauthorized drugs, prescription drugs or over the counter ("OTC") drugs; and
• follow these rules if taking prescription or OTC drugs:
  • use a prescription drug only if a licensed health care provider prescribed it within the last year;
  • use prescription or OTC drugs only if they do not affect the ability to work effectively and safely;
  • follow directions, including dosage limits and usage cautions;
  • not abuse, share, or intentionally misuse prescription or OTC drugs; and
  • keep prescription and OTC drugs in the original containers or bring only a single day supply.

In addition, no employee may use, sell, possess, transfer or purchase alcohol or unauthorized drugs outside of Company Work where such conduct: (i) constitutes a direct threat to Company property, another Company employee or any person or entity with whom the Company has a business relationship; (ii) affects an employee`s job performance; (iii) generates publicity or circumstances adversely affecting AKSM or its employees; and/or (iv) results in a criminal conviction.

DEFINITIONS:

Company Work: means all employee scheduled working hours (including when on call or paid standby) and all times when an employee is on Company premises, conducting Company business, representing the Company, attending a Company function, and/or driving a Company or personal vehicle with regard to Company business or a Company function.

Unauthorized Drug: means any substance (a) which is not legally obtained and whose use, possession, or transfer is restricted or prohibited by law; (b) which is legally obtained and usable but is not being legally obtained or used; and/or (c) all forms of narcotics, depressants, inhalants, stimulants, hallucinogens, opiates, or other drugs or preparations, which alter a person`s physical or emotional state, including marijuana (whether legal or illegal under local, state or federal law), and substances such as rubber cement, glue or gasses that when misused, can have a narcotic effect.

Under The Influence: means that the employee has alcohol or an unauthorized drug in his or her system and is affected by such alcohol or unauthorized drug so as to impair performance of job duties and responsibilities.

EMPLOYEE DRUG AND ALCOHOL TESTING:

Except as otherwise required by applicable law, AKSM maintains the right to request alcohol and/or drug testing of any employee at any time without advance notice. Testing will be done in accordance with applicable law.

All employees subject to Department of Transportation regulations are subject to alcohol and/or drug testing in accordance with applicable Department of Transportation requirements.

An employee will be subject to the same consequences as a positive test if he/she: refuses the screening or test, will not sign the required forms or refuses to cooperate in the testing process, adulterates or dilutes the specimen, substitutes the specimen with that from another person or sends an imposter to the test.

SEARCHES:

AKSM may search employees, their property, and Company property, including desks, lockers, or other stationary containers, Company and personal vehicles, bags and other property when there is reasonable suspicion to believe that the employee has engaged in prohibited conduct.

CONFIDENTIALITY:

Information and records relating to employee drug and/or alcohol screening and dependencies will be treated as confidential information and in accordance with applicable law. Such information may be disclosed among managers and supervisors on a need to know basis and may also be disclosed when relevant to a grievance, charge, claim or other legal proceeding initiated by or on behalf of the employee.

SHARED RESPONSIBILITY:

A healthy, safe and productive alcohol and drug free workplace is achieved through cooperation and shared responsibility. Employees are required to report dangerous behavior to their supervisor or the Human Resources Department.

EMPLOYEE ASSISTANCE:

AKSM encourages any employee who has developed an addiction to or dependence on alcohol and/or drugs to seek assistance. Treatment for alcoholism and/or drug use may be covered by insurance; however, the ultimate financial responsibility for treatment belongs to the employee. An employee will not be disciplined for seeking assistance in correcting a drug or alcohol abuse problem, but will be held to the same standards of conduct and performance as an employee who has no such problem. An employee who is seeking or receiving assistance for alcoholism and/or drug use: (i) will not escape discipline by first requesting treatment or leave after being selected for testing or violating this policy; and (ii) will not be excused from penalties for engaging in prohibited conduct or otherwise failing to comply with this policy.

Any employee who engages in prohibited conduct, fails to comply with this policy and/or has a positive test (or is deemed to have a positive test due to one of the reasons set forth above) will be subject to disciplinary action up to and including termination of employment.

All users must follow this policy and any additional policy that may be adopted by AKSM.

GENERAL PROVISIONS FOR USE OF INTERNET AND ELECTRONIC COMMUNICATIONS SYSTEMS.

Business Use:

 

AKSM-provided computer systems that allow access to the Internet and electronic communication systems are the property of AKSM and are provided to facilitate the effective and efficient conduct of AKSM business. Users are permitted access to the Internet and electronic communication systems to assist in the performance of their jobs.

Personal Use:

 

Personal use means use that is not job-related. In general, incidental and occasional personal use of AKSM's Internet access or electronic communication systems is permitted; however, personal use is prohibited if it:

• Interferes with the user's productivity or work performance, or with any other employee's productivity or work performance;
• Adversely affects the efficient operation of the computer system;
• Violates any provision of this policy, any supplemental policy adopted by AKSM supplying the Internet or electronic communication systems, or any other policy, regulation, law or guideline as set forth by local, State or Federal law.

Users employing AKSM's Internet or electronic communication systems for personal use must present their communications in such a way as to be clear that the communication is personal and is not a communication of AKSM.

No Expectation of Privacy:

 

No user should have any expectation of privacy in any message (sent, retrieved, or received), privacy file, image or data created, by use of AKSM's equipment and/or access. AKSM has a right to monitor any and all aspects of their computer systems including, but not limited to, sites, instant messaging systems, chat groups, or news groups visited by users, material downloaded or uploaded by users, and e-mail sent or received by users. Such monitoring may occur at any time, without notice, and without the user's permission.

Prohibited Activities:

 

Certain activities are prohibited when using the Internet or electronic communications. These include, but are not limited to:

• Accessing, downloading, printing or storing information with sexually explicit content as prohibited by law;
• Downloading or transmitting fraudulent, threatening, obscene, intimidating, defamatory, harassing, discriminatory, or otherwise unlawful messages or images;
• Installing or downloading computer software, programs, or executable files contrary to policy;
• Sending e-mail using another's identity, an assumed name, or anonymously.

Security:

 

The distribution of electronic communications is difficult to control and routing mistakes can easily occur. Copies of electronic communications can be forwarded without the sender's knowledge or permission to unintended recipients. Therefore, electronic communications should be drafted and sent with at least the same level of care, professional judgment and discretion as paper memoranda or documents.

User Responsibilities:

 

The conduct of computer users who access the Internet or send e-mail containing an AKSM domain address (i.e., __@aksm.com) reflects on the character and professionalism of AKSM. When engaging in such conduct, whether for personal or official purposes, employees are expected to do so in a responsible and professional manner. All users are responsible for exercising appropriate care to protect AKSM's computer systems against the introduction of viruses. When using AKSM's Internet access or electronic communications, equipment and capability, individuals must use the Internet or electronic communication systems only in accordance with this policy and maintain the conditions of security (including safeguarding of passwords) under which they are granted access to such systems.

AKSM Online Office:

 

New employees will be issued a user name and password that will enable them to gain access to the online office. It is the employee's responsibility to maintain the confidentiality of their user name and password. Sharing of such information is strictly prohibited. If an employee believes that someone is using their information to gain access to the online office they must inform their supervisor and notify the AKSM information services department immediately.

Violations:

 

Violations of this policy will be addressed under appropriate disciplinary policy or procedures. The appropriate level of disciplinary action will be determined on a case-by-case basis with sanctions up to or including termination.

AKSM is committed to a work environment that is free of harassment and discrimination in order to maintain a productive work environment in which people are treated with dignity, decency and respect.

The Company prohibits harassing conduct by any employee (including managers, supervisors and non-supervisory employees), or any non-employee on Company property, which affects tangible job benefits; interferes unreasonably with an individual`s work performance; or creates an intimidating, hostile, or offensive working environment. The Company also prohibits the filing of groundless and malicious harassment complaints.

Harassment is not only unlawful, it is wrong and the Company will not tolerate harassing behavior in the workplace.

What is harassment?

Harassment is unwelcome verbal, physical or visual conduct that is based upon a persons protected status (such as race, color, sex/gender, national origin, religion, age, disability status, genetic information, marital status, veteran status, citizenship status, or any other basis protected by applicable law) that affects tangible job benefits; interferes unreasonably with an individual`s work performance; or creates an intimidating, hostile, or offensive working environment.

Sexual harassment is a form of harassment that consists of unwelcome sexual advances, requests for sexual favors, and other physical, verbal or visual conduct based on sex when: (i) submitting to the conduct is an explicit or implicit term or condition of employment; (ii) submitting to or rejecting the conduct is used as the basis for an employment decision; or (iii) the conduct has the purpose or effect of unreasonably interfering with an individual`s work performance or creating an intimidating, hostile or offensive working environment.

Sexual harassment may include explicit sexual propositions, sexual innuendo, suggestive comments, sexually oriented "kidding" or "teasing", "practical jokes", jokes about gender-specific traits, foul or obscene language or gestures, displays of foul or obscene printed visual material (including both print and electronic display) and physical conduct such as patting, pinching, touching someone`s clothing, brushing against another`s body or interfering with normal movement.

Sexual harassment does not refer to normal, courteous, mutually respectful, non-coercive interactions between employees that are acceptable to and welcome by both parties, as well as those around them. It refers to behavior that is not welcome, is personally offensive, debilitates morale and interferes with work effectiveness.

What should you do if you are being harassed or witness harassment?

All employees, regardless of their positions, and visitors, are covered by this policy and are expected to take appropriate measures to ensure that prohibited conduct does not occur. If you experience, witness or become aware of any form of unlawful harassment or offensive conduct as described above, you are required to immediately report the suspected harassment to the Human Resources Department, of if Human Resources is unavailable, report the conduct to your supervisor or any other member of management. If you believe your supervisor is harassing you, you must report this conduct immediately to the Human Resources Department or another supervisor or member of management.

Investigation.

AKSM will investigate complaints of harassment promptly. Employees are required to cooperate in any investigation. If the investigation confirms that harassment has occurred, the Company will take corrective action. AKSM will maintain confidentiality to the extent possible, but this may not be possible in all cases.

No Retaliation.

Retaliation against any employee for filing a complaint or participating in an investigation is prohibited. If you face retaliation or become aware of any harassment-based retaliation in the workplace, you are required to immediately report the suspected retaliation to the Human Resources Department, of if Human Resources is unavailable, report the suspected retaliation to your supervisor or any other supervisory employee or member of management. If you believe your supervisor is retaliating against you, you must report this conduct immediately to the Human Resources Department or another supervisor or member of management.

Any employee, supervisor, or manager who is found to have engaged in harassment (including sexual harassment), who engages in harassment-based retaliation in the workplace or fails to comply with this policy, will be subject to disciplinary action up to and including termination of employment.

AKSM is committed to providing its employees a work environment that is safe, secure and free of harassment, threats, intimidation and violence. AKSM recognizes that workplace violence is a growing problem that should be addressed by all employers and therefore adopts this zero tolerance policy for workplace violence. Consistent with this policy, threats or acts of physical violence, including intimidation, harassment, and/or coercion which involve or affect employees or which occur on AKSM property will not be tolerated.

Threats or Acts of Violence Defined:

 

"Threats or acts of violence" include conduct against persons or property that is sufficiently severe, offensive, or intimidating that creates a hostile, abusive, or intimidating work environment for one or more employees.

Workplace Violence:

 

Prohibited workplace violence includes, but is not limited to, the following:

• All threats or acts of violence occurring on AKSM property, regardless of the relationship between the company and the individual involved in the incident.
• All threats or acts of violence not occurring on AKSM property, but involving someone who is acting in the capacity of a representative of AKSM.
• All threats or acts of violence not occurring on AKSM property, but involving an employee of AKSM if the threats or acts of violence affect the legitimate interests of AKSM.
• Any threats or acts of violence resulting in the conviction of an employee or agent of AKSM, or of an individual performing services on the company's behalf on a contract or temporary basis, under any criminal code provision relating to threats or acts of violence that adversely affect the legitimate interests of AKSM.

Examples of Prohibited Conduct:

 

Specific examples of conduct that may be considered "threats or acts of violence" prohibited under this policy include, but are not limited to, the following:

• Hitting or shoving an individual.
• Threatening to harm an individual or his/her family, friends, associates, or their property.
• The intentional destruction or threat of destruction of property owned, operated, or controlled by AKSM.
• Making harassing or threatening telephone calls, or sending harassing or threatening letters or other forms of written or electronic communications.
• Intimidating or attempting to coerce an employee to do wrongful acts, as defined by applicable law, administrative rule, policy, or work rule that would affect the business interests of the company.
• The willful, malicious and repeated following of another person, also known as "stalking", and making of a credible threat with intent to place the other person in reasonable fear for his or her safety.
• Making a suggestion that an act to injure persons or property is "appropriate", without regard to the location where such suggestion occurs.
• Unauthorized possession or inappropriate use of firearms, weapons, or any other dangerous devices on AKSM property.

Application of Prohibition:

 

The prohibition against threats and acts of violence applies to all AKSM personnel, contract and temporary workers, and anyone else on AKSM property. Violations of this policy by any individual will be subject to legal action, as appropriate.

Duty to Report/Investigate:

 

If you believe that the actions or words of a manager, supervisor, another employee, or a non-employee constitutes violence in the workplace of you or of another employee, you have a responsibility to immediately report the suspected violence to your supervisor or any other member of management or supervisory employee.

 

The Company will investigate complaints of violence promptly. Employees are required to cooperate in any investigation. Retaliation against any employee for filing a complaint or participating in an investigation is prohibited.

Disciplinary Action:

 

Any employee, supervisor, or manager who is found to have engaged in violence in the workplace will be subject to disciplinary action up to and including discharge.

No Weapons on Company Property:

 

In the interest of maintaining an environment that is safe and free of violence for its employees and visitors, AKSM strictly prohibits the wearing, transporting, storage, presence or use of dangerous weapons on company property, regardless of whether or not the person is licensed to carry the weapon. Any employee who violates this policy is subject to disciplinary action, up to and including discharge. A client or visitor who violates this policy may be removed from the property and reported to police authorities. This policy does not apply to any law enforcement personnel or security personnel engaging in official duties.

Company Property:

 

Property covered by this policy includes all company-owned or leased buildings and surrounding areas, such as sidewalks, walkways, parking lots and driveways under the company's ownership or control. Furthermore, this policy applies to all company-owned or leased vehicles and all vehicles that come onto company property.

Dangerous Weapons:

 

Dangerous weapons include, but are not limited to, handguns, firearms, explosives, knives and other weapons further defined by statute and/or local ordinance.

Searches:

 

AKSM reserves the right at any time and at its discretion to search all company-owned or leased vehicles and all vehicles, packages, containers, briefcases, purses, lockers, desks and persons entering company property, for the purpose of determining whether any dangerous weapon has been brought onto company property or premises in violation of this policy. Any employee failing or refusing to promptly permit a search under this policy will be subject to discipline up to and including termination.

If employees have a question regarding whether an item is covered under this policy, they should contact the Human Resources department. It is the employee's responsibility to make sure that any item possessed by them is not prohibited by this policy.

Personal phone calls must not interfere with your work. You are permitted to make limited local area calls on company telephones for essential personal business during lunch or "break" periods only. Please do not abuse this privilege. Emergency calls regarding illness or injury to family members, changed family plans, or calls for similar reasons may be made at any time. Incoming urgent calls will be directed to you.

You are encouraged to use the parking areas designated for our employees. Remember to lock your car every day and park within the specified areas.

Courtesy and common sense in parking will avoid accidents, personal injuries, damage to your vehicle and to the vehicles of other employees. If you should damage another car while parking or leaving, immediately report the incident, along with the license numbers of both vehicles and any other pertinent information you may have, to your manager.

AKSM does not assume any liability for any loss or damages you may sustain.

This page is reserved for future use.

An employee of AKSM is not prohibited from working for other employers; however, doing so must not distract or hinder the employee's ability to perform his/her responsibilities at AKSM and must not create a conflict of interest. Employees must inform their immediate supervisor of all additional employment.

This page is reserved for future use.

To promote the health and safety of staff and patients, AKSM requires that its clinical staff members maintain Healthcare Provider CPR certification.

All clinical staff members must be CPR certified by the American Heart Association. This certification must include either: (i) the 2016 Basic Life Support Level; or (ii) for certifications issued prior to February, 2016, the Basic Life Support (BLS) training at the Healthcare Provider level.

All clinical staff employees must complete the American Heart Association re-certification every two years.

A neat, professional appearance contributes to the positive impression you make on our customers. Good grooming and appropriate dress reflect employee pride and self-confidence and enhances our company image.

AKSM employees are expected to be suitably attired and groomed during working hours and when representing the Company. Clinical employees are expected to wear appropriate uniforms as determined by management. Non-clinical employees are expected to wear suitable business casual attire or, if appropriate based on the occasion, suitable business attire, as determined by management.

To be considered suitable, attire must be neat, clean and in good repair. Suitable attire does not include jeans (except on a Company designated jean day), flip-flops, stretch pants, sweatshirts, sweat suits, sweatpants, tee shirts, shorts, hats, tank tops, crop tops, halter tops, camouflage, clothing with inappropriate slogans or exercise wear of any kind.

AKSM reminds each employee to use common sense and good judgment when dressing for work. If you are in doubt as to the appropriateness of a piece of clothing, do not wear it.

AKSM managers may exercise reasonable discretion to determine appropriateness in employee dress and appearance. Employees who are not dressed appropriately may be sent home to change and, except as otherwise required by applicable law, will not be paid for the time.

Failure to dress appropriately may lead to disciplinary action, up to and including termination of employment.

By law, AKSM is obligated to keep accurate records of the time worked by employees. Because of the unique work schedules of AKSM employees, an accurate time sheet is crucial to ensure legal compliance with state and federal law and to ensure the efficient use of AKSM resources. All non-exempt employees who work more than Forty (40) hours in a work week will be compensated at one and one-half (1-1/2) times their regular hourly rate.

This policy establishes rules and procedures for recording hours worked and submitting time sheet records.

Pay Period:

 

AKSM utilizes a bi-weekly pay period (26 pay periods per year).

Standard Work Week:

 

The standard workweek begins on Sunday at 12:01 a.m. and ends on Saturday at 12:00 a.m.

AKSM Online Office:

 

Every employee who is required to submit a time sheet record has access to the online time sheets through AKSM Online Office via the Internet. If an employee does not have access to AKSM Online Office, he or she must immediately inform his or her manager, AKSM information systems and the human resource department.

Guaranteed Hours:

 

For those employees who are guaranteed hours, as delineated by their position, AKSM guarantees a total agreed upon number of hours of work time in a two-week pay period. This calculation includes any overtime and TAP time during the same pay period.

Recording Work Hours:

 

Accurate Recordkeeping:

1. All time worked shall be entered on the time sheet. No employee will perform work for AKSM without compensation.
2. Employees shall accurately record lunch periods and all periods of absences.
3. Employees who arrive late must accurately record the time he or she arrived on their online time sheet record.
4. Each employee is solely responsible for his or her online time sheet record and its accuracy. Employee's are strictly prohibited from altering another employee's time sheet record and/or from influencing anyone else to alter his or her time sheet record.

Errors:

1. In the event of an error in accurately recording hours worked or absences from work, the employee shall immediately notify his or her manager or the V.P. of Operations to make appropriate adjustments.
2. It is the employee's responsibility to correct all errors and omissions prior to submitting the time sheet for final approval.

Submission of Time Sheets:

 

1. All time sheets must be submitted on a weekly basis electronically via the online office system.
2. Each employee shall submit his or her time sheet record no later than the end of the workday on Friday.
1. Limited Exception: If an employee is required to work on a Saturday or given prior approval by his or her manager to perform work on a Saturday, the employee shall submit his or her time sheet for that work week by the end of the work day on Saturday.
3. Online time sheet records are confidential and can only be viewed by the individual employee, the employee's managers, and the human resources department. Once the employee submits his or her online time sheet record, it cannot be altered or changed. If the online time sheet record is rejected, the employee must submit a new time sheet for review and manager approval.
4. The employee's manager must review and approve the time sheet submitted by the employee. The manager may either approve or reject the time sheet.
1. Approved Time Sheet: After an employee's time sheet is approved by management, the time sheet will be submitted to the human resource department for processing.
2. Rejected Time Sheet: If a manager rejects an employee's time sheet record, the manager will provide a written explanation for the rejection. The employee will receive notification via the online office messaging system that their time sheet was rejected and the reason why it was rejected.
3. Submission of Corrected Time Sheet: Upon receiving a notice of a rejected time sheet, the employee shall immediately submit a new time sheet with any and all necessary changes for manager approval. Upon manager approval, the corrected time sheet will be submitted to the human resource department for processing.

Late Time Sheets:

 

Any time sheet record not submitted by the stated deadline is considered late. Submission of a late time sheet will result in the following:

1. Compensation
1. Current Pay Period: The employee will be compensated for the hours that AKSM has a reasonable expectation to believe the employee actually performed work.
2. Subsequent Pay Period: When the employee finally submits and receives approval for an accurate time sheet record, AKSM will true-up with the employee during the next possible pay period.
2. Disciplinary Action: An employee who submits a late time sheet will be subject to disciplinary action.

Falsification of Time Sheets:

 

Falsifying online time sheet records will result in disciplinary action, up to and including immediate termination.

Examples of falsifying online time sheet records include, but are not limited to, the following:

1. Not accurately recording all hours worked during the workweek.
2. Not accurately recording lunch periods.
3. Not accurately recording all periods of absences from work.
4. Not accurately recording time of arrival and time of departure.
5. Recording hours when no work was actually performed.
6. Submitting inaccurate or misleading explanations for work performed.
7. Failing to submit explanation for work when required to do so.

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This page is reserved for future use.

AKSM is required by law to make certain deductions from your paycheck each time one is prepared. Among these are your Federal, State and Local income taxes and your contribution to Social Security as required by law. These deductions will be itemized on your check stub. The amount of the deductions may depend on your earnings and on the information you furnish on your W-4 form regarding the number of dependants/exemptions you claim. Any change in name, address, telephone number, marital status or number of exemptions must be reported to your manager immediately, to ensure proper credit for tax purposes. The W-2 form you receive for each year indicated precisely how much of your earnings were deducted for these purposes.

From time to time, it may be necessary for you to perform overtime work in order to complete a job. If you are a "non-exempt" employee and you perform overtime work, you will be paid one and one-half (1-1/2) times your regular hourly wage for any time over 40 hours per week that you work.

Overtime is paid for "hours worked" and does not include vacation, sick, jury duty, paid holiday.

California Employees:

California has specific rules regarding overtime. Please consult with the HR Department for details on how this policy is modified under California law.

AKSM recognizes that meal and break periods are of great value in enhancing morale and productivity. Meal periods without pay are to be taken if your scheduled shift is greater than 5 hours. Likewise, a paid 15-minute break is permitted for those scheduled for an 8-hour shift.

For a meal break, it is the employee's responsibility to schedule at a time when there is adequate coverage for their area or at a time that is non-conflicting with the treatment schedule. Please understand that you may not "work through lunch" in order to arrive late, leave early, or work extra time.

At times it may be necessary for employees to remain on duty and work during their meal period due to lack of immediate coverage for the meal period. In these cases, the employee is paid for their entire meal period. When completing their time sheets, the employee must mark "no lunch" on the specific date.

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This page is reserved for future use.

This page is reserved for future use.

We hope you will manage your financial affairs so that we will not be obligated to execute any court-ordered wage assignment or garnishment against your wages. However, whenever court ordered deductions are to be taken from your paycheck, you will be notified.

According to the Federal Wage Garnishment Act, two (2) or more garnishments by separate creditors in a twelve-month period may be cause for dismissal.

Every effort is made to avoid errors in your paycheck. It is your responsibility to review your paycheck, your receipt. If you believe an error has been made, tell your manager immediately. Any necessary correction will be made and this correction will be noted on your next paycheck.

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AKSM is very pleased to offer employees a comprehensive insurance package. These benefits are available (on a sliding scale) to all employees if hired to work at least 40 hours per pay period or if by hire agreement employee qualifies to receive medical benefits.

HEALTH- INCLUDES DENTAL & VISION- SLIDING SCALE- ALL AMOUNTS LISTED ARE PER PAY:

Group Life Insurance:

AKSM will provide 1x annual salary Group Life Insurance for all employees scheduled 40 hours or greater per pay period. Additional coverage is available at employee cost.

Optional Life Insurance:

All employees working 40 hours or greater per pay period will have the opportunity to purchase additional Life Insurance. The employee will pay 100% of the cost.

Short Term Disability (STD) Insurance:

All employees working 40 hours per pay period or greater will be covered by STD Insurance. The entire cost of this policy for only the employee will be paid by AKSM.

Long Term Disability Insurance:

All employees working 40 hours per pay period or greater will have the opportunity to purchase Long Term Disability Insurance. The employee will pay 100% of the cost.

401 (k) Retirement Savings Plan:

All employees scheduled to work 40 hours or greater per pay period may participate during the first quarterly open enrollment period (1/1, 4/1, 7/1, or 10/1), following the completion of 6 months of employment and 500 service hours. AKSM will match 50% of the employee`s contribution up to 3%, i.e. an employee must contribute 6% of his or her salary to receive the maximum 3% match by AKSM.

A contingent employee must work at least 1000 hours and one year of service to be eligible for the plan. If the employee completes 1000 hours and one year of service, then such employee will enter the plan on the entry date following completion of the year of service, provided the employee is employed by the Employer on that entry date.

You are entitled to take off up to three (3) workdays with pay to attend the funeral and take care of personal matters related to the death of a member of your immediate family.

Immediate family is defined as:

 

A PARENT

SPOUSE

SPOUSE'S PARENT

CHILD

SPOUSE'S CHILD BY FORMER MARRIAGE

BROTHER

SISTER

A one (1) day paid funeral leave will be granted in the case of the death of:

 

GRANDPARENT

SPOUSE'S GRANPARENT

With your manager's approval, you may take up to one full day to attend funerals of other relatives and friends. You must take this time from your TAP bank if available.

"Workday" is defined as eight (8) hours for full time employees and will be prorated accordingly for part time employees.

Employees scheduled to work 19 hours or less per week are not eligible for this benefit.

An excused absence for family death may not be retroactive, postponed, or split. The employee must provide verification of need (obituary, death certificate, etc.).

AKSM recognizes that employees need time off from work in the event of illness, injury or pressing personal matters. AKSM provides employees with sick days to use in the event of illness or injury and a personal day to use for pressing personal matters.

Sick days, personal day and vacation days are not interchangeable.

Sick Days:

Unless otherwise required by applicable law:

• sick days are to be used for illness or injury.
• sick days are not to be used for scheduled medical, dental or other appointments.
• if scheduled appointments cannot be arranged outside of work hours, vacation or personal time should be used.
• if an employee will be absent due to illness or injury, the employee should notify his or her direct supervisor/manager as soon as reasonably possible.
• full time employees are provided five (5) paid sick days per year following completion of a ninety (90) day orientation period and thereafter on each employment anniversary.
• part-time employees are provided a pro-rated number of paid sick days per year, based upon the number of scheduled hours per the employee`s offer letter, following completion of a ninety (90) day orientation period.
• contingent employees are not eligible for paid sick days.

If you are absent because of illness or injury, to the extent permitted by applicable law, you may be required to submit written documentation from a medical professional: (i) confirming the illness or injury; and/or (ii) that you are able to resume normal work duties before you will be allowed to return to work. You will be responsible for any charges made by a medical professional for this documentation. This documentation will be placed in your personnel file.

If you are absent due to illness or injury after exhausting your sick days and are not on leave under the Family and Medical Leave Act, you must use your available personal day and vacation days to cover the absence, except as otherwise required by applicable law.

Personal Day:

The Personal Day may be used for any purpose.

If an employee will be using his or her Personal Day for a scheduled matter, the use of the Personal Day must be coordinated and approved in writing by the employee`s direct supervisor/manager.

If an employee will be using his or her Personal Day for an unscheduled emergency, the employee must notify his or her direct supervisor/manager as soon as reasonably possible.

Full time employees are provided one paid (1) personal day per year following completion of a ninety (90) day orientation period and thereafter on each employment anniversary.

Part-time employees are provided a pro-rated number of paid personal hours, based upon the number of scheduled hours per the employee`s offer letter, following completion of a ninety (90) day orientation period.

Contingent employees are not eligible for paid personal leave.

Abuse of Paid Sick Leave:

Employees must use sick leave for its intended purpose. Management will monitor employee use of sick leave for indications of abuse. Abuse of paid sick leave may result in disciplinary action up to and including termination of employment.

Accumulation of Sick Days and Personal Day:

Except as otherwise required by applicable law, sick days and personal days may not be carried over and accumulated in subsequent years. Exceptions to this policy may be made in unusual circumstances, each case to be considered separately by management.

Arizona, California and Georgia Employees:

Arizona, California and Georgia state laws have specific rules regarding paid sick leave. Arizona, California and Georgia employees should consult the supplemental materials posted on the AKSM online office for how this policy is modified by the law of their state.

The company provides paid time off for vacation and other personal needs of its employees. Sick days, personal days and vacation days are not interchangeable.

Eligibility:

Employees will begin to earn vacation benefits on their first day of employment.

Earning Vacation:

Full Time Employees:

Full time employees earn vacation benefits on a pro-rata basis in accordance with the following schedule:

Length of Continuous Employment	Maximum Vacation Benefits per Employment Year	Earned per hour until Maximum is reached
First Year	5 days (40 hours)	.02
After 1 year	10 days (80 hours)	.04
After 5 years	15 days (120 hours)	.06
After 10 years	20 days (160 hours)	.08

 

Part Time Employees:

Part time employees MAY be eligible to earn vacation benefits. Part time Employees must contact the Human Resources Department regarding eligibility.

Vacation Payout/Accumulation:

The intent of vacation time provided under this policy is that it be used during the twelve month period following the employee`s employment anniversary date ("Employment Year"). Employees will be paid for up to a maximum of the equivalent of one week of earned but unused vacation time (part time employees who are eligible for vacation benefits will be paid on a pro-rata basis based on scheduled weekly work hours) which remains as of the employee`s anniversary date each year. Earned but unused or unpaid vacation time may not be carried over and/or accumulated in subsequent employment years. Exceptions to this policy may be made in unusual circumstances, each case to be considered separately by management, or as expressly required by applicable state and local law.

Calculation of Vacation Pay:

Calculation of vacation pay does not include incentive pay, bonuses, or other special forms of compensation.

Scheduling Vacation:

Effort will be made to grant an employee`s request for vacation at the time he or she desires to take it; however, the company must maintain adequate staffing at all times and all requests for vacation are subject to denial.

Vacation schedules must be coordinated and approved in writing by the employee`s direct supervisor/manager. Requests for vacation must be submitted in writing to the employee`s direct supervisor/manager with a reasonable amount of advance notice to permit the employee`s supervisor/manager to evaluate the request.

Any denial of a vacation request may be reconsidered by management if operational needs and/or circumstances change.

An employee may, in an emergency, use vacation time to cover unscheduled absences; however, excessive unscheduled absences will result in disciplinary action, up to and including termination of employment. Employees may not work unpaid in lieu of taking vacation, personal or sick time.

An employee may submit a request to use vacation time that has not yet been earned. If the request is granted and the employee separates from employment prior to earning the amount of vacation time used, the employee`s final paycheck will be reduced by the dollar amount equal to the used but unearned vacation time.

Holiday Pay During Vacation:

Employees who are on paid vacation leave will receive holiday pay when any company recognized holiday occurs during the scheduled vacation. For example, if an employee takes vacation for the week of Thanksgiving, the employee will be paid for three days of vacation and two holidays.

Note: Employee must be an actively working employee to receive Holiday Pay.

Separation from Employment:

When an employee separates from employment the employee will receive compensation for unused earned vacation time or will have their final paycheck reduced by the amount of used but unearned vacation time.

Calculating Compensation or Reduction upon Separation of Employment:

Calculations are based on 2,000 annual hours for full time employees. Calculations for part time employees who are eligible for vacation benefits will be made on a pro-rata basis of the 2,000 annual hours.

 

Earned Vacation:

For illustrative purposes only the following is an example of an employee who separates from employment with earned but unused vacation benefits:

A full time employee makes $10.00 per hour and is eligible to earn 10 days (80 hours) of annual vacation benefits. The employee separates from employment after working 25 business days (200 hours) of the 2nd Employment Year without using any vacation time.

80 hours/2000 hours = .04 hour of vacation time earned per hour
200 hours x.04 = 8 hours earned vacation time
$10.00 hourly wage x 8 hours of earned vacation time = $80.00

The employee will be paid $80.00 for EARNED but unused vacation time.

 

Unearned Vacation:

For illustrative purposes only the following is an example of an employee who separates from employment after using unearned vacation benefits:

A full time employee makes $10.00 per hour and is eligible to earn 10 days (80 hours) of annual vacation benefits. The employee separates from employment after working 25 business days (200 hours) of the employment year and the employee took 2 full days of vacation.

80 hours/2000 hours = .04 hour of vacation time earned per hour
200 hours x .04 = 8 hours earned vacation time
16 hours of vacation used - 8 hours earned = 8 hours of unearned vacation
$10.00 hourly wage x 8 hours of used but unearned vacation time = $80.00

The employee`s final paycheck will be reduced by $80.00 for use of UNEARNED vacation time.

TAP Quickview:

As a convenience to the employee earned vacation will be calculated and recorded in TAP Quickview on AKSM Online Office. Vacation is earned based on employee`s actual employment anniversary date. Accordingly, it is for administrative purposes only that the maximum amount of annual vacation time an employee is eligible to earn is placed into TAP Quickview on the first day of the month of the employee`s anniversary date. As a convenience to the employee earned vacation will be calculated and recorded in TAP Quickview.

Employees are permitted to use the information contained in TAP Quickview to aid the employee in requesting and scheduling vacation time ONLY. Employees must notify their manager immediately if they feel there is an error in TAP Quickview.

Employees are not permitted to rely on the information contained in TAP Quickview in determining what, if any, vacation time will be paid and/or what dollar amount, if any, the employee`s final paycheck will be reduced by upon separation of employment.

California Employees:

California State law has specific rules regarding vacation time. California employees should consult the Supplemental Employee Handbook for California Employees on how this policy is modified under California law.

The following holidays are recognized by AKSM as paid holidays:

• New Years Day
• Memorial Day
• 4th of July
• Labor Day
• Thanksgiving
• Day after Thanksgiving for non-clinical employees or Float Holiday* for clinical employees
• Christmas

All holidays are scheduled on the day designated by common business practice.

Full time employees will receive eight (8) hours of holiday pay for each recognized holiday.

Part-time employees will receive a prorated amount of holiday pay, based upon the number of scheduled hours per the employee`s offer letter, for each recognized holiday.

Contingent employees are not eligible for holiday pay.

An employee will receive holiday pay if a recognized holiday falls during the employee`s ninety (90) day orientation period.

* Float Holiday

Non-clinical employees are not provided with a Float Holiday because the day after Thanksgiving is a recognized holiday for all non-clinical employees.

For all clinical employees, the day after Thanksgiving is recognized as a float holiday. AKSM will not cancel treatment schedules on this day. Each area manager will determine appropriate staffing to cover the needs for their area.

Employees who have been approved in advance to be off will receive float holiday pay for that day even if no cases are scheduled. The staff required by management to work on the day after Thanksgiving, or required by management to be on call, will have the use of the float holiday for a later scheduled date chosen by the employee and approved by management. Work schedules of mobile personnel must consist of actual patient treatments or be approved by the manager. Data entry will not be approved on that date unless directed by the manager.

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While we hope both you and AKSM will mutually benefit from your continued employment, we realize that it may become necessary for you to leave your job with AKSM.

You may resign your position at any time, with or without cause, with or without notice, for any reason or no reason at all, except as otherwise provided by applicable law or contract. If you anticipate resigning your position with AKSM, AKSM requests that you notify your manager at least two (2) weeks in advance of the date that you leave. Management employees are requested to give four (4) weeks notice.

In the event of termination of employment, earned vacation time will be paid out. Except as otherwise required by applicable law, sick, holiday or personal days not utilized prior to termination will not be paid out at the time of termination of employment.

AKSM property is provided to employees so that they are able to do their jobs in a thorough and efficient manner. All property issued by AKSM to its employees is and will remain the property of AKSM. Limited use of such property for personal use may be acceptable with prior written approval from the employee's immediate supervisor.

Property Agreement:

 

Employees are responsible for items issued to them or in their possession or control. Each time an item is issued to an employee, the employee must sign a property agreement acknowledging receipt of the item. The Agreement must provide a description of the property, the condition of the property (New, Excellent, Good, or Fair) and the serial number. The Agreement must inform the employee of their obligation to return said property when a member of management asks them to do so or when their employment with AKSM terminates for whatever reason. This Agreement must be reviewed and updated annually.

Lost, Damaged, or Stolen Property:

 

It is the employee' s responsibility to review and update the Agreement to ensure that company records accurately reflect all property in the employee's possession. If any AKSM Property is lost, damaged, or stolen, the employee must inform their immediate supervisor as well as complete the on-line Incident Reporting Tool. Replacement of the item and who will be responsible for the cost of replacement will be determined on a case-by-case basis. If AKSM determines the item was lost, damaged, or stolen as a result of the employee's negligence or fault, the employee may be required to pay AKSM the replacement cost of the item.

Examples of AKSM property issued to Employees:

 

Examples of property issued to AKSM employees include but is not limited to the following:

• Computer equipment
• Printers
• Scanners
• Fax Machines
• Keys
• Manuals
• Cellular Mobile phones
• Pagers
• Parking permits
• Vehicles
• Written materials
• Video training films

Return of Property:

 

Upon request of management or upon termination of employment, employees must immediately return all property listed on the Property Agreement as well as any other AKSM property in their possession. The property must be in the same or substantially similar condition as when the employee received it.

Payroll withholdings:

 

Failure to return AKSM property will result in the employee being charged the replacement cost of said item(s). AKSM will withhold from the employee's check or final paycheck the replacement cost of any items that are not returned when required. The employee's final paycheck will not be issued to an employee until all AKSM property is returned and/or all amounts due to AKSM are paid in full.

Theft:

 

Failure to return AKSM property and not pay the replacement costs necessary to replace said item(s) is Theft. AKSM will take all actions, civil and/or criminal, deemed appropriate to recover or protect its property.

In instances where an employee voluntarily leaves our employ, AKSM management would like to discuss your reasons for leaving and any other impressions that you may have about AKSM. If you decide to leave, you will be asked to grant us the privilege of an exit interview. During the exit interview, you can express yourself freely. It is hoped that this exit interview will help us part friends, as well as provide insights into possible improvements we can make.

In the event you leave the employ of AKSM, we will, upon your written request, provide you with a letter confirming that you worked at AKSM for a specific period of time.

As an employee, do not, under any circumstances, respond to any requests for information regarding another employee unless it is part of your assigned job responsibilities. If it is not, and you receive a request for a reference, you must forward the request to the Human Resources Department or management for a response.

Whenever people gather together to achieve goals, some rules of conduct are needed to help everyone work together efficiently, effectively, and harmoniously. At AKSM, we hold ourselves to a high standard of quality where the rules and authority figures simply assure that quality is maintained.

By accepting employment with us, you have a responsibility to AKSM and to your fellow employees to adhere to certain rules of behavior and conduct. The purpose of these rules is not to restrict your rights, but rather to be certain that you understand what conduct is expected and necessary. When each person is aware that he or she can fully depend upon fellow workers to follow the rules of conduct, then our organization will be a better place to work for everyone.

Certain standards of employee conduct are necessary for the efficient operation of AKSM and for the benefit and safety of all employees. Conduct that interferes with operations, discredits AKSM, or is offensive to fellow employees or customers will not be tolerated.

AKSM reserves the right to determine the appropriate level of discipline for any behavior problem.

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All employees at one time or another will receive or have access to Confidential Information. Any employee in possession of any Confidential Information must maintain the confidentiality of such information. An employee may not disclose to any unauthorized third party any Confidential Information or use such information other than in furtherance of AKSM's legitimate business purposes.

"Confidential Information" means any proprietary or other non-public information, licensure, certification, accreditation and permit information, cost and expense data, business and development plans, processes, management techniques, operating records, patient mix data, technologies, utilization data, regulatory compliance data, service know-how, technical expertise regarding the operation of equipment relating to the operations of any of the parties, marketing data, distribution methods or data, third-party and managed-care agreements and other contractual arrangements, all information pertaining to the development and syndication of provider-owned entities engaged in the establishment and operation of facilities, such written, oral, or graphic information that may not be generally determined from public or published information, technical data, trade secrets or know-how, including, but not limited to, research, plans for research, product plans, products, processes, designs, formulas, methods, developmental or experimental work, improvements, marketing and sales information, budgets, draft or unpublished financial information or statements, services, suppliers, customer lists and names and contact information of actual and prospective customers, prices and costs, information regarding the skills and compensation of other employees or consultants of AKSM, home address and telephone information of other employees and consultants, hardware and software configurations, developments, inventions, laboratory notebooks, designs, drawings, and any and all tangible and intangible information relating to the business of AKSM which is not known by actual or potential competitors of AKSM or by the general public, or is proprietary information of AKSM or its customers or suppliers, whether of a technical nature or otherwise.

Proprietary information includes information or knowledge that AKSM has determined must not be disclosed to others, except as required by law or permitted by AKSM policy, because doing so could disadvantage AKSM competitively or financially or because the information belongs to others (e.g., customers or suppliers) and AKSM has agreed to maintain the confidentiality of such information.
All employees at one time or another will receive Confidential Information. Any employee in possession of any Confidential Information must maintain the confidentiality of such information. An employee may not disclose to any unauthorized third party any Confidential Information or use such information other than in furtherance of AKSM's legitimate business purposes. Upon termination of employment, all Confidential Information held by an employee must be returned to AKSM; and an employee has an ongoing and continuing obligation to maintain the confidentiality of AKSM's Confidential Information following the employee's termination of employment.

Employee's Responsibility: Each employee is responsible for ensuring that Confidential Information is protected from theft, damage, unauthorized disclosure or inappropriate use. Confidential Information should only be disclosed within AKSM to those employees who need to know such information in the performance of their duties. When there is a legitimate business need to disclose Confidential information outside AKSM, a nondisclosure agreement is required, and the General Counsel of AKSM or his designee must be consulted. Documents containing Confidential Information should not be left unattended and should be maintained in secure areas when not in use. When routed by inter-office mail, documents containing Confidential Information should be appropriately designated or marked (e.g., "secret" or "confidential") and should be secured from public view while in transit. AKSM employees will always use common sense to help prevent accidental disclosure of Confidential Information. It is important to remember that it is easy to be overheard in public places such as airplanes, elevators and restaurants, and when using portable communications devices.

If in doubt about whether to release Confidential and/or proprietary information or about the conditions for releasing it, employees shall not disclose such information without consulting their supervisor or the Legal Department of AKSM or his designee. Employees will immediately notify their supervisor if Confidential Information is lost, stolen or compromised. Employees will report any attempt by unauthorized persons to obtain Confidential Information.

Upon termination of employment, all Confidential Information held by an employee must be returned to AKSM. All employees have an ongoing and continuing obligation to maintain the confidentiality of AKSM's Confidential Information following the employee's termination of employment.

Any unauthorized disclosure of Confidential Information will result in immediate disciplinary action that could include immediate termination.

PURPOSE:

 

To provide timely documentation of the condition of a patient, employee or equipment within a 24 hour period following an unusual incident or the knowledge of such.

POLICY:

 

It is the goal of AKSM to maintain high standard of quality care for patients, employees and equipment. It is the duty of all AKSM employees to completely and accurately document all problems, incidents or damage encountered. All reports shall be recorded via the On-Line Reporting tool.

 

Additional photo documentation may be required for equipment damage beyond minor cosmetic level.

 

The appropriate manager will follow-up with the personnel to discuss issues related to the incident and to determine the proper course of action to be taken.

 

Failure to report an incident completely and accurately may lead to disciplinary action up to and including termination.

PURPOSE:

To create a Compliance Officer (CO) position that will serve as the focal point for compliance activities and be responsible for oversight of the development, implementation and daily operation of the compliance program.

POLICY:

1. The CO`s primary responsibility is the implementation and effective operation of the AKSM compliance program.
2. Organizationally, the CO will be located in the office of the Chief Operating Officer who will provide day-to-day supervision. In addition, the CO will (a) report regularly to the C.E.O. and have direct access to the Board of Managers, (b) have authority to investigate compliance violations and act as needed, and (c) have access to review all needed information, including contracts, billing records, and contractual arrangements.
3. The Audit Committee of the Board of Managers will provide Board-level oversight of the CO`s activities.
4. The CO will report quarterly to the Audit Committee of the Board on the implementation of the Compliance Program.

COMPLIANCE OFFICER RESPONSIBILITIES

The Compliance Officer will:

1. Oversee and monitor the design, implementation and continuous improvement of the compliance program.
2. Review and update the AKSM Code of Conduct as needed to ensure its continuing currency and relevance in providing guidance to management and employees.
3. Develop, maintain, and revise compliance policies and procedures for the operation of the compliance program and related activities to prevent illegal, unethical, or improper conduct.
4. Implement organization-wide training and communication programs to ensure that all employees are educated on the Code of Conduct and the compliance program.
5. Develop and manage a "Hotline" system and other "feedback" mechanisms that encourage managers and employees to report suspected fraud and other improprieties without fear of retaliation.
6. Independently investigate and act on matters related to compliance and ensure that corrective actions are taken where indicated.
7. Develop and oversee a system for uniform enforcement of violations of rules, regulations, policies, procedures, and the Code of Conduct and, where appropriate, ensure proper reporting of potential violations of law to the duly authorized law enforcement agencies.
8. Respond appropriately if a violation is uncovered, including a direct report to the Board of Directors or external agency if deemed necessary.
9. Identify areas of potential compliance vulnerability and risk; and thereafter provide specific direction for the resolution of problematic issues, as well as general guidance to the organization on how to deal with similar situations.
10. Ensure that employees, medical staff, contractors and vendors are properly screened against the HHS/OIG List of Excluded Individuals and Entities (LEIE) and the GSA Debarment List.
11. Prepare periodic reports and evidence for the Board on the progress and effectiveness of the compliance program.

PURPOSE:

 

Individuals assigned to the Compliance Office have access to highly confidential and in some cases privileged information. Much of this information will pertain to privacy related issues. All such information must be treated in a fiduciary manner.

POLICY:

 

Everyone who works in or on behalf of the Compliance Office will be instructed in the importance of confidentiality and their role as a fiduciary for compliance-related matters. Every individual who works in the Compliance Office must sign the AKSM Confidentiality Agreement.

PROCEDURES:

 

1. Compliance Office employees must agree to maintain in confidence all information derived from their employment with AKSM, especially information related to their compliance-related duties. The Compliance Office staff must agree, both during and after the term of their AKSM employment, NOT TO:
   • Disclose any confidential information regarding AKSM or its clients to any person, firm, corporation, association or other entity for any reason or purpose whatsoever, or
   • Use confidential AKSM information for personal advantage.
2. Confidential information is any and all information learned through employment with AKSM that is not known to the general public. This information includes, but is not limited to:
   • Patient information
   • Financial information
   • Technical information
   • Information relating to the contents of contracts
   • Any other proprietary or valuable information of AKSM or its patients.
3. Upon termination of employment with AKSM, the Compliance Officer and any other individuals engaged in the compliance program must agree NOT to retain the original or any copies of any file, document, record, or memorandum relating in any manner whatsoever to AKSM, its patients, employees, vendors or shareholders, regardless of whether it was prepared by the individual or otherwise came into their possession. All such files, documents, records, and memoranda in the possession of anyone employed by or assigned to the AKSM Compliance Office will be returned to AKSM prior to employment termination.
4. In acknowledgement of the above, the Compliance Officer and any other employees assigned to the Compliance Office will sign the AKSM Non-Disclosure Agreement, which will be maintained in the individual's Human Resources file.

PURPOSE:

 

To ensure the proper management and destruction of compliance program records, including maintaining the confidentiality of all individuals who report incidents or situations to the Compliance Office.

BACKGROUND:

 

The Compliance Office may receive and/or generate a substantial volume of documents and other information, in both electronic and hard copy format (hereafter "records"). Certain records must be maintained for given periods of time as specified by laws, regulations, or contractual obligations. Other records provide evidence of the operation of the compliance program itself. Records relating to a specific incident must be retained even beyond the established retention period if an internal review or investigation is being conducted. Otherwise, all records should be destroyed on a periodic basis.

POLICY:

 

1. The AKSM Compliance Officer (CO) is responsible for implementing AKSM's Compliance Program Records Management policy. Specifically, the Compliance Officer will:
• Maintain all records for the minimum period required by applicable state or federal law/regulation.
• Retain records that substantively affect the obligations of the company or the Compliance Office.
• Regularly destroy records pursuant to a standard policy and established records retention schedule.
• Ensure that records are secure and private and protect employee and client privacy rights, as well as AKSM proprietary information.
2. No records will be altered or destroyed in anticipation of a government investigation or that have been requested pursuant to a matter of litigation.

The American Kidney Stone Management, Ltd. ("AKSM, Ltd.") and Innovative Medical Technologies, LLC ("IMT") companies ("Companies") are committed to providing high quality care and services and conducting their respective businesses ethically and in compliance with all applicable federal, state and local laws and regulations ("Applicable Laws") and professional standards.

To support this commitment and as an essential part of their compliance programs, AKSM, Ltd. and IMT each maintain a written Code of Conduct (together, the "Codes of Conduct") stating the objectives that the Companies strive to meet in all circumstances. Employees are expected to use the Codes of Conduct to guide them to make the right decisions when dealing with both routine and complex situations encountered as part of their daily activities, including but not limited to those related to:

• Quality of care and services
• Compliance with laws and regulations
• Billing, coding and records integrity
• Conflicts of interest
• Physician owners
• Human resources
• Health and safety
• Safeguarding resources and assets
• Communication and the open door policy
• Reporting issues and concerns
• Non-retaliation policy
• Hotline reporting process

Employees must adhere to the Codes of Conduct and all Applicable Laws when performing their jobs. Promotion of, and adherence to the Codes of Conduct will be factors in evaluating the performance of employees and will be considered in decisions regarding promotion and compensation of employees.

The Companies rely on their employees to identify potential issues in order that they can be timely and appropriately addressed. If an employee becomes aware of or has a reasonable suspicion of a violation of Applicable Laws or the AKSM or IMT Codes of Conduct, the employee must report the violation or suspected violation immediately in accordance with the policy on Compliance Reporting and Non-Retaliation. AKSM and IMT have a strict non-retaliation policy to protect employees who report issues and concerns in good faith.

Failure to adhere to the Codes of Conduct or to timely report violations of Applicable Laws or the Codes of Conduct may result in disciplinary action up to and including termination of employment.

PURPOSE:

 

The development and implementation of regular education and training for employees are integral parts of an effective compliance program. The AKSM training program is designed to familiarize employees with the Compliance Program, the Code of Conduct, the Compliance Office, and how compliance applies in the work environment. This policy spells out the specific goals and component of the Employee Compliance Training Program.

POLICY:

 

All employees, including new hires, will receive regular compliance training. Initial compliance training for all employees should be completed within 6 months after the compliance program is established. New employees will be trained within 30 days after the start of their employment with AKSM. Thereafter refresher compliance training will be conducted annually.

1. Compliance training is mandatory for all members of the Board of Managers and for all employees, including executive leadership, management, clinical staff and office staff. Approximately 1 hour of compliance training will be provided every year.
2. Evidence of employee training will be obtained by training acknowledgement forms that will be maintained both in the compliance office and in the employee's human resources file.
3. Training materials will be standardized, so that everyone who signs the acknowledgement form will have received the same training. Curriculum materials will be written in clear, straightforward language that all participants can readily understand.
4. The AKSM Compliance Officer (CO) will deliver compliance training or an individual designated by the CO who has been properly trained to present the training. Compliance trainers must be knowledgeable of (a) the AKSM compliance program, (b) applicable federal laws, regulations and guidance, (c) AKSM compliance policies and (d) the AKSM Code of Conduct.
5. To ensure the greatest value, consideration will be given to using interactive training, including case studies of real-life situations that could occur on the job.
6. At a minimum, the training content will cover:
• An explanation of how the compliance program is structured and operated, including introduction of the compliance officer.
• A thorough review of the Code of Conduct.
• A discussion of how to apply the Code to everyday work situations, including employees' affirmative duty to adhere to the Code and the potential consequences for failure to do so.
• Reference to selected compliance policies as appropriate.
• The open lines of communication AKSM has established to encourage employees to report problems, emphasizing AKSM's non-retaliation policy and the AKSM C.E.O.'s absolute commitment to non-retaliation.
• The ability to report outside the chain of command, including discussion of the Employee Hotline with assurance of confidentiality and anonymity.

PROCEDURES:

 

1. The CO will develop the compliance training and ensure that it meets the policy requirements discussed above.
2. Every employee will participate in compliance training and will receive a copy of the AKSM Code of Conduct.
3. Every employee will acknowledge receipt of the Code and participation in training by signing and dating a Training Acknowledgement Form (attached). The original signed form will be retained in the Compliance Office and a copy will be retained in the employee's personnel file.
4. The training content will adhere to the requirements spelled out above.
5. At the conclusion of the training session, employees will be asked to complete a short training evaluation form (copy attached). To promote honest and candid feedback, the training evaluation forms will be completed anonymously. After the training, the CO will analyze the evaluations to identify ways in which the training can be improved.

PURPOSE

 

AKSM is committed to the timely identification and resolution of all issues that may adversely affect employees, patients or the organization. To operationalize this commitment, AKSM has established communication channels to report problems and concerns including a telephone hotline. Employees are encouraged to report problems or concerns either anonymously or in confidence via the hotline when they deem appropriate. The hotline establishes an avenue for employees or interested parties to report suspected criminal activity or illegal or unethical conduct occurring in the organization in the event that other resolution channels are ineffective or the caller wishes to remain anonymous.

POLICY

 

1. AKSM will maintain a telephone hotline that employees may use to report problems and concerns either anonymously or in confidence.
2. Employees who report problems and concerns via the hotline in good faith will be protected from any form of retaliation or retribution.
3. All employees who handle hotline reports are expected to act with utmost discretion and integrity in assuring that information received is acted upon in a reasonable and proper manner. Everyone who receives or is assigned responsibilities for hotline reports shall agree to the terms of confidentiality.
4. The Compliance Officer (CO) is responsible for operation of the hotline. This includes ensuring that all hotline calls are addressed in an appropriate and timely manner, as well as in accordance with this and all related policies and procedures. Other responsibilities include:
• Ensuring proper functioning of the hotline;
• Establishing reporting and records maintenance procedures;
• Conducting appropriate investigations and follow-up;
• Referring calls when appropriate;
• Providing feedback to callers when necessary;
• Reporting hotline activity to the company C.E.O.; and
• Maintaining security for all calls and related documents.

PROCEDURES

 

1. Hotline operations (call receipt and reporting) will be conducted by an outside agency that specializes in handling employee hotlines in the health care industry. The CO is responsible for ensuring that the outside agency fulfills its contractual obligations and maintains an appropriate level of service and effectiveness.
• Calls will be documented on the confidential hotline intake form and forwarded to the CO.
• Callers will be provided an identification number to protect their identity.
• All callers to the hotline will hear the same pre-recorded message explaining their rights, any limitations, non-retaliation policy, and other pertinent information.
• No attempt will be made to identify a caller who requests anonymity.
• Whenever callers disclose their identity, it will be held in confidence to the fullest extent practical or allowed by law.
2. Once a report is received, the CO will conduct appropriate follow-up and investigation. This process may involve other departments, as appropriate, for advice or further investigation. All matters relating to the investigation will be handled with discretion and held in confidence to the fullest extent practical. If the CO is not, in good faith, satisfied that a matter brought before other departments was appropriately addressed and resolved, the CO will be responsible for and is authorized to take the matter to other persons in positions of authority.
3. The CO will bring all calls to final resolution and closure.
4. The CO will report periodically to the C.E.O. and the Audit Committee of the Board regarding hotline activity. The report will include the total number of calls received, actions taken, and general results from the hotline operation. The report will also include any recommendations for system-wide improvements or corrective actions arising from the results of the operation and related investigations.
5. The CO will maintain all hotline records, including investigative information, in a locked cabinet with access limited to officially authorized individuals. Hotline records will be retained for 5 years.

AUDITING OF THE HOTLINE

 

1. To ensure that the hotline is operating in conformance with its objectives and procedures, the CO (or a designated independent entity) will conduct periodic audits of all aspects of the hotline operation.
2. Hotline audits will focus on the following areas:
   
   Receiving Calls:
   • Are calls to the hotline answered promptly?
   • Do callers hear a prerecorded message?
   • Does the operator ask a set of uniform questions, treat callers professionally, and encourage them to elaborate on all critical areas covered by their call?
   • Are callers given an appropriate report identification number and thanked for calling the hotline?
   
   Logistics and Operations:
   • Is AKSM's telephone system structured to ensure the origin of a hotline call is not identified on the AKSM telephone bill and cannot be traced?
   • Are documents maintained in a secure area, in accordance with AKSM's records management policy? Are all logs and summary documents maintained in such as way as to protect callers' anonymity and confidentiality?
   • Are follow-up and investigative activities handled promptly and appropriately?
   
   Effectiveness:
   • Do employees view the hotline as a viable communications channel?
   • Do employees feel they can call the hotline anonymously or in confidence and without fear of retaliation?
   
   
3. The CO will report periodically to the C.E.O. and Audit Committee of the Board on the results of hotline audits, and will recommend any needed changes for the C.E.O.'s approval.

HOTLINE NUMBER

 

The toll-free hotline phone number is 1-800-826-6762

PURPOSE:

 

AKSM is committed to following uniform enforcement and discipline practices for individuals who fail to comply with federal and state laws, regulations, guidelines and policies, and the AKSM Code of Conduct. This policy and its supporting procedures spell out these practices for all AKSM employees, supervisors, and executives.

POLICY:

 

1. AKSM will comply with all laws and regulations, the principles set forth in the Code of Conduct, the AKSM Policy Manual, and the specific policies and procedures relating to each department and discipline.
2. All individuals, regardless of position, who fail to comply will receive consistent and appropriate discipline.
3. Consistent enforcement and disciplinary actions will be taken for all substantiated violations of rules, regulations, compliance policies, and the Code of Conduct.
4. Management is responsible for ensuring that employees under their supervision receive adequate training on compliance relevant to specific job duties and responsibilities.
5. All managers must take reasonable steps to prevent violations of the Code of Conduct by providing proper guidance and monitoring of employee activities.

PROCEDURES:

 

1. AKSM managers will discipline employees under their supervision in an appropriate and consistent manner. The type of disciplinary action will be determined on a case-by-case basis and, where appropriate, in consultation with the Compliance Officer (CO) and/or Human Resources. Discipline imposed in response to instances of non-compliance discovered through investigations conducted by the CO will likewise be determined on a case-by-case basis in consultation with Human Resources and the AKSM C.E.O. The range of sanctions will include verbal warnings, written warnings, written reprimands, probation, demotion, suspension, or termination, as appropriate.
2. Punishment for serious violations may subject an individual to immediate termination. Examples of serious violations include:
   • Intentional, reckless or negligent conduct that violates the Code of Conduct, applicable laws, or the program requirements of federal or state health plans;
   • Failure to report conduct that the individual knew was a violation of the Code of Conduct, applicable laws or the program requirements of federal or state health plans;
   • Willfully filing a false report or providing false information in connection with an organization or government investigation of an alleged violation; or
   • Failure to correct behavior for which an individual was disciplined previously.
   An individual whose conduct otherwise would justify termination may, at the sole discretion of the organization, have lesser discipline imposed as a result of voluntary disclosure of the violation and/or full and complete cooperation during any investigation.
3. Human Resources will inform the CO of any allegations of improper conduct by AKSM personnel and the basis for the allegations, and will provide the CO with copies of all documents related to disciplinary action, including reprimands, letters to the file, and notices of termination for disciplinary reasons.
4. The CO will review all disciplinary actions taken against AKSM personnel to (a) ascertain if they involve violations of applicable laws, program requirements of Medicare, Medicaid or other third-party payors, the Code of Conduct, or other compliance policies or procedures, and (b) to ensure that discipline for such violations is being imposed in an appropriate and consistent manner.
   
   If the CO concludes that inappropriate discipline will be or has been imposed, the CO will make recommendations to the C.E.O. and the Audit Committee of the Board. The C.E.O. may either accept the disciplinary sanction imposed or develop alternative measures.
5. Nothing in this policy shall be interpreted as granting AKSM employees any right to challenge or seek further review of the disciplinary action imposed upon them by their supervisor or by any other AKSM official. The review processes set forth in this policy are for the sole benefit of AKSM in an effort to enhance the effectiveness of its Compliance Program.

The AKSM and Innovative Medical Technologies companies employ various measures to avoid employing or engaging in a business relationship with persons or entities that have been excluded from a federal health care program and/or who are subject to sanction or adverse action that could impact compliance with applicable laws and regulations (Sanctioned Persons), including:

• requiring candidates for hire to answer questions on the employment application regarding past and pending exclusions and license sanctions and taking reasonable steps to verify that the employment application is complete;
• conducting background searches on candidates for hire;
• conducting credentialing verification of credentialed employees at time of hire and annually thereafter; and
• maintaining procedures to (i) screen employees, members of the AKSM Board of Managers and health care related contractors against the U.S. Department of Health and Human Services Office of Inspector General List of Excluded Individuals/Entities, the U.S. System for Award Management exclusion register, and various state Medicaid exclusion lists prior to hiring/board appointment and on a monthly basis during the period of hire/board appointment; and (ii) not employ or engage in a business relationship with a Sanctioned Person.

All employees are required to notify the AKSM HR Manager in the event that they become subject to, or become aware that anyone with whom the Companies conduct business have become subject to, any action, complaint, investigation or notification that has resulted in or could result in:

• exclusion, debarment or other prohibition from participation in a federal health care program including (including Medicare, Medicaid and other federal and state governmental programs) or federal procurement program; or
• the reduction, limitation, termination, revocation, suspension, probation or voluntary or involuntary relinquishment or withdrawal of any health care license, registration or certification and/or any other license related to such.

Failure to comply with the requirements above may result in disciplinary action, up to and including termination of employment.

The American Kidney Stone Management, Ltd. ("AKSM") and Innovative Medical Technologies, LLC ("IMT") companies recognize that a critical aspect of their respective compliance programs is establishing a culture that promotes prevention, detection and resolution of instances of conduct that do not conform to applicable federal, state and local laws and regulations ("Applicable Laws"), professional and ethical standards and the companies` policies.

To promote this culture, AKSM and IMT have established a compliance issue reporting process and a strict non-retaliation policy to protect employees and others who report compliance issues and concerns in good faith.

EMPLOYEE RESPONSIBILITIES:

An "open-door" policy is maintained at all levels of management to encourage employees to report actual or suspected compliance issues and concerns.

All employees who become aware of or reasonably suspect actual or potential violations of Applicable Laws, the AKSM or IMT Codes of Conduct, professional or ethical standards, the companies` policies or other compliance related issues ("Compliance Issues") have an affirmative duty and responsibility to immediately report the issue(s) to their manager, the Compliance Officer or the Human Resources Department.

Employees may all call the toll-free ComplianceHotline Phone number at 1-800-826-6762 to report actual or suspected Compliance Issues and concerns. Callers to the hotline may remain anonymous.

All management employees are required to immediately report all Compliance Issues to the Compliance Officer.

While employees cannot exempt themselves from the consequences of their own misconduct by reporting an issue, self-reporting may be taken into account in determining the appropriate course of action.

RESOLUTION PROCESS

All potential Compliance Issues will be resolved and/or investigated, as applicable, in accordance with the policies on Compliance Issue Resolution and Investigating Alleged Wrongdoing.

NON-RETALIATION:

Any form of retaliation against any employee who reports a perceived Compliance Issue or concern in good faith is strictly prohibited. The AKSM and IMT companies will not take any retaliatory action against any employee for:

• Exercising any right under, or participation in any process established by Applicable Laws;
• Reporting a perceived Compliance Issue in good faith to any manager, the Compliance Officer or the Human Resources Department;
• Testifying, assisting, or participating in an AKSM or IMTinvestigation, compliance review, proceeding, or hearing; or
• Opposing in good faith any act or practice which is a violation of Applicable Laws, the AKSM or IMT Codes of Conduct, professional or ethical standards or the companies` policies.

Any employee who fails to timely report a Compliance Issue or commits or condones any form of retaliation will be subject to disciplinary action, up to and including termination.

PURPOSE:

 

To establish a framework for managing and responding to compliance issues reported to the Compliance Officer.

BACKGROUND:

 

AKSM is committed to an organizational culture that promotes prevention, detection and resolution of misconduct. Communication channels for employees to report problems and concerns are an important element of an open culture and of the AKSM compliance program. Employees are encouraged to report issues via the normal chain of command, to Human Resources, the Hotline or directly to the Compliance Officer (CO). The CO is responsible for facilitating resolution of issues and problems arising from expressed employee concerns, complaints, and allegations (hereafter “complaints). For confirmed complaints, the CO is also responsible for determining whether the problems are systemic and warrant additional examination or broader action.

POLICY:

 

1. Employees may use any communication channel they deem appropriate to report issues. Retaliation or retribution for reporting issues in good faith is prohibited.
2. While the CO is responsible for resolving compliance-related issues only, employees should not be discouraged from using compliance communication channels to report their non-compliance concerns. The CO should redirect non-compliance related calls to the appropriate entity or department or politely redirect employees to the appropriate manager.
3. Any compliance issues related to the operation of the compliance program should be referred directly to the CO.
4. To the extent practical or allowed by law, the CO must maintain the confidentiality or anonymity of an employee when requested.

PROCEDURES:

 

1. Issues received by the CO, including those reported through the Hotline, will be either reviewed by the CO or referred to the appropriate AKSM entity or department for response within 20 working days.
2. Issues with the potential for legal liability or containing issues of a legal nature will be referred to legal counsel.
3. The CO should involve various members of the management and employee population when appropriate to resolve issues.
4. The CO will ensure that the following administrative steps are taken within one business day of receipt to ensure that matters brought to the CO's attention, including Hotline calls, will be resolved in a timely manner:
• Assign a unique file number to facilitate management of the issue to resolution;
• Log the matter into a tracking system to facilitate tracking the issue to resolution and reporting to oversight bodies;
• Assign for review or other action as appropriate;
• Establish and track deadlines to ensure timely resolution; and
• File in a manner that facilitates security, maintenance and retrieval of information.
5. For compliance-related issues, the CO or the CO's designee will conduct or oversee an initial inquiry that may include document review, interviews, audit or other appropriate investigative techniques. The CO or designee should (a) conduct a fair and impartial review of all relevant facts; (b) restrict the inquiry to those necessary to resolve the issue; and (c) conduct the inquiry with as little visibility as possible while gathering pertinent facts.
6. The CO should ensure that the following are accomplished:
• Fully debrief complainant when available;
• Notify appropriate internal parties;
• Identify cause of problem, desired outcome, affected parties, applicable guidelines, possible regulatory or financial impact;
• Determine the necessary corrective action measures (e.g., training/education, policy changes, operational changes, system changes, personnel changes)
• Develop a complete list of findings and recommendations;
• Document the inquiry;
• Ensure that recommended corrective action has been considered by management and appropriate action taken in a timely manner;
• Independently verify completion of recommended and agreed upon correction action; and
• Ensure that all inquiry records are maintained securely in accordance with the Compliance Office records management policy.

PURPOSE:

 

Allegations of wrongdoing in the workplace received by any AKSM employee will be acted upon immediately. Wrongdoing includes violations of the Code of Conduct, policies/procedures, rules, and regulations, as well as criminal acts. This policy sets forth the guidelines for investigating alleged violations.

POLICY:

 

The Compliance Officer (CO), in consultation with AKSM legal counsel where appropriate, will be responsible for directing internal investigations of alleged violations of the Code of Conduct, compliance policies, or applicable laws and regulations. If the allegation is criminal in nature, the CO will consult with AKSM legal counsel to determine whether to refer the matter to a law enforcement agency.

PROCEDURES:

 

An investigation consists of establishing scope, gathering facts (including conducting interviews), determining contributing factors for an allegation that is verified, and reporting findings and possible corrective actions. While no single approach will be appropriate to all circumstances, the following procedures should be considered and generally adhered to in conducting an investigation.

Establish the Scope of the Investigation considering the following factors:

• What is the nature of the allegation?
• Are pertinent documents available?
• Are the individuals who may have been involved available to interview?
• What is the time frame of the possible irregularity?
• How much time is available to complete the inquiry?

Gathering Facts:

• Gather facts as promptly as possible.
• Review all pertinent documents.
• Interview employees if appropriate.

Interviewing Employees:

• Treat interviewees with respect.
• Keep all information confidential, sharing it only with those who “need to know.”
• Protect the confidentiality of information sources.
• Conduct interviews in person and in private, with one interviewee at a time.
• Routine interviews can be conducted one-on-one.
• Sensitive interviews should be conducted by two people to ensure that the manner, circumstance and content of the interview are supported by a witness.
• Inform the interviewee that the purpose of the inquiry is to gather facts on behalf of the Compliance Office.
• Document the employee's full name, title, employment history, and supervisor's name.
• State that the interview will remain in confidence to the extent compatible with a proper resolution of all issues, correction of any improprieties, and AKSM' s need to disclose certain types of wrongdoing to enforcement and regulatory authorities.
• Offer no opinions on whether the employee has a problem, or how the matter under review would be resolved.
• If the employee to be interviewed is suspected of serious misconduct, legal counsel should be present. Counsel should advise the employee of the seriousness of the matter, AKSM's commitment to disclose the investigation's results to the government, and the employee's right to retain independent counsel. If the employee requests that his or her lawyer be present, suspend the interview immediately.

Reporting:

• The CO will prepare a written report of investigation findings.
• The report should be written assuming that it will eventually be read by an outside party. Do not assume that the reader will be familiar with AKSM or the nature of its business.
• Normally the report will be shared with the C.E.O., the Audit Committee of the Board, and legal counsel, with next steps determined based on guidance from legal counsel.

PURPOSE:

 

The Federal Sentencing Guidelines and the HHS/OIG Compliance Guidance documents call for a program of ongoing auditing and monitoring to ensure compliance. There are two areas in which auditing and monitoring should take place: (1) monitoring the effectiveness of the compliance program itself and (2) auditing the claims process to ensure that claims are properly coded, that medical documentation is complete, and that every step of the process is free from error.

An important component of the AKSM compliance program is the use of audits and/or other evaluation techniques to monitor compliance and assist in the reduction of identified problem areas. AKSM has established internal controls that promote adherence to applicable federal and state law, and the program requirements of Federal, State and private health plans. This policy focuses the organization's resources to monitor the effectiveness of the compliance program and to periodically audit identified risk areas.

POLICY:

 

AKSM will monitor the effectiveness of its compliance program and conduct periodic audits of identified compliance risk areas. The Compliance Officer (CO) will be responsible for monitoring the compliance program itself, and will facilitate the auditing of risk areas.

PROCEDURES:

 

Monitoring Compliance Program Effectiveness

1. On an annual basis, the CO will develop and carry out a program monitoring work plan designed to determine whether the various elements of the compliance program have been carried out effectively.
2. Any identified deficiencies will be included in the following year's work plan.
3. The CO will periodically report to the C.E.O. and the Audit Committee of the Board on the status and outcome of compliance program effectiveness monitoring.

Auditing and Monitoring Compliance-Related Risk Areas

4. The CO will recommend and facilitate auditing and monitoring of identified risk areas related to compliance with laws and regulations, organizational policies, procedures and the Code of Conduct. (Risk areas may be identified through the regular course of business, external alerts or internal reporting channels).
• Management will conduct and/or oversee compliance reviews with guidance and assistance from the CO.
• The CO will verify completion of compliance reviews and any corrective action measures arising from them. The CO will also validate corrective measures that address any weaknesses identified by the process.
5. The CO will periodically report to the C.E.O. and the Audit Committee of the Board on the status and outcome of auditing and monitoring risk areas.

PURPOSE:

 

To provide general guidance to ensure the accurate submission of claims for medically appropriate services.

BACKGROUND:

 

With the increased public concern for accurate and medically appropriate bills submitted for health care services rendered to patients, AKSM has decided to reinforce its billing and coding policies to include oversight by the Compliance Officer.

POLICY:

 

AKSM is committed to billing practices that comply fully with all federal and state laws, regulations, guidelines and policies. This commitment includes ensuring that bills are accurate and that services claimed are medically necessary, properly documented, and actually provided.

The following procedures provide general guidance for all employees. Specific guidance in the manner by which the billing system will operate can be found in the Policies and Procedures of those operations.

PROCEDURES:

 

1. The Compliance Officer (CO) will work with the AKSM billing office¹ to ensure that the reimbursement and billing procedures in this policy are integrated into their normal operations.
2. The CO will ensure that the AKSM Code of Conduct provides general guidance on appropriate coding and billing practices and that compliance training covers billing and coding compliance.
3. The CO will ensure that specialized training is provided to billing staff as part of their new employee orientation. All employees receiving this training will be asked to acknowledge this training by signing a form. These forms will be retained by the Compliance Office.
4. All billing staff will participate in periodic compliance training.
5. Any AKSM staff member who identifies a potential billing or reimbursement discrepancy must immediately report the discrepancy to his or her supervisor, the Compliance Office, or the Compliance Hotline.
6. The AKSM billing office will ensure that reimbursement and billing manuals and materials are up-to-date.
7. The AKSM billing office will periodically review internal billing, claims processing, and reimbursement to verify that all billing activities conform to current AKSM policies and procedures.
8. On an annual basis, the CO will review the AKSM billing office to:
• Evidence that all billing staff have been trained in proper billing and coding procedures;
• Verify that billing policies, manuals and related materials are up to date; and
• Validate that billing management has properly verified billing procedures and practices.

PURPOSE:

 

To provide guidance on the waiver of patient co-payments and deductibles.

BACKGROUND:

 

The Federal Health Care Anti-Kickback Statute imposes criminal penalties on individuals and entities that offer, pay, solicit, or receive "remuneration" as an inducement to generate business payable by Medicare or Medicaid. The language of the Anti-Kickback Statute is very broad in scope, and many seemingly harmless activities, even those that could be beneficial to customers, could be found to violate the law.

Like many private insurance plans, Medicare includes a beneficiary cost-sharing requirement. The routine waiver of Medicare coinsurance and deductibles can violate both the anti-kickback statute and the False Claims Act, and is prohibited.

POLICY:

 

AKSM, and any billing companies acting on behalf of AKSM, will bill all customers for applicable deductible and co-payment amounts and make good faith efforts to collect payment. If reasonable collection efforts fail, co-payments and/or deductibles may be waived on a case-by-case basis, provided that reasons are fully documented. All such waivers will be identified in such a way that routine review of the decisions can be made by a third party.

Under no circumstances will AKSM engage in any of the following activities:

• Advertise to the general public that Medicare or private insurance is accepted as payment in full, or that patient will incur no out-of-pocket expenses.
• Routinely use "financial hardship" as a reason to avoid charging co-payments.
• Collect coinsurance and deductibles only where the beneficiary has Medicare supplemental insurance coverage.
• Charge Medicare patients higher amounts than those charged to other persons for similar services (e.g. to offset the waiver of coinsurance and deductibles).
• Fail to collect coinsurance and deductibles from selected patients for reasons unrelated to indigence or managed care contracting.

PROCEDURES:

 

1. AKSM and its designated billing entity will bill customers for all applicable deductible and co-payment amounts and make good faith efforts to collect payment.
2. Waiver of co-payments or deductibles on a case-by-case basis will be allowed if the following criteria are met:
1. The waiver is not advertised;
2. The waiver is not routinely offered; and
3. The waiver satisfies one of the following:
• It is made after an individualized, good faith assessment of financial need, or
• Reasonable efforts to collect the co-payments or deductibles have failed.
3. Reasons for the waiver will be clearly documented and all waivers shall be identified in such a way that a third party can conduct a routine review of the decisions.
4. Periodically, the AKSM Compliance Office will review the list of waivers of deductibles and co-payments to ensure adherence to this policy.

To ensure the health and safety of staff and patients, this policy memorializes the long standing policies, of the American Kidney Stone Management, Ltd. and Innovative Medical Technologies, LLC companies ("Companies"), requiring clinical staff immunization.

All clinical staff members with patient contact are required to provide proof of required immunizations prior to starting employment. The required immunizations are dependent upon job title and/or duties. The immunizations could include PPD, Hep B, MMR, TDAP, Varicella, and Influenza (Flu).

The verification of the immunizations and/or immunization completion and/or titers must be provided to the Human Resource Department prior to the employment start date. Thereafter,all clinical employees are required to stay in compliance and current with all required immunizations throughout their employment with the Companies. Any employee deemed to not to be in compliance or current with all applicable immunization requirements, will not be permitted to have patient contact and may not be permitted to work until such time as compliance is achieved. In addition to any other disciplinary actions the Companies may take and except as otherwise required by applicable law, time away from work due to the failure to maintain applicable immunizations will, at the applicable Company`s discretion, be treated as unpaid leave or vacation time.

Failure to maintain required immunizations may result in disciplinary action, up to and including termination of employment.

PURPOSE:

 

To provide guidance on the voluntary disclosure of misconduct to the appropriate regulatory or enforcement agencies.

BACKGROUND:

 

One purpose of the AKSM compliance program is to identify any misconduct that could constitute a violation of criminal, civil, or administrative law or compliance program policies and procedures and, if found to be an actual violation, to take steps to address the misconduct. Such steps may include a voluntary disclosure to an appropriate law enforcement or regulatory agency.²

Detection and timely reporting of misconduct will help maintain AKSM’s integrity as an organization and preserve its status as a reliable, honest and trustworthy provider of healthcare services. Further, organizations that voluntarily disclose civil, criminal, or administrative law in a timely manner may be subject to reduced sanctions and penalties from regulatory and enforcement agencies.

POLICY:

 

1. If misconduct is detected or reported internally, AKSM will determine, via inquiry and investigation, if credible evidence exists to indicate that a violation of criminal, civil, or administrative law has occurred.
2. If credible evidence of a legal violation exists, AKSM will promptly respond to the offense by developing a corrective action initiative to remedy the violation and to prevent its recurrence. In addition, after consultation with legal counsel, AKSM may disclose the misconduct to the appropriate law enforcement or regulatory agency.
3. Any inquiries and/or investigations will be conducted expeditiously to ensure that all requisite reporting is accomplished within 30 days of the date that the offense was detected, in accordance with statutory or regulatory guidelines.

PROCEDURES:

 

1. Any AKSM employee who receives an allegation or report of a possible violation of criminal, civil, or administrative law will immediately notify and refer the entire matter to his or her supervisor and the AKSM Compliance Officer (CO).
2. The CO, with guidance as appropriate from AKSM legal counsel, will investigate the allegation.
3. The AKSM C.E.O., CO and legal counsel will review the investigation results to determine what, if any, corrective action is warranted.
4. If the investigation reveals a violation of the False Claims Act, disclosure may need to be made to the appropriate civil and/or criminal law enforcement agency within 30 days to qualify for a reduction from treble damages to not less than double damages. AKSM will rely on advice from legal counsel in deciding whether voluntary disclosure is warranted.

BACKGROUND/PURPOSE:

 

Federal and state law enforcement and regulatory agencies sometimes make unannounced visits to health care providers, either at work or at home, to conduct interviews to gather information for audits, inquiries, and investigations. AKSM needs to respond consistently and appropriate to any official requests for information. This policy provides guidance on how to handle unannounced visits by government representatives. Procedures for handling search warrants or subpoenas are covered by separate policies.

POLICY:

 

AKSM is committed to responding appropriately and to not interfering with any lawful audit, inquiries, or investigations. All AKSM employees will remain courteous and professional when dealing with investigators or agents.

PROCEDURES:

 

Visits to AKSM

1. If an individual arrives at an AKSM facility and identifies himself or herself as a government auditor, investigator or other representative, treat him or her with respect and courtesy.
2. Request identification and reason for the visit. However, do not attempt to photocopy credentials, as this is a violation of federal law.
3. Ask the individual to wait in an unused office or location where business is not conducted.
4. Immediately contact the senior manager on duty, the Compliance Officer (CO) and legal counsel.
5. Await direction from legal counsel and the CO. Do not submit to questioning or an interview. Do not provide documents or other information.

Visits to any location outside AKSM, e.g. personal residence

1. You have the right to decline an interview or to postpone an interview until you have had an opportunity to seek legal counsel or other advice.
2. Be aware that only a government attorney working with an attorney representing the person to be interviewed can make promises binding the government.
3. If you choose to be interviewed, you have the following rights;
• To have an attorney or someone else present as a witness;
• To take notes, including questions asked and your responses;
• To know the full identity of all persons who interview you (name, position, and agency);
• To end an interview at any time without providing a reason; and
• To decline to answer any questions.
4. If you agree to be interviewed, answer questions truthfully. If you do not know the answer to a question, say so.
5. Immediately report any visit by government agents, investigators, or auditors to legal counsel and the CO.
6. If you are subjected to a search warrant, contact legal counsel and the CO immediately and provide them with details.
7. Politely object if you see any overt flaw in the warrant or if the agents are searching anything you deem to be outside the scope of the warrant. Do not interfere should agents proceed and search. Note the fact for legal counsel to support a future protest.
8. Request an "inventory list" of the documents and items seized by the agents. Ensure that it is detailed enough to identify the documents and items taken by the agents. Maintain a separate record of the areas searched and documents/items seized.
9. Other than providing information to direct the agents to information requested, do not submit to any form of questioning or interviewing. If more than one employee is present, only one employee should respond to the agent's questions.
10. Always remain present while the agents are conducting the search.

BACKGROUND/PURPOSE:

 

A subpoena is an official demand for testimony or the disclosure of documents or other information originating from a law enforcement or administrative agency. Subpoenas have serious legal implications and require legal review prior to response. This policy establishes AKSM policies and procedures to follow in the event that a subpoena is received.

POLICY:

 

AKSM is committed to full compliance with any lawful subpoena. Employees will remain courteous and professional when dealing with investigators or agents delivering a subpoena. No individual will impede the delivery of a subpoena in any way.

PROCEDURE:

 

1. If a subpoena is received, either in person or via the mail, it must be delivered immediately to the senior manager present, generally the C.E.O..
2. If the subpoena is delivered in person, the senior manager will obtain the name, title, and telephone number of the agent or investigator serving the subpoena, as well as any other information provided by that individual.
3. AKSM employees will neither volunteer information to an agent/investigator nor submit to any form of questioning or interviewing at the time the subpoena is served.
4. The senior manager will immediately contact legal counsel to request assistance in responding to the subpoena.

PURPOSE:

 

To provide guidance on responding the search warrants.

BACKGROUND:

 

Criminal enforcement agencies are increasing using search warrants in investigations of "white collar" health care fraud and abuse. A search warrant permits the government to immediately seize records and other evidence. Although AKSM believes that such an event is extremely unlikely, due to its potentially serious legal implications, AKSM is establishing a policy and procedures to cover such a situation.

POLICY:

 

Employees will remain courteous and professional at all times in dealing with agents and officers of the court. No one will impede the agents in any way in executing their orders. Employees will respond to the agents' requests, but it is not necessary to tell them how to do their business, volunteer information, or help them. The agents may enter into and look at virtually anything in the defined location, including any room, locked cabinets, file, desk drawers, and individual workspaces. If needed, they may use forced entry.

Government agents bearing a warrant are acting as agents of the court. Any interference could be viewed as obstruction of justice, an actionable offense.

PROCEDURES:

 

1. If government agents arrive unannounced, AKSM reception staff will immediately notify the senior AKSM manager available, generally the C.E.O..
2. The senior manager will receive the search warrant, and, in consultation with legal counsel, will interact with the government agents.
3. In interacting with the government agents, the senior manager should:
1. Meet the agents quickly and inquire politely how they may be assisted.
2. Note their names and the agencies they represent.
3. Do not attempt to copy their credentials, as this is a violation of federal law.
4. Ask to review the warrant and request a copy.
5. Examine the search warrant carefully to determine the specific premises it covers and what specific documents/evidence are sought.
6. Point out any overt flaw in the warrant and politely object to any searches outside the scope of the warrant, but do not interfere if the agents search in the objected area. Instead, note the fact for legal counsel and any results of the search may be later suppressed.
7. Request time to consult with counsel before search begins. (It is likely that the request will not be honored.)
8. To the degree possible, work out an agreement of the areas of search as described in the warrant.
9. Make copies of any records seized.
10. Notify the agents of any designated privileged files and documents on the premises. If they seize any of these records, note that they had been so advised.
4. The senior manager will immediately notify AKSM legal counsel and provide them with a copy of the warrant.
5. If appropriate, the senior manager will designate other employees to monitor the search.
6. All other AKSM employees will remain at their workstations and not interact with the agents in any way. They will direct any questions from the agents to the senior manager.
7. The Compliance Officer (CO) will maintain a written record of events occurring during the search, including number/identity of agents, areas searched, times of search, records/materials taken (including patient records), and any other pertinent information.

PURPOSE:

All AKSM employees have an obligation to conduct business within guidelines that prohibit actual or potential conflicts of interest. This policy is established to ensure that patient care and business activities are conducted in an objective manner and are not motivated by desire for personal or financial gain.

POLICY:

1. Employees are required to disclose any actual or potential conflict of interest and seek guidance on how to handle the situation. A conflict of interest is any situation in which financial or other personal considerations may compromise or appear to compromise:
   • An employee`s business judgment;
   • Delivery of customer care or services; or
   • An employee`s ability to do his or her job effectively.
   
   
   An actual or potential conflict of interest occurs when an employee is in a position to influence a decision that may result in a personal gain for that employee or for a relative as a result of business dealings. For the purpose of this policy, a relative is any person who is related by blood or marriage, or whose relationship with the employee is similar to that of persons who are related by blood or marriage.
   
   
2. Business dealings with outside entities should not result in unusual gain for those entities, AKSM, or an employee. Unusual gain refers to bribes, product bonuses, special fringe benefits, unusual price breaks, and other windfalls designed to ultimately benefit either the employer, the employee, or both. Certain nominal benefits are allowed in accordance with the Business Courtesies and Gift policy.
3. Personal gain may result not only in cases where an employee or relative has a significant ownership in a firm with which AKSM does business but also when an employee or relative receives any kickback, bribe, substantial gift, or special consideration as a result of any transaction or business dealings involving AKSM.
4. No "presumption of guilt" is created by the mere existence of a relationship with outside entities. However, if an employee has any influence on transactions involving purchases, contracts, or leases, he or she must immediately disclose to the appropriate manager, senior officer, and or the Compliance Officer (CO) the existence of any actual or potential conflict of interest so that safeguards can be established to protect all parties.
5. All AKSM information, data, designs, plans and ideas are the property of AKSM and should never be given to an outside firm or individual except through normal channels with appropriate prior authorization. Any improper transfer of material or disclosure of information, even though it is not apparent that an employee has personally gained by such action, is prohibited.

PROCEDURES:

1. Actual or potential conflicts of interest must be disclosed to appropriate management personnel, human resources and/or the CO.
2. Employees must seek guidance and approval from senior management before pursuing any business or personal activity that may constitute a conflict of interest.

PURPOSE:

 

To provide guidelines for accepting or providing business courtesies and gifts.

BACKGROUND:

 

AKSM recognizes that there are legitimate and lawful reasons to accept or provide reasonable business courtesies from a current or potential business associate to further develop business relationships or take advantage of educational opportunities. In addition, situations may arise when employees will be offered gifts from patients or business associates. While business courtesies are acceptable in some industries, in healthcare they can pose a risk for conflict of interest or fraud and/or abuse related to anti-kickback laws and regulations.

POLICY:

 

1. AKSM prohibits employees from offering, giving, soliciting, or accepting unreasonable business or professional courtesies, including entertainment and gifts. In general, a business or professional courtesy is unreasonable if:
   • It may appear to corrupt or influence the judgment of the recipient, or to secure preferential treatment; or
   • Public disclosure of the gift would be embarrassing to AKSM or the giver.
2. These guidelines pertain only to relationships with individuals and entities outside AKSM. They do not pertain to actions between AKSM and its employees or to actions among AKSM employees.
3. Under no circumstances will an employee solicit business courtesies, entertainment, or gifts.
4. Any departure from this policy requires prior written approval from the CEO or Compliance Officer (CO).

PROCEDURES:

 

Receiving Business Courtesies

1. Employees may accept invitations to social events in order to further develop business relationships, provided that the associated costs are reasonable and appropriate.
2. Employees may accept invitations to attend training, educational or informational opportunities. However, prior to accepting any such invitation, the employees must receive written approval from a senior manager.
3. Business courtesies that could influence or appear to influence an employee in the conduct of their duties must be declined.

Extending Business Courtesies

1. Employees may extend invitations to current or potential business associates to attend a social or educational event. The purpose of the event must not be to improperly influence relationships, business outcomes, or referral sources.
2. During these events, topics of a business nature must be discussed and the host must be present.
3. Costs associated with such an event must be reasonable and appropriate.
4. Such invitations must be infrequent with respect to a particular individual or entity.

Receiving Gifts

1. Employees may accept reasonable and appropriate gifts from any individuals or organizations.
2. Perishable or consumable gifts given to a departments or groups may be accepted so long as they are reasonable and appropriate.
3. Employees may never accept cash or cash equivalents (such as gift certificates) in connection with their responsibilities.
4. Employees are prohibited from soliciting (asking/requesting) gifts.
5. Gifts that would influence or appear to influence an employee in the conduct of their duties or responsibilities must be declined.

Giving Gifts

1. Employees may provide gifts so long as they are not provided with the purpose of improperly influencing relationships, business outcomes, or referral sources.
2. Cash gifts or cash equivalents, such as gift certificates, must be reasonable and appropriate.

PURPOSE:

 

To ensure the health and safety of staff and patients.

POLICY:

 

All clinical staff members, both mobile and fixed sites and other employees who work in fixed treatment facilities hired by AKSM shall have a 2-step Mantoux TB test done prior to working at AKSM. The results of this testing must be presented to the Human Resource Department prior to beginning work. However, if 3 consecutive years of prior Mantoux TB testing without any lapse can be submitted, the 2-step Mantoux TB testing will not be required.

Thereafter, such employees shall have a one step Mantoux TB test every 12 months during the course of their employment. If a lapse in the annual Mantoux TB testing occurs, a 2-step Mantoux TB test will be required.

Note: For positive TB test results one initial chest x-ray will be required, along with the completion of an annual positive TB follow up questionnaire that must be signed off by the employee's direct supervisor.

Thereafter, a chest x-ray will be required of the employee every 5 years.

The AKSM and Innovative Medical Technologies companies (individually a "Company" or collectively the "Companies") are committed to conducting business in accordance with sound and ethical business practices, applicable laws and their respective Codes of Conduct.

At times, emergencies (severe weather, fires, power failures, earthquakes, etc.) can disrupt the company operations or may require the closing of a work facility. The managers will monitor their area and have on hand appropriate contact information for employees, physicians, facilities and patients when applicable. Management will make the decision for the effected region and inform all effected as to delay, schedule change or closing of a facility.

In the event management determines to close or cancel treatment schedule, the time off from scheduled work will be paid and will not require the use of TAP time.

Employees who are late or absent due to their own determination of their circumstances, must use TAP if available. The Employee must call their manager for their approval first.

An employee who was already scheduled off on day of closing or cancellation of the schedule by management will be required to use TAP time as pre-arranged.

The American Kidney Stone Management, Ltd. and Innovative Medical Technologies, LLC companies ("Companies") are required by law and/or contracts with customers to protect the privacy and confidentiality of protected health information ("PHI").

The Companies are committed to the protection of PHI and to compliance with applicable provisions of the Health Insurance Portability and Accountability Act of 1996 and its related Privacy and Security Rules and Regulations, as amended from time to time ("HIPAA") and state privacy laws. In furtherance of this commitment, the Companies have, among other things:

• adopted HIPAA Privacy Polices and HIPAA Security Policies which are located on AKSM online office (as amended from time to time, "HIPAA Policies");
• appointed a Privacy Officer and a Security Officer; and
• instituted mandatory HIPAA training for all employees upon hire and annually

A violation of HIPAA and/or state privacy laws could result in substantial civil and criminal penalties for the Companies and the responsible employee and have a detrimental impact on the Companies` reputation and business relationships (see the sections on Penalties and Breach below).

WHAT IS PHI?

PHI is individually identifiable health information, held or transmitted by a HIPAA covered entity or its "Business Associate" (a person or entity that creates, receives, maintains or transmits PHI for another under HIPAA) in any form, whether electronic, paper, or oral. PHI includes information that relates to the following:

• the individual`s past, present, or future physical or mental health or condition;
• the provision of health care to the individual; or
• the past, present, or future payment for the provision of health care to the individual.

PHI includes common identifiers, such as name, zip code, address, birth date, Social Security Number, telephone numbers, fax numbers, email addresses, medical record numbers, health plan beneficiary numbers, account numbers, certificate/license numbers, vehicle identifiers and serial numbers including license plates, device identifiers and serial numbers, web universal resource locaters (URLs), internet protocol (IP) address numbers, biometric identifiers including finger and voice prints, full face photographic images and/or other comparable images, and/or any other unique identifying number, characteristic or code.

WHAT ARE EMPLOYEE RESPONSIBILITIES WITH REGARD TO HIPAA AND PHI?

All employees are required to comply with all the HIPAA Policies and other privacy policies and procedures implemented by the Companies from time to time, including, but not limited to the following:

• Only use "Devices" (such as a laptop, tablet, portable hard-drive, flash drive, cell phone, diskette etc.) that have AKSM IT Department approved encryption to transport PHI;
• Use Devices only when you must transport PHI and always permanently delete all PHI from the Device once it has been downloaded on AKSM secure online office;
• Always use only AKSM secure online office when accessing PHI;
• Never download or maintain PHI on any personal and/or unencrypted Device;
• Never email PHI unless you are using AKSM`s encrypted secure email;
• Never text PHI;
• Never leave PHI in a voicemail message;
• Never share your passwords or use someone else`s password to access the system;
• Never disclose PHI to an unauthorized person;
• Never discuss patients in a public setting;
• Always use PHI only when necessary to perform your job duties and then use only the minimum necessary to perform your job duties;
• Always keep PHI secure at all times;
• Never leave PHI sitting around unprotected, including on printers, fax machines, copiers, or in your house, a vehicle or storage;
• Never put PHI in a waste bin or dumpster;
• Always destroy paper PHI by shredding it or placing it in a designated locked shred bin;
• Always contact the IT Department for instruction prior to transfer, removal, sale or disposal of Devices or equipment which may contain PHI;
• Never supply PHI to any vendor or contractor until the AKSM Legal Department has confirmed that any required Business Associate Agreement is in place; and
• Always immediately report any actual, potential or suspected PHI "Breach", as described below, to the Privacy Officer, the Security Officer and your immediate supervisor and cooperate in any related investigation and mitigation efforts.

If you have a question about proper handling of PHI or the HIPAA Policies, contact your immediate supervisor, the Privacy Officer, the Security Officer or the Legal Department.

WHAT IS A BREACH?

A "Breach" is the acquisition, access, use or disclosure of PHI in a manner not permitted by HIPAA which compromises the security or privacy of the PHI. Examples of incidents that could result in a Breach include, but are not limited to:

• loss or theft of documents, unencrypted Devices or equipment containing PHI;
• inadvertently sending PHI to the wrong recipient, wrong address or wrong number;
• improper disposal of documents, unencrypted Devices or equipment containing PHI;
• hacking of an unencrypted computer; or
• disclosing PHI to an unauthorized person.

A Breach of the Companies` PHI could have very serious consequences. In addition to the potential for civil and criminal penalties against the applicable Company and the responsible employee, the Companies are required to report all Breaches to the Secretary of Health and Human Services, the individuals whose unencrypted PHI was Breached and certain states. In the event that there is a Breach involving 500 or more individuals, the applicable Company must notify prominent media outlets serving the applicable state(s), potentially resulting in negative publicity.

PENALTIES:

Civil Monetary Penalties: The following potential monetary penalties for a HIPAA violation can be assessed on a daily basis with separate fines issued for different aspects of the same incident. There could be penalties for violation of state privacy laws in addition to the potential penalties set forth below.

Unknowing Violations:

• Minimum/Maximum per violation = $100/$50,000
• Not to exceed $1,500,000 for identical violations in a calendar year

Violations Due to Reasonable Cause and Not Willful Neglect:

• Minimum/Maximum per violation = $1000/$50,000
• Not to exceed $1,500,000 for identical violations in a calendar year

Violations Due to Willful Neglect:

• Minimum/Maximum per violation = $10,000/$50,000 Minimum/Maximum, if corrected in 30 days or $50,000 Minimum if not corrected within 30 days
• Not to exceed $1,500,000 for identical violations in a calendar year

Criminal Penalties: The potential criminal penalties for violation of the HIPAA Privacy Rule are as follows:

Violations Due to Wrongful Disclosure: for a knowing violation of the HIPAA Privacy Rule (other than those set forth below), a convicted person may be:

• fined up to $50,000; and
• imprisoned for up to one year

Violations Due to False Pretenses: for a violation of the HIPAA Privacy Rule under false pretenses, a convicted person may be:

• fined up to $100,000; and
• imprisoned for up to five years

Violations with Intent to Sell, Transfer or Use PHI: for violating a requirement of the HIPAA Privacy Rule with the intent to sell, transfer or use PHI for commercial advantage, personal gain or malicious harm, a convicted person may be:

• fined up to $250,000; and
• imprisoned up to ten years.

DISCIPLINARY ACTION:

In addition to any potential civil and criminal penalties, an employee who violates HIPAA and/or fails to follow the Companies` HIPAA Polices and/or other privacy policies and procedures implemented by the Companies from time to time will face disciplinary action, up to and including, termination of employment.

This page is reserved for future use.

This page is reserved for future use.

The Company will provide its eligible employees with family and medical leave ("FML") in accordance with the Family and Medical Leave Act ("FMLA") and any applicable state laws. The purpose of this policy is to provide employees with a general description of their FML rights under the FMLA. Employees will be provided FML in accordance with applicable law.

ELIGIBILITY:

To qualify to take FML under this policy, the employee must meet all of the following conditions:

• Has worked for AKSM for a total of 12 months (including any periods of absence for military service);
• Has worked at least 1,250 hours during the 12 month period immediately preceding the commencement of the leave (time spent on paid or unpaid leave is not included in the 1,250 hours); and
• Works at a location where AKSM has at least 50 employees employed within 75 miles of that location.

TYPE AND AMOUNT OF COVERED LEAVE:

A. A covered employee may be granted up to a total of 12 workweeks of unpaid leave during "any 12-month period" for one or more of the following reasons:

• The birth of a son or daughter of employee and in order to care for that child;
• Placement with the employee of a son or daughter for adoption or foster care and in order to care for the newly placed child;
• To care for an immediate family member (spouse, son, daughter or parent) with a serious health condition;
• For a serious health condition that makes the employee unable to perform the essential functions of his or her job; or
• For any qualified exigency arising out of the fact that a spouse, son, daughter, or parent is a military member on covered active duty or call to covered active duty status.

Spouses employed by AKSM are jointly entitled to a combined total of 12 workweeks of FML for the reasons stated in 1-3 and 5 above.

B. An eligible employee may also take up to 26 workweeks of leave during a "single 12-month period" to care for a covered military member with a serious injury or illness, when the employee is the spouse, son, daughter, parent, or next of kin of the military member.

Spouses employed by AKSM taking the leave described in B above are jointly entitled to a combined total of 26 workweeks.

CALCULATION OF AVAILABLE LEAVE:

For FML requests under A above, the 12-week entitlement period will be determined on a rolling 12 month period, measured backward from the date FML is to be used. Each time an employee takes FML, the remaining leave entitlement is any balance of the 12 weeks not used during the immediately preceding 12 months. For example, if an employee has taken eight weeks of leave, the employee still has a balance of four weeks available if taken within the same 12-month period.

For the military caregiver FML under B above, the single 12 month period begins on the first day the employee takes leave for this reason and ends 12 months later, regardless of the 12 month period for FML requests under A above.

Any leave taken for one or more circumstances under A and/or B above will be counted against the employee`s total available leave under A and/or B above.

Employee vacation, sick and personal time may be used in conjunction with FML. When no vacation, sick or personal time is used, the FML will be unpaid.

ADMINISTRATIVE TERMINATION:

If you are absent from work for more than the amount of approved leave, you may be administratively terminated in AKSM`s discretion unless otherwise prohibited by law. You are welcome to re-apply subject to the AKSM`s usual hiring policies.

INTERMITTENT OR REDUCED SCHEDULE FML:

FML may be taken all at once or, when medically necessary, intermittently or on a reduced-leave schedule. Employees requesting intermittent/reduced schedule FML must make a reasonable effort to schedule medical treatment so as not to unduly interrupt AKSM`s operations. Employees should try to reach an agreement with AKSM before taking intermittent/reduced schedule FML. Only the amount of intermittent/reduced schedule FML actually taken is counted toward the calculation of the balance of available leave.

NOTICE AND CERTIFICATION:

Employees seeking to use FML leave are required to provide 30-day advance notice of the need to take FML leave when the need is foreseeable and such notice is practicable. If the leave is unexpected, employees should notify AKSM as soon as practicable.

The employee must provide medical certification supporting the need for leave due to a serious health condition affecting the employee or an immediate family member. AKSM reserves the right to request a second opinion if the validity of a medical certification is questioned. This is done at AKSM`s expense. If the first and second opinion differ, AKSM may request that the employee obtain a final and binding third opinion of a jointly selected health care provider whose fee will be paid by AKSM.

AKSM will require confirmation of the need for military leave.

If requested by AKSM, the employee shall submit periodic reports during FML regarding the employee`s status and intent to return to work.

Before the return from leave due to a serious personal health condition, the employee must present a fitness-for duty certificate from the health care provider. The employee`s return to work may be delayed until such certificate is submitted.

Failure to: (i) provide complete medical certification; (ii) submit to required second and third opinions; or (iii) provide a fitness for duty certificate may be cause for discipline, up to and including termination of employment.

MAINTENANCE OF INSURANCE BENEFITS:

AKSM will maintain insurance benefits (health, dental, vision, life and disability) for an employee on FML, whenever such insurance was provided before the leave was taken, at the same level and under the same conditions as if the employee had continued to work. The employee will be responsible for paying the employee share of such insurance premiums. While the employee is on paid leave, AKSM will continue to make payroll deductions to collect the employee`s share of the premium(s). While the employee is on unpaid leave, the employee will be required to reimburse AKSM for the employee`s share of the premium(s) in accordance with arrangements approved by AKSM.

JOB RESTORATION:

Generally, upon return from FML, an employee will be returned to their original job, or an equivalent job with equivalent pay, benefits and other terms and conditions of employment. AKSM may choose to exempt certain key employees from this requirement and not return them to the same or equivalent position.

AKSM will compensate AKSM employees for travel time greater than a total of thirty (30) minutes per day and greater than a total of thirty (30) miles per day ("30/30 policy"). Travel time starts/ends when you leave/return to your home/hotel.

Any requests for reimbursement outside of the 30/30 policy must be pre-approved by appropriate management personnel.

The 30/30 policy does not apply to the following employees:

• Drivers of AKSM owned vehicles
• Corporate office personnel, unless traveling on AKSM business and pre-approved by appropriate management personnel.

Example of 30/30 policy: AKSM employee stayed at a hotel 10 minutes away from the facility and 2 hours away from home. Total travel time for the day was 2 hours and 10 minutes (130 minutes). The AKSM employee will be reimbursed for 100 minutes. (130 minutes-30 minutes=100 minutes) The same would apply to the mileage for the day.