J.5_Code_of_Business_Ethics_and_Conduct_Attestation.docx

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Inpatient Rehabilitation Facility (IRF), Long Term Care Facility (LTCH), and Hospice Quality Reporting Programs Analytics, Outreach, and Support Data Analysis
Solicitation number
RFP-CMS-2015-8A-0101
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J.5 Code of Business Ethics and Conduct Attestation

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Attachment J.5 – Code of Business Ethics and Conduct Attestation

RFP-CMS-2015-8A-0101

(Insert Offeror/Company Name) understands and unconditionally assents to the requirements of the Section of the RFP entitled Code of Business Ethics and Conduct Attestation (section L.16 Tab C) and attests that it has in place an effective Code of Business Ethics and Conduct program that articulates and demonstrates the Offeror’s commitment to ethical and legal conduct. Specifically, the (Insert Offeror/Company Name) attests to the requirements in the table below.

Compliance Program Requirements

1. (Insert Offeror/Company Name) has a written Code of Business Ethics and Conduct in place or will have it in place within 30 days of contract award..

2. (Insert Offeror/Company Name) has a compliance officer.

3. (Insert Offeror/Company Name) has a process to receive ethics and compliance-related complaints that permits anonymous reporting, including a fraud hotline poster, per FAR 52.203-14.

4. (Insert Offeror/Company Name) has disclosed all known, probable, or suspected [reportable] events to CMS [(see H.2)] on completed and current CMS contracts that require(d) the reporting of such events, in accordance with the terms and conditions of the respective contract(s) that included such a reporting requirement.

5. (Insert Offeror/Company Name) has disclosed, in an addendum to this attestation, any and all known criminal or civil investigations or proceedings against the Offeror (whether under the False Claims Act, Civil Monetary Penalty statutes, or other similar authorities), any and all known qui tam lawsuits against the Offeror, and any and all known administrative misconduct of the Offeror, within the past ten (10) years. For this purpose, the term “Offeror” means the Offeror and any parent or affiliate of the Offeror whose conduct may be attributed to the Offeror. If the Offeror has nothing to disclose under this heading, state as much in the attached addendum.

6.

7.

8.

9.

(Insert Offeror/Company Name) agrees that this Attestation and the attached addendum will become a part of the organization’s proposal. As an individual with authority to bind the (Insert Offeror/Company Name), I accept responsibility for this written document.

(Signature)_________________________(Signature)_______________________
(Type full name) (Executive Title)(Type full name) Compliance Officer

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