Discuss the issue of fraud in the provision of behavior analytic services.
1. As a BCBA, what steps can you take to prevent fraud in your work place?
2. Discuss this from the perspective of a supervisor
3. Discuss this from the perspective of an employee in the clinic setting.
4. List all applicable BCBA ethics codes sections. Provide the rationale for the chosen code(s)
You can use the following articles and websites:
Ethical Billing: Misunderstanding vs Fraud – ABA Ethics Hotline
Tampa Bay Autism Service Provider Agrees To Pay $675,000 To Resolve Civil Healthcare Fraud Allegations | USAO-MDFL | Department of Justice
Professional and Ethical Compliance Code for Behavior Analysts
BEHAVIOR ANALYST CERTIFICATION BOARD® =
=
®
The Behavior Analyst Certification Board’s (BACB’s) Professional and Ethical Compliance Code for Behavior Analysts (the “Code”) consolidates, updates, and replaces the BACB’s Professional Disciplinary and Ethical Standards and Guidelines for Responsible Conduct for Behavior Analysts. The Code includes 10 sections relevant to professional and ethical behavior of behavior analysts, along with a glossary of terms. Effective January 1, 2016, all BACB applicants and certificants will be required to adhere to the Code.
_________________________
In the original version of the Guidelines for Professional Conduct for Behavior Analysts, the authors acknowledged ethics codes from the following organizations: American Anthropological Association, American Educational Research Association, American Psychological Association, American Sociological Association, California Association for Behavior Analysis, Florida Association for Behavior Analysis, National Association of Social Workers, National Association of School Psychologists, and Texas Association for Behavior Analysis. We acknowledge and thank these professional organizations that have provided substantial guidance and clear models from which the Code has evolved.
Approved by the BACB’s Board of Directors on August 7, 2014.
This document should be referenced as: Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts. Littleton, CO: Author.
© 2014 Behavior Analyst Certification Board,® Inc. (BACB®), all rights reserved. Ver. March 18, 2019.
2
=
=
®
Contents
1.0 1.01 1.02 1.03 1.04 1.05 1.06 1.07
2.0 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15
3.0 3.01 3.02 3.03 3.04 3.05
4.0 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11
Responsible Conduct of Behavior Analysts Reliance on Scientific Knowledge Boundaries of Competence Maintaining Competence through Professional Development Integrity Professional and Scientific Relationships Multiple Relationships and Conflicts of Interest Exploitative Relationships
Behavior Analysts’ Responsibility to Clients Accepting Clients Responsibility Consultation Third-Party Involvement in Services Rights and Prerogatives of Clients Maintaining Confidentiality Maintaining Records Disclosures Treatment/Intervention Efficacy Documenting Professional Work and Research Records and Data Contracts, Fees, and Financial Arrangements Accuracy in Billing Reports Referrals and Fees Interrupting or Discontinuing Services
Assessing Behavior Behavior-Analytic Assessment Medical Consultation Behavior-Analytic Assessment Consent Explaining Assessment Results Consent-Client Records
Behavior Analysts and the Behavior-Change Program Conceptual Consistency Involving Clients in Planning and Consent Individualized Behavior-Change Programs Approving Behavior-Change Programs Describing Behavior-Change Program Objectives Describing Conditions for Behavior-Change Program Success Environmental Conditions that Interfere with Implementation Considerations Regarding Punishment Procedures Least Restrictive Procedures Avoiding Harmful Reinforcers Discontinuing Behavior-Change Programs and Behavior-Analytic Services
3
=
=
®
Contents, continued
5.0 5.01 5.02 5.03 5.04 5.05 5.06 5.07
6.0 6.01 6.02
7.0 7.01 7.02
8.0 8.01 8.02 8.03 8.04 8.05 8.06
9.0 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09
Behavior Analysts as Supervisors Supervisory Competence Supervisory Volume Supervisory Delegation Designing Effective Supervision and Training Communication of Supervision Conditions Providing Feedback to Supervisees Evaluating the Effects of Supervision
Behavior Analysts’ Ethical Responsibility to the Profession of Behavior Analysts Affirming Principles Disseminating Behavior Analysis
Behavior Analysts’ Ethical Responsibility to Colleagues Promoting an Ethical Culture Ethical Violations by Others and Risk of Harm
Public Statements Avoiding False or Deceptive Statements Intellectual Property Statements by Others Media Presentations and Media-Based Services Testimonials and Advertising In-Person Solicitation
Behavior Analysts and Research Conforming with Laws and Regulations Characteristics of Responsible Research Informed Consent Using Confidential Information for Didactic or Instructive Purposes Debriefing Grant and Journal Reviews Plagiarism Acknowledging Contributions Accuracy and Use of Data
10.0 Behavior Analysts’ Ethical Responsibility to the BACB 10.01 Truthful and Accurate Information Provided to the BACB 10.02 Timely Responding, Reporting, and Updating of Information Provided to the BACB 10.03 Confidentiality and BACB Intellectual Property 10.04 Examination Honesty and Irregularities 10.05 Compliance with BACB Supervision and Coursework Standards 10.06 Being Familiar with This Code 10.07 Discouraging Misrepresentation by Non-Certified Individuals
4
=
=
®
1.0 Responsible Conduct of Behavior Analysts.
Behavior analysts maintain the high standards of behavior of the profession.
1.01 Reliance on Scientific Knowledge. Behavior analysts rely on professionally derived knowledge based on science and behavior analysis when making scientific or professional judgments in human service provision, or when engaging in scholarly or professional endeavors.
1.02 Boundaries of Competence.
(a) All behavior analysts provide services, teach, and conduct research only within the boundaries of their competence, defined as being commensurate with their education, training, and supervised experience.
(b) Behavior analysts provide services, teach, or conduct research in new areas (e.g., populations, techniques, behaviors) only after first undertaking appropriate study, training, supervision, and/or consultation from persons who are competent in those areas.
1.03 Maintaining Competence through Professional Development.
Behavior analysts maintain knowledge of current scientific and professional information in their areas of practice and undertake ongoing efforts to maintain competence in the skills they use by reading the appropriate literature, attending conferences and conventions, participating in workshops, obtaining additional coursework, and/or obtaining and maintaining appropriate professional credentials.
1.04 Integrity.
(a) Behavior analysts are truthful and honest and arrange the environment to promote truthful and honest behavior in others.
(b) Behavior analysts do not implement contingencies that would cause others to engage in fraudulent, illegal, or unethical conduct.
(c) Behavior analysts follow through on obligations, and contractual and professional commitments with high quality work and refrain from making professional commitments they cannot keep.
(d) Behavior analysts’ behavior conforms to the legal and ethical codes of the social and professional community of which they are members. (See also, 10.02a Timely Responding, Reporting, and Updating of Information Provided to the BACB)
(e) If behavior analysts’ ethical responsibilities conflict with law or any policy of an organization with which they are affiliated, behavior analysts make known their commitment to this Code and take steps to resolve the conflict in a responsible manner in accordance with law.
Professional and Ethical Compliance Code for Behavior Analysts
5
=
=
®
1.05 Professional and Scientific Relationships. (a) Behavior analysts provide behavior-analytic services only in the context of a defined, professional,
or scientific relationship or role. (b) When behavior analysts provide behavior-analytic services, they use language that is fully
understandable to the recipient of those services while remaining conceptually systematic with the profession of behavior analysis. They provide appropriate information prior to service delivery about the nature of such services and appropriate information later about results and conclusions.
(c) Where differences of age, gender, race, culture, ethnicity, national origin, religion, sexual orientation, disability, language, or socioeconomic status significantly affect behavior analysts’ work concerning particular individuals or groups, behavior analysts obtain the training, experience, consultation, and/or supervision necessary to ensure the competence of their services, or they make appropriate referrals.
(d) In their work-related activities, behavior analysts do not engage in discrimination against individuals or groups based on age, gender, race, culture, ethnicity, national origin, religion, sexual orientation, disability, language, socioeconomic status, or any basis proscribed by law.
(e) Behavior analysts do not knowingly engage in behavior that is harassing or demeaning to persons with whom they interact in their work based on factors such as those persons’ age, gender, race, culture, ethnicity, national origin, religion, sexual orientation, disability, language, or socioeconomic status, in accordance with law.
(f) Behavior analysts recognize that their personal problems and conflicts may interfere with their effectiveness. Behavior analysts refrain from providing services when their personal circumstances may compromise delivering services to the best of their abilities.
1.06 Multiple Relationships and Conflicts of Interest.
(a) Due to the potentially harmful effects of multiple relationships, behavior analysts avoid multiple relationships.
(b) Behavior analysts must always be sensitive to the potentially harmful effects of multiple relationships. If behavior analysts find that, due to unforeseen factors, a multiple relationship has arisen, they seek to resolve it.
(c) Behavior analysts recognize and inform clients and supervisees about the potential harmful effects of multiple relationships.
(d) Behavior analysts do not accept any gifts from or give any gifts to clients because this constitutes a multiple relationship.
1.07 Exploitative Relationships.
(a) Behavior analysts do not exploit persons over whom they have supervisory, evaluative, or other authority such as students, supervisees, employees, research participants, and clients.
6
=
=
®
(b) Behavior analysts do not engage in sexual relationships with clients, students, or supervisees, because such relationships easily impair judgment or become exploitative.
(c) Behavior analysts refrain from any sexual relationships with clients, students, or supervisees, for at least two years after the date the professional relationship has formally ended.
(d) Behavior analysts do not barter for services, unless a written agreement is in place for the barter that is (1) requested by the client or supervisee; (2) customary to the area where services are provided; and (3) fair and commensurate with the value of behavior-analytic services provided.
2.0 Behavior Analysts’ Responsibility to Clients.
Behavior analysts have a responsibility to operate in the best interest of clients. The term client as used here is broadly applicable to whomever behavior analysts provide services, whether an individual person (service recipient), a parent or guardian of a service recipient, an organizational representative, a public or private organization, a firm, or a corporation.
2.01 Accepting Clients.
Behavior analysts accept as clients only those individuals or entities whose requested services are commensurate with the behavior analysts’ education, training, experience, available resources, and organizational policies. In lieu of these conditions, behavior analysts must function under the supervision of or in consultation with a behavior analyst whose credentials permit performing such services.
2.02 Responsibility.
Behavior analysts’ responsibility is to all parties affected by behavior-analytic services. When multiple parties are involved and could be defined as a client, a hierarchy of parties must be established and communicated from the outset of the defined relationship. Behavior analysts identify and communicate who the primary ultimate beneficiary of services is in any given situation and advocate for his or her best interests.
2.03 Consultation.
(a) Behavior analysts arrange for appropriate consultations and referrals based principally on the best interests of their clients, with appropriate consent, and subject to other relevant considerations, including applicable law and contractual obligations.
(b) When indicated and professionally appropriate, behavior analysts cooperate with other professionals, in a manner that is consistent with the philosophical assumptions and principles of behavior analysis, in order to effectively and appropriately serve their clients.
7
=
=
®
2.04 Third-Party Involvement in Services.
(a) When behavior analysts agree to provide services to a person or entity at the request of a third party, behavior analysts clarify, to the extent feasible and at the outset of the service, the nature of the relationship with each party and any potential conflicts. This clarification includes the role of the behavior analyst (such as therapist, organizational consultant, or expert witness), the probable uses of the services provided or the information obtained, and the fact that there may be limits to confidentiality.
(b) If there is a foreseeable risk of behavior analysts being called upon to perform conflicting roles because of the involvement of a third party, behavior analysts clarify the nature and direction of their responsibilities, keep all parties appropriately informed as matters develop, and resolve the situation in accordance with this Code.
(c) When providing services to a minor or individual who is a member of a protected population at the request of a third party, behavior analysts ensure that the parent or client-surrogate of the ultimate recipient of services is informed of the nature and scope of services to be provided, as well as their right to all service records and data.
(d) Behavior analysts put the client’s care above all others and, should the third party make requirements for services that are contraindicated by the behavior analyst’s recommendations, behavior analysts are obligated to resolve such conflicts in the best interest of the client. If said conflict cannot be resolved, that behavior analyst’s services to the client may be discontinued following appropriate transition.
2.05 Rights and Prerogatives of Clients.
(a) The rights of the client are paramount and behavior analysts support clients’ legal rights and prerogatives.
(b) Clients and supervisees must be provided, on request, an accurate and current set of the behavior analyst’s credentials.
(c) Permission for electronic recording of interviews and service delivery sessions is secured from clients and relevant staff in all relevant settings. Consent for different uses must be obtained specifically and separately.
(d) Clients and supervisees must be informed of their rights and about procedures to lodge complaints about professional practices of behavior analysts with the employer, appropriate authorities, and the BACB.
(e) Behavior analysts comply with any requirements for criminal background checks.
2.06 Maintaining Confidentiality.
(a) Behavior analysts have a primary obligation and take reasonable precautions to protect the confidentiality of those with whom they work or consult, recognizing that confidentiality may be established by law, organizational rules, or professional or scientific relationships.
8
=
=
®
(b) Behavior analysts discuss confidentiality at the outset of the relationship and thereafter as new circumstances may warrant.
(c) In order to minimize intrusions on privacy, behavior analysts include only information germane to the purpose for which the communication is made in written, oral, and electronic reports, consultations, and other avenues.
(d) Behavior analysts discuss confidential information obtained in clinical or consulting relationships, or evaluative data concerning clients, students, research participants, supervisees, and employees, only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters.
(e) Behavior analysts must not share or create situations likely to result in the sharing of any identifying information (written, photographic, or video) about current clients and supervisees within social media contexts.
2.07 Maintaining Records.
(a) Behavior analysts maintain appropriate confidentiality in creating, storing, accessing, transferring, and disposing of records under their control, whether these are written, automated, electronic, or in any other medium.
(b) Behavior analysts maintain and dispose of records in accordance with applicable laws, regulations, corporate policies, and organizational policies, and in a manner that permits compliance with the requirements of this Code.
2.08 Disclosures.
Behavior analysts never disclose confidential information without the consent of the client, except as mandated by law, or where permitted by law for a valid purpose, such as (1) to provide needed professional services to the client, (2) to obtain appropriate professional consultations, (3) to protect the client or others from harm, or (4) to obtain payment for services, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose. Behavior analysts recognize that parameters of consent for disclosure should be acquired at the outset of any defined relationship and is an ongoing procedure throughout the duration of the professional relationship.
2.09 Treatment/Intervention Efficacy.
(a) Clients have a right to effective treatment (i.e., based on the research literature and adapted to the individual client). Behavior analysts always have the obligation to advocate for and educate the client about scientifically supported, most-effective treatment procedures. Effective treatment procedures have been validated as having both long-term and short-term benefits to clients and society.
(b) Behavior analysts have the responsibility to advocate for the appropriate amount and level of
9
=
=
®
service provision and oversight required to meet the defined behavior-change program goals. (c) In those instances where more than one scientifically supported treatment has been established,
additional factors may be considered in selecting interventions, including, but not limited to, efficiency and cost-effectiveness, risks and side-effects of the interventions, client preference, and practitioner experience and training.
(d) Behavior analysts review and appraise the effects of any treatments about which they are aware that might impact the goals of the behavior-change program, and their possible impact on the behavior- change program, to the extent possible.
2.10 Documenting Professional Work and Research.
(a) Behavior analysts appropriately document their professional work in order to facilitate provision of services later by them or by other professionals, to ensure accountability, and to meet other requirements of organizations or the law.
(b) Behavior analysts have a responsibility to create and maintain documentation in the kind of detail and quality that would be consistent with best practices and the law.
2.11 Records and Data.
(a) Behavior analysts create, maintain, disseminate, store, retain, and dispose of records and data relating to their research, practice, and other work in accordance with applicable laws, regulations, and policies; in a manner that permits compliance with the requirements of this Code; and in a manner that allows for appropriate transition of service oversight at any moment in time.
(b) Behavior analysts must retain records and data for at least seven (7) years and as otherwise required by law.
2.12 Contracts, Fees, and Financial Arrangements.
(a) Prior to the implementation of services, behavior analysts ensure that there is in place a signed contract outlining the responsibilities of all parties, the scope of behavior-analytic services to be provided, and behavior analysts’ obligations under this Code.
(b) As early as is feasible in a professional or scientific relationship, behavior analysts reach an agreement with their clients specifying compensation and billing arrangements.
(c) Behavior analysts’ fee practices are consistent with law and behavior analysts do not misrepresent their fees. If limitations to services can be anticipated because of limitations in funding, this is discussed with the client as early as is feasible.
(d) When funding circumstances change, the financial responsibilities and limits must be revisited with the client.
10
=
=
®
2.13 Accuracy in Billing Reports.
Behavior analysts accurately state the nature of the services provided, the fees or charges, the identity of the provider, relevant outcomes, and other required descriptive data.
2.14 Referrals and Fees.
Behavior analysts must not receive or provide money, gifts, or other enticements for any professional referrals. Referrals should include multiple options and be made based on objective determination of the client need and subsequent alignment with the repertoire of the referee. When providing or receiving a referral, the extent of any relationship between the two parties is disclosed to the client.
2.15 Interrupting or Discontinuing Services.
(a) Behavior analysts act in the best interests of the client and supervisee to avoid interruption or disruption of service.
(b) Behavior analysts make reasonable and timely efforts for facilitating the continuation of behavior- analytic services in the event of unplanned interruptions (e.g., due to illness, impairment, unavailability, relocation, disruption of funding, disaster).
(c) When entering into employment or contractual relationships, behavior analysts provide for orderly and appropriate resolution of responsibility for services in the event that the employment or contractual relationship ends, with paramount consideration given to the welfare of the ultimate beneficiary of services.
(d) Discontinuation only occurs after efforts to transition have been made. Behavior analysts discontinue a professional relationship in a timely manner when the client: (1) no longer needs the service, (2) is not benefiting from the service, (3) is being harmed by continued service, or (4) when the client requests discontinuation. (See also, 4.11 Discontinuing Behavior-Change Programs and Behavior-Analytic Services)
(e) Behavior analysts do not abandon clients and supervisees. Prior to discontinuation, for whatever reason, behavior analysts: discuss service needs, provide appropriate pre-termination services, suggest alternative service providers as appropriate, and, upon consent, take other reasonable steps
to facilitate timely transfer of responsibility to another provider.
3.0 Assessing Behavior.
Behavior analysts using behavior-analytic assessment techniques do so for purposes that are appropriate given current research.
11
=
=
®
3.01 Behavior-Analytic Assessment.
(a) Behavior analysts conduct current assessments prior to making recommendations or developing behavior-change programs. The type of assessment used is determined by client’s needs and consent, environmental parameters, and other contextual variables. When behavior analysts are developing a behavior-reduction program, they must first conduct a functional assessment.
(b) Behavior analysts have an obligation to collect and graphically display data, using behavior-analytic conventions, in a manner that allows for decisions and recommendations for behavior-change program development.
3.02 Medical Consultation.
Behavior analysts recommend seeking a medical consultation if there is any reasonable possibility that a referred behavior is influenced by medical or biological variables.
3.03 Behavior-Analytic Assessment Consent.
(a) Prior to conducting an assessment, behavior analysts must explain to the client the procedure(s) to be used, who will participate, and how the resulting information will be used.
(b) Behavior analysts must obtain the client’s written approval of the assessment procedures before implementing them.
3.04 Explaining Assessment Results.
Behavior analysts explain assessment results using language and graphic displays of data that are reasonably understandable to the client.
3.05 Consent-Client Records.
Behavior analysts obtain the written consent of the client before obtaining or disclosing client records from or to other sources, for assessment purposes.
4.0 Behavior Analysts and the Behavior-Change Program. Behavior analysts are responsible for all aspects of the behavior-change program from conceptualization to implementation and ultimately to discontinuation.
12
=
=
®
4.01 Conceptual Consistency.
Behavior analysts design behavior-change programs that are conceptually consistent with behavior- analytic principles.
4.02 Involving Clients in Planning and Consent.
Behavior analysts involve the client in the planning of and consent for behavior-change programs.
4.03 Individualized Behavior-Change Programs.
(a) Behavior analysts must tailor behavior-change programs to the unique behaviors, environmental variables, assessment results, and goals of each client.
(b) Behavior analysts do not plagiarize other professionals’ behavior-change programs.
4.04 Approving Behavior-Change Programs.
Behavior analysts must obtain the client’s written approval of the behavior-change program before implementation or making significant modifications (e.g., change in goals, use of new procedures).
4.05 Describing Behavior-Change Program Objectives.
Behavior analysts describe, in writing, the objectives of the behavior-change program to the client before attempting to implement the program. To the extent possible, a risk-benefit analysis should be conducted on the procedures to be implemented to reach the objective. The description of program objectives and the means by which they will be accomplished is an ongoing process throughout the duration of the client-practitioner relationship.
4.06 Describing Conditions for Behavior-Change Program Success.
Behavior analysts describe to the client the environmental conditions that are necessary for the behavior-change program to be effective.
4.07 Environmental Conditions that Interfere with Implementation.
(a) If environmental conditions prevent implementation of a behavior-change program, behavior analysts recommend that other professional assistance (e.g., assessment, consultation or therapeutic intervention by other professionals) be sought.
(b) If environmental conditions hinder implementation of the behavior-change program, behavior analysts seek to eliminate the environmental constraints, or identify in writing the obstacles to doing so.
