CORPORATE COMPLIANCE

Tim TimmonsVice President

Compliance and Regulatory ServicesHealth Future, LLC

CORPORATE COMPLIANCE

Tim TimmonsVice President

Compliance and Regulatory ServicesHealth Future, LLC

PRESENTATION OUTLINE

WHAT IS A CORPORATE COMPLIANCE PROGRAM

WHY DO WE NEED ONE RECOMMENDED PROGRAM ELEMENTS WHAT MAKES A PROGRAM EFFECTIVE PLAN FOR ASSISTING AWPHD HOSPITALS

WHAT IS A CORPORATE COMPLIANCE PROGRAM

WHAT IS A CORPORATE COMPLIANCE PROGRAM

A program that articulates the hospitals’ commitment to the provision of health care services in full compliance with all federal, state and local laws and regulations, and that sets forth a plan for proactively preventing, detecting, and reporting violations of the laws and regulations which govern the services that they provide.

WHY DO WE NEED ONE?

REASONS TO DEVELOP A CORPORATE COMPLIANCE

PROGRAM

Operationalizes the commitment to ethical and lawful behavior

Reduces the liklihood of violations and employee whistleblowing

Reduces exposure to civil and criminal liability Enhances public credibility

REASONS TO DEVELOP A CORPORATE COMPLIANCE

PROGRAM Provides assurance of lawful behavior to Board

and senior management Provides for mitigation of sentences if

convicted of criminal fraud Protects Board members and officers -

Caremark decision Improves the speed and quality of responses to

lawsuits or investigations

RECOMMENDED PROGRAM ELEMENTS

OIG PROGRAM GUIDANCE Compliance policies and procedures Oversight by high-level personnel Discretionary authority vested in reliable

individuals Effective training and education Auditing and monitoring Consistent disciplinary mechanisms Appropriate responses to detected violations

OIG PROGRAM GUIDANCE

The compliance program should include all seven of the elements required by the U.S. Sentencing Commission and OIG Guidelines

The recommendations of the OIG’s Compliance Program Guidance for Hospitals must be considered, depending upon their applicability to each particular hospital. The hospital should be prepared to justify non-compliance with any recommendations

WRITTEN POLICIES AND PROCEDURES

The Hospital Code of Ethics is the foundation of the compliance program

Each employee should sign an attestation that he/she will abide by the Code and the compliance program

Policies and procedures should be developed for the hospital as a whole, and for the high risk areas

OVERSIGHT BY HIGH-LEVEL PERSONNEL

Designation of a corporate compliance officer May be a part-time responsibility Responsible for coordinating the planning,

implementation and monitoring of the program Direct access to the CEO and the Board, regardless of

his/her direct reporting relationship Establishment of a compliance committee

EFFECTIVE EDUCATION AND TRAINING

Required of all hospital staff, employees, physicians, independent contractors and other significant agents

New employees must be educated early Training in other languages for culturally diverse

staff should be used Number of hours of training should be specified

• High-risk areas should receive more training• Training must be documented

EFFECTIVE LINES OF COMMUNICATION

Access to the compliance officer necessary Develop non-retaliation and confidentiality policies Advise employees that anonymity can’t be

guaranteed Employees should report all suspected misconduct Document employee questions and answers,

investigations and results Use of hotlines is encouraged if needed

DISCIPLINARY ENFORCEMENT

Discipline should be consistently enforced Background investigations should be

conducted for new employees who have discretionary authority to make decisions that may involve compliance or who have compliance oversight

AUDITING/MONITORING

All OIG Work Plan risk areas should be reviewed over the course of the year

Additional high-risk areas should be reviewed based on priority

The effectiveness of the compliance program should be formally evaluated annually

AUDITING/MONITORING – OIG PROGRAM GUIDANCE

Hospitals Laboratories

Home Health Hospice

Long Term Care DME

Physician Offices Third Party Billing

Medicare + Choice Rx Manufacturers

RESPONSES TO DETECTED VIOLATIONS

Steps should be taken to immediately correct problems detected

Report misconduct to the appropriate governmental agency not more than 60 days after discovering credible evidence of a violation

Investigate suspected violations ASAP Overpayments should be promptly refunded

WHAT MAKES A PROGRAM EFFECTIVE?

WHAT MAKES A PROGRAM EFFECTIVE?

Support of board and executive staff Ongoing education of staff, particularly in the high-

risk areas Monitoring and auditing (reviewing) high-risk areas Consistency in enforcement HCCA publishing effectiveness criteria

PLAN FOR ASSISTING AWPHD HOSPITALS

PLAN FOR ASSISTING MEMBER HOSPITALS

Provide a model comprehensive compliance program, addressing all high-risk areas

Provide compliance education to key hospital personnel

Update AWPHD hospitals on significant new compliance developments

Provide compliance tools for effective program implementation

Provide compliance consultation

QUESTIONS?