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Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC...
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Transcript of Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC...
![Page 1: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/1.jpg)
Healthcare Compliance: 2014
Stuart Freedman, MPHHSC Chief Compliance Officer
Monica Wilson, JD, CHCManager, HSC Compliance
![Page 2: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/2.jpg)
Topics Covered
• Regulator Behavior• Compliance Response
![Page 3: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/3.jpg)
REGULATOR BEHAVIORHow the OIG behaves and how HSC Compliance responds
![Page 4: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/4.jpg)
![Page 5: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/5.jpg)
2013 Enforcement Numbers
• $5.6B recovered• 3,214 new excluded parties• 960 criminal actions• 472 civil actions
• How did we get here?
![Page 6: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/6.jpg)
OIG Motivations
• Money– Protect the Medicare trust funds– Government budget– Medicare enrollment
• Headlines– Demonstrate effectiveness
![Page 7: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/7.jpg)
OIG Behavior
• Looking beyond “fraud”– Quality– Waste and abuse– Exclusion authorities
• Data analytics• Regulatory creep
![Page 8: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/8.jpg)
Available Information
• Statutes and regulations• Guidance documents• Corporate Integrity Agreements (CIAs)• Presentations at conferences• News reports and press releases
![Page 9: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/9.jpg)
PROTECTING THE HSCHow we respond to all of this
![Page 10: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/10.jpg)
Achievements
• HSC Code of Ethics and training• Awareness• Hired an Educator• New hotline and incident management system
![Page 11: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/11.jpg)
![Page 12: Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.](https://reader035.fdocuments.net/reader035/viewer/2022062321/56649edf5503460f94bef516/html5/thumbnails/12.jpg)
Coming Soon
• Consolidation• Investigation processes• Training calendar