Healthcare Compliance Presentation

CINNTI – “confirmation of workplace protection for everyone”

Presenter: Kendall Brune, PhD, MBA, LNHAFellow – American College of Healthcare Administrators

Compliance and Beyond

It does not matter how small or LARGE your complex is

12 room ILF- VA

276 bed SNF

It is a Scary Proposition~!

Compliance is a LEAP of FAITH



Healthcare companies have seen the development of mandatory compliance requirements increase over the past few years. The sources of these requirements include:

• US Sentencing Guidelines• OIG/Health and Human Services Guidance• Medicare Part C & D Mandatory Compliance Guidelines• Affordable Care Act• FAR Acquisition Regulations.



Recently, mandatory compliance requirements were enacted through statute in the Affordable Care Act (Sections 6102 and 6401). Under the ACA, companies are prohibited from participating in Federal heath care programs unless their compliance programs contain certain core elements.

The ACA sets out required core elements. The HHS regulations are likely to draw from the statute and from earlier regulatory proceedings which solicited input on the basic compliance program requirements.

Nursing homes will be expected to have operational compliance programs that are effective in preventing criminal and civil health care violations, and promoting quality of care by March 23, 2013.

What does this NH regulation have to do with my ALF?


Compliance and BeyondHealthcare and Long Term Care

Compliance

What is a ―sanctioned entity ?

Entity convicted of any criminal offense that triggers a mandatory exclusion under Section 1128(a), including:

• Felony conviction for health care fraud;• Conviction related to patient abuse and/or neglect;• Failure to repay Health Education Assistance Loans;• Conviction related to fraud against non‐health care programs;• Misdemeanor conviction for controlled substances;• License revocation or suspension; and• Misdemeanor health care fraud conviction.

Share FBI and OIG cards – Welcome to my

ALF~!

Fact Sheet ALF and Wrongful Deaths?

Public defender Kathryn Benson, left, talks with Richard Allen Williams following his arraignment in Boone County (Mo.) Circuit Court. Williams, 36, pleaded innocent Monday to 10 counts of first-degree murder for allegedly killing patients a decade ago while working as a nurse at the Truman Memorial Veterans Hospital in Columbia, Mo. Boone County Prosecutor Kevin Crane told the court he would seek the death penalty in the case. (July 23, 2002)

An investigation by the FBI and the Office of Inspector General in the Department of Veterans Affairs determined that 41 people died on Ward 4E between May and August 1992 while Williams was on duty. Investigators concluded patients were 20 times more likely to die while Williams was working than while 11 other nurses were on duty.

Owners did not check out his Background?

His license was not suspended…. The VA did not report any problems…. The Administrator was glad an RN applied…. Meanwhile, the number of deaths increased at Ashland during

the time Williams was there. From June 1993 to June 1994, more than half the home's 55 residents died - nearly triple the average death rate for nursing homes in Missouri. The Boone County medical examiner's office focused on 30 deaths that occurred during the year Williams worked at Ashland.

Six residents died in the 10 months after Williams' dismissal from the home on July 13, 1994. No charges resulted. Williams was removed after state inspectors found that he had failed to adequately supervise staff to ensure the safety, treatment and care of residents.

http://murderpedia.org/male.W/w/williams-richard-allen.htm



Compliance and Beyond- Future Aging

Technology – High Tech & High Touch

How can we add the Value of Human Element? Compliance?



Compliance

Affordable Care Act (ACA) core requirements should include:

1. Written policies, procedures and standards of conduct to prevent and detect inappropriate behavior.

2. Designation of a chief compliance officer.

3. Effective education and training programs for the governing body for all employees.

4. Maintenance of a hotline and anonymous reporting procedures to protect the anonymity of complainants and to protect whistleblowers from retaliation.

5. A system to respond to allegations of improper conduct and the enforcement of appropriate disciplinary action against employees who have violated internal compliance policies, applicable statutes, regulations or Federal health care program requirements.

6. The use of audits and/or other evaluation techniques to monitor and track compliance and assist in the reduction of identified problem areas.

7. The investigation and remediation of identified systemic problems including making any necessary modifications to the organization’s compliance and ethics program.



Compliance

What are you doing about your compliance and how comfortable are you that your current licensed staff / vendors?

• Are properly licensed• Have no Sanctions or Disciplinary Actions• Maintain required Certificates • Are not Excluded or Debarred by OIG/GSA• Maintain proper Continuing Education• Files are ready for Joint Commission or State audits

Rooting out health care fraud is central to the well-being of both our citizens and the overall economy. http://www.fbi.gov/about-us/investigate/white_collar/health-care-fraud

http://www.fbi.gov/about-us/investigate/white_collar/health-care-fraud

http://www.fbi.gov/about-us/investigate/white_collar/health-care-fraud



Compliance

Recommended program levels for current licensed staff and vendors:

Compliance Plans Minimum

Medium Maximum

General Services Administration Excluded Parties List System (GSA) X X X

Office of the Inspector General List of Excluded Individuals/Entities (OIG) X X X

Office of Foreign Assets Control Specially Designated Nationals (OFAC) X X X

State exclusions, sanctions, and debarment X X X

Instant SSN (social security number) Trace X X X

National Practitioner Data Bank (NPDB) X X

Professional License Verification X X

Nationwide Federal Criminal Record Search X X

Statewide Criminal Records Search X X

Registered Sex Offender Search X X

Ethics Training X

Continuing Education Training X



Compliance

Licensed Employees Only?

Do you have one place to go to determine the compliance for your entire organization?

2012, American Senior Communities recently settled with the OIG for $376,000 for employing 7 excluded providers. Fines included CNA's and kitchen staff.

Housekeepers?Drivers?Transporters?Dietary Staff – OH YesVOLUNTEERS?

My Dietary Manager



Compliance

Recommended program levels for non-licensed staff and vendors:

Compliance Plans Minimum

Medium Maximum

Instant SSN (social security number) Trace X X X

Nationwide Federal Criminal Record Search X X X

Statewide Criminal Records Search X X X

Registered Sex Offender Search X X X

Ethics Training X X X

Employment & I9 Verification X X

W-9 Verification X X

Workers Compensation Insurance Verification X X

General Liability Insurance Verification X X

Business Partner / Owner Search X X

County Civil / Lawsuit Search X



Compliance

The cost of not knowing?

Medicare/Medicaid Billing Participation1. Up to $10,000 fine for each item/service billed2. Treble (3x) damages3. Possible exclusion4. Charges under Federal False Claims Act

Legal Liability 5. Negligent hire or retention6. Loss of CMS Reimbursement Privileges (PPACA 6502)7. State fines for practicing without a license

Has it effected you, it has me~! RN & LPN story



Compliance

The cost of not knowing? – 2 examples

Example #1 - The U.S. Justice Department has accused RehabCare Group Inc. of paying more than $10 million in kickbacks to gain access to Medicare and Medicaid patients in Missouri nursing homes.

RehabCare began making payments in 2006 to induce a Missouri nursing home chain to grant RehabCare a contract to provide therapy services.

RehabCare’s revenue-sharing arrangement with the nursing home owner -- Sikeston, Mo.-based Health Systems Inc. -- defrauded the federal Medicare and Medicaid programs of millions of dollars, federal investigators allege.

Example # 2 - California’s Attorney General announced that the former director of nursing at a hospital in the Kern Valley Healthcare District was sentenced to three years in state prison for the “convenience drugging” of elderly patients, including one who ended up dying.

Gwen D. Hughes, the former nursing director, was charged with the deaths of three patients in the original lawsuit. She pled no contest to a single felony count of elder abuse last October, with a special allegation that the abuse resulted in the death of a patient.

http://www.rehabcare.com/about-us/

http://www.rehabcare.com/about-us/

http://www.manta.com/c/mtmsx0m/health-system-inc



Compliance

The cost of not knowing?

OIG also excluded 3,131 individuals and entities from participation in Federal health care programs in FY 2012. OIG reported 778 criminal actions against individuals or entities that engaged in crimes against HHS programs; and 367 civil actions.

The OIG reported $6.9 billion in expected recoveries which consisted of $923.8 million in audit receivables and $6 billion in investigative receivables for FY 2012.

Date Provider Self-Disclosure?

Amount of CMP Assessed

11/13/12 Hospital Yes $248,362.78

10/12/12 Hospital & Cardiology Practice

Yes $172,604.00

10/12/12 Physician d/b/a Physician’s Medical

Clinic

Yes $43,014.80

10/07/12 Home Health Agency Yes $81,102.06

10/07/12 Hospital Yes $150,000.00

09/26/12 Hospital Yes $120,580.25

09/25/12 Treatment Center Yes $105,794.24

09/19/12 Neighborhood Health Clinic

Yes $103,485.79

09/19/12 Hospital Yes $417,440.78

08/22/12 Hospital Yes $138,452.00

08/02/12

Hospital

Yes

$206,669.53

07/13/12 Community Clinic Yes $207,440.19

Sample listing



Compliance

GCT Advantages

• More than just a background check• Each compliance package is customized• Employee and vendor screening• No Cost for certifying outside vendors• International capabilities• Our system monitors monthly for changes• Nationwide databases• Secure documentation management• State of the art security to protect all data• On-site user interface for security or visitor center

GCT is a simple, efficient, cost-effective solution to manage your compliance with confidence. We also recognize that your operations must always remain audit ready.Why? We’ve been there as licensed Administrators~!...been there with Federal Surveyors, with FBI and OIG. It is NOT pretty or a cake walk.



Compliance

For any questions contact:GCT – Healthcare and Long Term Care Compliance Expert

Kendall Brune PhD, MBA, LHNA, [email protected]: 314-757-0131

Global Compliance Trackera KAEGEM division

2800 West Higgins Road, Suite 980Hoffman Estates, Illinois 60169Toll Free:1-888-327-6067E-mail: [email protected]

mailto:[email protected]

mailto:[email protected]

Healthcare Compliance Presentation

Health & Medicine

Transcript of Healthcare Compliance Presentation