The New Corporate Integrity Agreements: What Did the Board Know and When Did They Know It?
|
|
- Rudolph White
- 5 years ago
- Views:
Transcription
1 The New Corporate Integrity Agreements: What Did the Board Know and When Did They Know It? Malcolm J. Harkins Center for Health Law Studies St. Louis University School of Law 2015 by Malcolm J. Harkins
2 AMENDED AND RESTATED CORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND OMNlCARE, INC. (Nov. 2, 2009) C. Certifications. The Implementation Report and Annual Reports shall include a certification by the Compliance Officer that: 1. to the best of his or her knowledge, Omnicare is in compliance with all of the requirements of this CIA; 2. he or she has reviewed the Report and has made reasonable inquiry regarding its content and believes that the information in the Report is accurate and truthful. (pp.32-33).
3 CORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, FOUNDATION HEALTH SERVICES, INC., RICHARDT. DASPIT, SR., et al. (June 5,2014). 2. Compliance Committee The Compliance Committee shall include the Compliance Officer, representatives from among senior personnel responsible for clinical operations and quality of care, human resources, operations, including Foundation's Director of Clinical Services, Richard T. Daspit, Sr., and any other appropriate officers or individuals necessary to thoroughly implement the requirements of this CIA.. For each scheduled [monthly] Compliance Committee meeting, senior management of Foundation shall report to the Compliance Committee, in writing, on the adequacy of care being provided by Foundation and senior representatives from facilities associated with Foundation shall be chosen, on a rotating and random basis, to report to the Compliance Committee on the adequacy of care being provided at their facilities. The minutes of the Compliance Committee meetings shall be made available to the OIG upon request. (pp. 4-5).
4 CORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, FOUNDATION HEALTH SERVICES, INC., RICHARDT. DASPIT, SR., et al. (June 5,2014). b. Board Resolution. For each Reporting Period of the CIA, the Board of Directors shall adopt a resolution summarizing the Board of Directors Committee's review and oversight of Foundation's compliance with the requirements set forth in this CIA, Federal health care program requirements, and professionally recognized standards of care. Each individual member of the Board of Directors Committee shall sign a statement indicating that he or she agrees with the resolution. (p.8).
5 I. CORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND HALIFAX HOSPITAL MEDICAL CENTER AND HALIFAX STAFFING, INC. (March 10,2014). 2. Compliance Committee. The Compliance Committee shall, at a minimum, include the Compliance Officer and other members of senior management necessary to meet the requirements of this CIA (e.g., senior executives of relevant departments, such as billing, clinical, human resources, audit, and operations).... (pp.4-5).
6 I. CORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND HALIFAX HOSPITAL MEDICAL CENTER AND HALIFAX STAFFING, INC. (March 10,2014). 3. Board of Commissioners Compliance Obligations. The Board of Commissioners of Halifax (Board) shall be responsible for the review and oversight of matters related to compliance with Federal health care program requirements and the obligations of this CIA. The Board must include independent (i.e., non-executive) members. c. for each Reporting Period of the CIA, adopting a resolution, signed by each member of the Board summarizing its review and oversight of Halifax s compliance with Federal health care program requirements and the obligations of this CIA.
7 CORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND HALIFAX HOSPITAL MEDICAL CENTER AND HALIFAX STAFFING, INC. (March 10,2014). 5. Management Accountability and Certifications. [C]ertain Halifax officers or employees (Certifying Employees) are specifically expected to monitor and oversee activities within the hospital and shall certify annually that the areas under their authority are compliant with applicable Federal health care program requirements and with the obligations of this CIA. These Certifying Employees shall include, at a minimum, the following: the President & Chief Executive Officer, the Senior Vice President & Chief Revenue Officer, the Executive Vice President & Chief Operating Officer, the Senior Vice President & Chief Quality Officer, the Executive Vice President & Chief Financial Officer, the Senior Vice President & Chief Medical Officer, the Vice President & Chief Nursing Officer, the Vice President & Chief Surgical Services Officer, the Vice President of Operations, the Vice President & Service Line Administrator and any other employees of Halifax with the title of Vice President or higher. (p.8).
8 CORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND HALIFAX HOSPITAL MEDICAL CENTER AND HALIFAX STAFFING, INC. (March 10,2014). Each Certifying Employee shall sign a certification that states as follows: I have been trained on and understand the compliance requirements and responsibilities as they relate to [department or functional area], an area under my supervision. My job responsibilities include ensuring that the [department or functional area] remains compliant with all applicable Federal health care program requirements, obligations of the Corporate Integrity Agreement, and Halifax Policies and Procedures, and I have taken steps to promote such compliance. To the best of my knowledge, except as otherwise described herein, the [department or functional area] of Halifax is in compliance with all applicable Federal health care program requirements and the obligations of the CIA. I understand that this certification is being provided to and relied upon by the United States. (p. 8).
9 Corporate Integrity Agreement Between the Office of Inspector General of the Department of Health Services and Extendicare Health Services, Inc. (Oct. 3, 2014). 6. Additional Extendicare Obligations: Extendicare Shall: c. Provide the [Independent] Monitor [selected by OIG] a report monthly, or sooner if requested by the Monitor, regarding each of the following occurrences: i. Deaths or injuries related to use of restraints; ii. iv. Deaths or injuries related to use of psychotropic medications; Deaths or injuries related to abuse or neglect; viii. Any other incident that involves or causes actual harm to a resident. Each such report shall contain the full name, social security or medical record number, and date of birth of the resident involved, the date of death or incident, and a brief description of the events surrounding the death or incident.
10 Corporate Integrity Agreement Between the Office of Inspector General of the Department of Health Services and Extendicare Health Services, Inc. (Oct. 3, 2014). 7. Additional Monitor Obligations: The Monitor Shall: d. If the Monitor has concerns about action plans that are not being enforced or systemic problems that could affect Extendicare's ability to render quality care to its residents, then the Monitor shall: report such concerns in writing to OIG; and simultaneously provide notice and a copy of the report to Extendicare's Compliance Committee and Board of Directors Committee.
11 Corporate Integrity Agreement Between the Office of Inspector General of the Department of Health Services and Extendicare Health Services, Inc. (Oct. 3, 2014). 3. Board of Directors Committee. Extendicare shall create a committee as part of its Board of Directors (hereinafter "Board of Directors Committee"). a. General Responsibilities. The purpose of the Board of Directors Committee shall be to review and provide oversight of matters related to Extendicare's compliance with the requirements set forth in this CIA, Federal health care program requirements, and professionally recognized standards of care. The Board of Directors Committee shall, at a minimum: ii. review the adequacy of Extendicare's system of internal controls, quality assurance monitoring and resident care; [and] iii. confirm that Extendicare's response to state, federal, internal, and external reports of quality of care issues is complete, thorough, and resolves the issue(s) identified;
12 Corporate Integrity Agreement Between the Office of Inspector General of the Department of Health Services and Extendicare Health Services, Inc. (Oct. 3, 2014). Board of Directors Committee Resolution. For each Reporting Period of the CIA, the Board of Directors Committee shall adopt a resolution Each individual member of the Board of Directors Committee shall sign a statement indicating that he or she agrees with the resolution. At a minimum, the resolution shall include the following language:. "The Board of Directors Committee has made a reasonable inquiry into the operations of Extendicare's Compliance Program. The Board of Directors Committee has also provided oversight on quality of care issues. Based on its inquiry and review, the Board of Directors Committee has concluded that, to the best of its knowledge, Extendicare has implemented an effective Compliance Program and Extendicare is in compliance with the requirements of the CIA, the Federal health care programs, and professionally recognized standards of care.
13 ACA Compliance Program Requirements The required components of a compliance and ethics program of an operating organization are the following: (B) Specific individuals within high-level personnel of the organization must have been assigned overall responsibility to oversee compliance with such standards and procedures and have sufficient resources and authority to assure such compliance. 42 USC 1320a-7j(b)(4).
14 CMS s Proposed Compliance Program Regulations Required components for all facilities. (1) [T]he designation of an appropriate compliance and ethics program contact to which individuals may report suspected violations.
15 CMS s Proposed Compliance (continued) Program Regulations (2) Assignment of specific individuals within the high-level personnel of the operating organization with the overall responsibility to oversee compliance with the operating organization s compliance and ethics program s standards, policies, and procedures, such as, but not limited to, the chief executive officer (CEO), members of the board of directors, or directors of major divisions in the operating organization. (3) Sufficient resources and authority to the specific individuals designated in paragraph (c)(2) of this section to reasonably assure compliance with such standards, policies, and procedures. 80 Fed. Reg , (July 16, 2015), Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities; Proposed Rule.
16 CMS s Proposed Compliance Program Regulations Compliance officer should report directly to the governing body. Compliance officer should not be subordinate to the general counsel, chief financial officer or the chief operating officer. 80 Fed. Reg , , (July 16, 2015), Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities; Proposed Rule.
17 Omnicare, Inc. v. Laborers Dist. Council Const. Industry, 135 S.Ct. 1318, 83 USLW 4187 (March 24, 2015). This case arises out of a registration statement that petitioner Omnicare filed in connection with a public offering of common stock. Omnicare is the nation's largest provider of pharmacy services for residents of nursing homes. Of significance here, two sentences in the registration statement expressed Omnicare's view of its compliance with legal requirements: We believe our contract arrangements with other healthcare providers, our pharmaceutical suppliers and our pharmacy practices are in compliance with applicable federal and state laws. We believe that our contracts with pharmaceutical manufacturers are legally and economically valid arrangements that bring value to the healthcare system and the patients that we serve.
18 Omnicare, Inc. v. Laborers Dist. Council Const. Industry, 135 S.Ct. 1318, 83 USLW 4187 (March 24, 2015). Most important, a statement of fact ( the coffee is hot ) expresses certainty about a thing, whereas a statement of opinion ( I think the coffee is hot ) does not. That remains the case if the CEO's opinion, as here, concerned legal compliance. If, for example, she said, I believe our marketing practices are lawful, and actually did think that, she could not be liable for a false statement of fact even if she afterward discovered a longtime violation of law. That still leaves some room for 11's false-statement provision to apply to expressions of opinion. As even Omnicare acknowledges, every such statement explicitly affirms one fact: that the speaker actually holds the stated belief. And so too the statement about legal compliance ( I believe our marketing practices are lawful ) would falsely describe her own state of mind if she thought her company was breaking the law. In such cases, 11's first part would subject the issuer to liability (assuming the misrepresentation were material).
19 Omnicare, Inc. v. Laborers Dist. Council Const. Industry, 135 S.Ct. 1318, 83 USLW 4187 (March 24, 2015). [A] reasonable investor may, depending on the circumstances, understand an opinion statement to convey facts about how the speaker has formed the opinion or, otherwise put, about the speaker's basis for holding that view. And if the real facts are otherwise, but not provided, the opinion statement will mislead its audience. Consider an unadorned statement of opinion about legal compliance: We believe our conduct is lawful. If the issuer makes that statement without having consulted a lawyer, it could be misleadingly incomplete. In the context of the securities market, an investor, though recognizing that legal opinions can prove wrong in the end, still likely expects such an assertion to rest on some meaningful legal inquiry rather than, say, on mere intuition, however sincere. Similarly, if the issuer made the statement in the face of its lawyers' contrary advice, or with knowledge that the Federal Government was taking the opposite view, the investor again has cause to complain: He expects not just that the issuer believes the opinion (however irrationally), but that it fairly aligns with the information in the issuer's possession at the time
20 IN RE OMNICARE, INC. SECURITIES LITIGATION, 769 F.3d 455 (6th Cir. 2014) The Complaint claims that Omnicare was fully aware of the [ ] deficiencies and that their wholly owned, operated and controlled pharmacies were submitting false and fraudulent Medicare and Medicaid claims. In particular, KBC averred that [the Internal Auditor] shared with [the CEO] the results of the [internal compliance] Audit[s] The Complaint also states that [o]n information and belief these results were given to all of the Individual Defendants. Id. at (Page ID #849). 9pp ). At bottom, KBC claimed that Omnicare and the Individual Defendants knew of these allegations of fraud or noncompliance and that, rather than confessing to the company s failures to comply with the regulations, Omnicare and its officers routinely made material misrepresentations about (1) its compliance with applicable laws, rules, and regulations; (2) its financial results; (3) the accuracy of the statements contained in its Forms 10 K and 10 Q; and (4) the root causes of its financial performance. (pp ).
21 IN RE OMNICARE, INC. SECURITIES LITIGATION, 769 F.3d 455 (6th Cir. 2014) We agree with the district court that the Complaint does not sufficiently tie [the CEO] (or any of the Individual Defendants) to the [compliance] audits, and thus, KBC has failed to plead sufficient facts showing that [the CEO] or the other Individual Defendants had actual knowledge that the Form 10 K statements were false. The Complaint states that [the Internal Auditor] presented the results of the [compliance] [A]udit[s] to Omnicare s Internal Audit and Corporate Compliance Committees, but it never states with particularity who sat on those committees or what the committee members responsibilities were in the corporate structure. (pp ).
22 IN RE OMNICARE, INC. SECURITIES LITIGATION, 769 F.3d 455 (6th Cir. 2014) [KBC] has not alleged with particularity what the specific results of the [[compliance] [A]udit[s] demonstrated or what was communicated to [the CEO], i.e.[,] how many pharmacies were involved, what specific irregularities were found, how many actual claims were involved, or how, or what, information was actually communicated. KBC merely makes general statements and heaps inference upon inference; the Complaint never alleges that Person A did Act B at Time C, which is required by the PSLRA. (p.482).
Agenda AN EFFECTIVE COMPLIANCE PROGRAM 3/17/2015. Quality Meets Compliance :
Quality Meets Compliance : An Integrated Approach to Improving Quality and Reducing Exposure in Health Care Lynn Barrett, J.D., CHC VP & Chief Compliance & Ethics Officer, Jackson Health System Peter Paige,
More informationRecover Health Training. Corporate Compliance Plan Code of Conduct Fraud & Abuse
Recover Health Training Corporate Compliance Plan Code of Conduct Fraud & Abuse 1 The Course Objectives When you complete this course you will be able to: Understand Recover Health s reasons for implementing
More informationNational Policy Library Document
Page 1 of 11 National Policy Library Document Policy Name: Medicare Programs: Compliance Element VII Prompt Response to Detected Offenses Policy No.: EJ44-83932 Policy Author: Author Title: Author Department:
More informationAnti-Fraud Plan Scripps Health Plan Services, Inc.
2015 Scripps Health Plan Services, Inc. 2015 Scripps Health Plan Services, Inc. Linda Pantovic, LVN Director Compliance & Performance Improvement Scripps Health Plan Services, Inc. 1/1/2015 Table of Contents
More informationAbuse and Neglect Investigation: Alaska Psychiatric Institute (API) API Violates Patients Rights in Handling Patients Grievances
Abuse and Neglect Investigation: Alaska Psychiatric Institute (API) API Violates Patients Rights in Handling Patients Grievances Issued April 5, 2011 Revised and reissued July 13, 2011 1 The Disability
More informationCompliance Program. Life Care Centers of America, Inc. and Its Affiliated Companies
Compliance Program Life Care Centers of America, Inc. and Its Affiliated Companies Approved by the Board of Directors on 1/11/2017 TABLE OF CONTENTS Page I. Introduction... 1 II. General Compliance Statement...
More informationOne Year Later THE IMPACT OF HEALTH CARE REFORM on Health Care Provider Audits and Compliance Programs
24 Health Care Law One Year Later THE IMPACT OF HEALTH CARE REFORM on Health Care Provider Audits and Compliance Programs By Andrew B. Wachler, Jennifer Colagiovanni, and Christopher J. Laney FAST FACTS:
More informationWhy do we care about these cases? HCCA Conference October 26, 2016
Enforcement, Compliance and Long Term Care: Nursing Homes HCCA Conference October 26, 2016 Andy Mao Assistant Director Elder Justice Initiative Coordinator United States Department of Justice Sally Blinken
More informationPHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE COMPLIANCE AND ETHICS PROGRAM MANUAL
PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE COMPLIANCE AND ETHICS PROGRAM MANUAL I. COMPLIANCE AND ETHICS PROGRAM BACKGROUND Philadelphia College of Osteopathic Medicine (PCOM) is committed to upholding
More informationA 12-Step Program to Better Compliance: A Practical Approach
A 12-Step Program to Better Compliance: A Practical Approach Kim Harvey Looney Anna M. Grizzle 615.850.8722 615.742.7732 kim.looney@wallerlaw.com agrizzle@bassberry.com 11389849 Strict Government Compliance
More information2012 Medicare Compliance Plan
2012 Medicare Compliance Plan Document maintained by: Gay Ann Williams Medicare Compliance Officer 1 Compliance Plan Governance The Medicare Compliance Plan is updated annually and is approved by the Boards
More informationAnalysis. Tracking Referrals: When Does a Hospital s Review of Referral Source Information Pose Stark Law Risks?
Analysis Tracking Referrals: When Does a Hospital s Review of Referral Source Information Pose Stark Law Risks? By Joseph E. Lynch, King & Spalding LLP, Washington, DC This article examines a pending Florida
More informationISDN. Over the past few years, the Office of the Inspector General. Assisting Network Members Develop and Implement Corporate Compliance Programs
Information Bulletin #7 ISDN National Association of Community Health Centers, Inc. INTEGRATED SERVICES DELIVERY NETWORKS SERIES For more information contact Jacqueline C. Leifer, Esq. or Marcie H. Zakheim,
More informationCompliance Program Guidance for General Hospitals
NEW YORK STATE DEPARTMENT OF HEALTH Office of the Medicaid Inspector General Compliance Program Guidance for General Hospitals James C. Cox, Medicaid Inspector General Issue Date: May 11, 2012 Compliance
More informationThe Department of Justice s Focus on Failure of Care Fraud Cases
The Department of Justice s Focus on Failure of Care Fraud Cases HCCA 17 TH ANNUAL COMPLIANCE INSTITUTE WASHINGTON, DC APRIL 21, 2013 SUSAN C. LYNCH, ESQ. U.S. DEPARTMENT OF JUSTICE SUSAN.LYNCH@USDOJ.GOV
More informationCompliance Program Updated August 2017
Compliance Program Updated August 2017 Table of Contents Section I. Purpose of the Compliance Program... 3 Section II. Elements of an Effective Compliance Program... 4 A. Written Policies and Procedures...
More informationAGENCY FOR PERSONS WITH DISABILITIES OFFICE OF INSPECTOR GENERAL ANNUAL REPORT JULY 1, 2013 JUNE 30, 2014
Barbara Palmer Director Carol Sullivan Inspector General AGENCY FOR PERSONS WITH DISABILITIES OFFICE OF INSPECTOR GENERAL ANNUAL REPORT JULY 1, 2013 JUNE 30, 2014 FLORIDA CAPTIAL, APRIL 2, 2014, AUTISM
More informationOn April 16, 2008, the Department. Draft Supplemental. Compliance Program Guidance for Nursing. Facilities
Draft Supplemental Compliance Program Guidance for Nursing Facilities By Cheryl L. Wagonhurst, Esq, CCEP; and Nathaniel M. Lacktman, Esq, CCEP Editor s note: Cheryl L. Wagonhurst is a partner with the
More informationNational Policy Library Document
Page 1 of 11 National Policy Library Document Policy Name: Medicare Compliance: Compliance Officer and Compliance Committee Policy No.: HR328-133757 Policy Author: Author Title: Author Department: Sheryl
More informationClinical Compliance Program
Clinical Compliance Program The University at Buffalo School of Dental Medicine, Daniel Squire Diagnostic and Treatment Center (UBSDM) has always been and remains committed to conducting its business in
More informationMDS 3.0: A Compliance Officer's Nightmare or Nirvana?
MDS 3.0: A Compliance Officer's Nightmare or Nirvana? 1 Introduction In October 2010, CMS implemented a new standardized resident assessment instrument called MDS 3.0 FY2012, new assessment type implemented:
More informationFraud, Abuse, & Waste, Oh My! Developing an Effective Compliance Program
Fraud, Abuse, & Waste, Oh My! Developing an Effective Compliance Program Program speaker The speaker for this program is Arlene Luu, RN, BSN, JD, CPHRM, Senior Patient Safety & Risk Consultant, MedPro
More informationAlignment. Alignment Healthcare
Alignment CODE OF CONDUCT Alignment Healthcare Our commitment to ethical conduct and compliance depends on all Alignment Healthcare personnel. If you find yourself in an ethical dilemma or suspect inappropriate
More informationHCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN. Post Acute Provider Specific Sections from OIG Work Plans
HCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN Kelly Priegnitz # Chris Puri # Kim Looney Post Acute Provider Specific Sections from 2012-2015 OIG Work Plans I. NURSING HOMES
More informationNational Policy Library Document
Page 1 of 5 National Policy Library Document Policy Name: Medicare Compliance: Compliance Officer and Compliance Committee Policy No.: HR328-133757 Policy Author: Author Title: Author Department: Sheryl
More informationCurrent Status: Active PolicyStat ID: COPY CONTRACTOR, MEDICAL STAFF, REFERRAL SOURCE AND EMPLOYEE SCREENING POLICY
Current Status: Active PolicyStat ID: 4305040 Origination: 01/2015 Last Approved: 11/2017 Last Revised: 11/2017 Next Review: 11/2018 Owner: Julie Groves: Compliance Office Policy Area: Compliance References:
More informationHealth Care Compliance Association 17 th Annual Compliance Institute. The Drive To Quality: Are You On The Bus or Under It?
Health Care Compliance Association 17 th Annual Compliance Institute The Drive To Quality: Are You On The Bus or Under It? April 21, 2013 Washington, DC 1 I. Introduction 1 In November 2012, OIG published
More informationARNOLD & PORTER UPDATE
ARNOLD & PORTER UPDATE Guide for Pharmaceutical Industry October 2002 On Monday, September 30, 2002, the Office of Inspector General, U.S. Department of Health and Human Services ( HHS OIG or OIG ) released
More informationAs promised in the 2006 statute1 and accompanying
New York Issues Compliance Guidance for Hospitals A Look at How the Guidance Stacks Up to OIG Recommendations Jack Wenik / Matthew McKennan Jack Wenik is a member er of the firm Sills, Cummis mis & Gross
More informationMedicare s Electronic Health Records Incentive Program- Overview
HCCA Upper Northeast Regional Conference Meaningful Use Best Compliance Practices May 17, 2013 Lourdes Martinez, Esq. lmartinez@garfunkelwild.com 111 Great Neck Road Great Neck, NY 11021 (516) 393-2200
More informationINSTITUTE ON MEDICARE/MEDICAID PAYMENT ISSUES MEDICARE CONDITIONS OF PARTICIPATION: WHAT IS YOUR GRADE?
INSTITUTE ON MEDICARE/MEDICAID PAYMENT ISSUES MEDICARE CONDITIONS OF PARTICIPATION: WHAT IS YOUR GRADE? Cindy Wisner, Esq. Teresa A. Williams, Esq. Trinity Health INTEGRIS Health, Inc. 20555 Victor Parkway
More informationOIG Opines On Propriety Of ED On-Call Coverage Arrangements By Michael Paddock and Lauren Kim, Crowell & Moring LLP*
OIG Opines On Propriety Of ED On-Call Coverage Arrangements By Michael Paddock and Lauren Kim, Crowell & Moring LLP* Over the last several years, due in part to the growing financial burden on both physicians
More informationAUDITOR GENERAL S REPORT
Appendix 1 AUDITOR GENERAL S REPORT 2012 ANNUAL REPORT ON FRAUD INCLUDING THE OPERATIONS OF THE FRAUD AND WASTE HOTLINE January 28, 2013 Jeffrey Griffiths, C.A., C.F.E. Auditor General TABLE OF CONTENTS
More informationFLORIDA LOTTERY OFFICE OF INSPECTOR GENERAL ANNUAL REPORT FISCAL YEAR
September 2013 FLORIDA LOTTERY OFFICE OF INSPECTOR GENERAL ANNUAL REPORT FISCAL YEAR 2012-13 Andy Mompeller Inspector General Table of Contents Overview 2 OIG Mission and Goal 3 Summary of OIG Activities
More informationDelayed Federal Grant Closeout: Issues and Impact
Delayed Federal Grant Closeout: Issues and Impact Natalie Keegan Analyst in American Federalism and Emergency Management Policy September 12, 2014 Congressional Research Service 7-5700 www.crs.gov R43726
More informationBOARD OF COOPERATIVE EDUCATIONAL SERVICES SOLE SUPERVISORY DISTRICT FRANKLIN-ESSEX-HAMILTON COUNTIES MEDICAID COMPLIANCE PROGRAM CODE OF CONDUCT
BOARD OF COOPERATIVE EDUCATIONAL SERVICES SOLE SUPERVISORY DISTRICT FRANKLIN-ESSEX-HAMILTON COUNTIES MEDICAID COMPLIANCE PROGRAM CODE OF CONDUCT Adopted April 22, 2010 BOARD OF COOPERATIVE EDUCATIONAL
More informationCAUTION. Introduction
Introduction Most physicians strive to work ethically, render high-quality medical care to their patients, and submit proper claims for payment. Society places enormous trust in physicians, and rightly
More informationCOMPLIANCE PLAN PRACTICE NAME
COMPLIANCE PLAN PRACTICE NAME Table of Contents Article 1: Introduction A. Commitment to Compliance B. Overall Coordination C. Goal and Scope D. Purpose Article 2: Compliance Activities Overall Coordination
More informationIllinois Association of Defense Trial Counsel P.O. Box 7288, Springfield, IL IDC Quarterly Vol. 14, No. 2 (14.2.
Health Law By: Roger R. Clayton Heyl, Royster, Voelker & Allen Peoria What Every Litigator Needs to Know About Recent Changes in EMTALA Introduction The Emergency Medical Treatment and Active Labor Act
More informationAssessment Framework for Designated Centres for Persons (Children and Adults) with Disabilities
Assessment Framework for Designated Centres for Persons (Children and Adults) with Disabilities January, 2015 1 About the The (HIQA) is the independent Authority established to drive high quality and safe
More informationMarch 5, March 6, 2014
William Lamb, President Richard Gelula, Executive Director March 5, 2012 Ph: 202.332.2275 Fax: 866.230.9789 www.theconsumervoice.org March 6, 2014 Marilyn B. Tavenner Administrator Centers for Medicare
More informationManaging employees include: Organizational structures include: Note:
Nursing Home Transparency Provisions in the Patient Protection and Affordable Care Act Compiled by NCCNHR: The National Consumer Voice for Quality Long-Term Care, April 2010 Part I Improving Transparency
More informationPage 1 of 7. August 7, 2017
Page 1 of 7 August 7, 2017 Honorable Seema Verma, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence
More informationRECENT DEVELOPMENTS 3/17/2015
Trends, Challenges, and Best Practices for an Effective Home Health Compliance Program Asha Scielzo, Special Counsel Pillsbury Winthrop Shaw Pittman Tina Rao, Chief Counsel of Healthcare Maxim Healthcare
More informationDISA INSTRUCTION March 2006 Last Certified: 11 April 2008 ORGANIZATION. Inspector General of the Defense Information Systems Agency
DEFENSE INFORMATION SYSTEMS AGENCY P. O. Box 4502 ARLINGTON, VIRGINIA 22204-4502 DISA INSTRUCTION 100-45-1 17 March 2006 Last Certified: 11 April 2008 ORGANIZATION Inspector General of the Defense Information
More informationAHLA Medicare & Medicaid Institute
AHLA Medicare & Medicaid Institute Conditions of Participation as a basis for Overpayment, Mandatory Report/ Refund, and False Claims Act Liability Timothy P. Blanchard Robert A. Hussar James G. Sheehan.
More information1) ELIGIBLE DISCIPLINES
PRACTITIONER S APPLICABLE TO ALL INDIVIDUAL NETWORK PARTICIPANTS AND APPLICANTS FOR THE PREFERRED PAYMENT PLAN NETWORK, MEDI-PAK ADVANTAGE PFFS NETWORK AND MEDI-PAK ADVANTAGE LPPO NETWORK of Arkansas Blue
More informationDecember 21, 2012 BY ELECTRONIC DELIVERY
BY ELECTRONIC DELIVERY CDR Krista M. Pedley, PharmD, MS, USPHS Director Office of Pharmacy Affairs Healthcare Systems Bureau Health Resources and Services Administration 5600 Fishers Lane Parklawn Building,
More informationA Day in the Life of a Compliance Officer
A Day in the Life of a Compliance Officer (for small physician practices) Mina Sellami, MBA, PMP, JD MedProv, LLC Julia Konovalov Medical Business Partners September 29, 2016 Agenda Government Regulations
More informationTHE MONTEFIORE ACO CODE OF CONDUCT
THE MONTEFIORE ACO CODE OF CONDUCT 2017 Approved by the Board of Directors on March 10, 2017 Our Commitment to Compliance As a central part of its Compliance Program, the Bronx Accountable Healthcare Network
More information(Signed original copy on file)
CFOP 75-8 STATE OF FLORIDA DEPARTMENT OF CF OPERATING PROCEDURE CHILDREN AND FAMILIES NO. 75-8 TALLAHASSEE, September 2, 2015 Procurement and Contract Management POLICIES AND PROCEDURES OF CONTRACT OVERSIGHT
More informationRequirements for Tax-Exempt Hospital Billing and Collection Practices Under the ACA
Requirements for Tax-Exempt Hospital Billing and Collection Practices Under the ACA Member Briefing, October 2016 Sponsored by the Tax and Finance Practice Group. Co-sponsored by the Academic Medical Centers
More information9/17/2018. Critical to Practices
Critical to Practices Provides: Reviewing quality of care provided to patients. Education to providers on documentation guidelines. Ensuring all services are supported, and revenue captured. Defending
More informationCase 1:15-cv EGS Document 50 Filed 12/22/15 Page 1 of 21 IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA
Case 1:15-cv-02115-EGS Document 50 Filed 12/22/15 Page 1 of 21 IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA FEDERAL TRADE COMMISSION, et al., Plaintiffs, Civil Action No. 1:15-cv-02115
More information2016 Hospital Conference. Objectives. The Bureau of Health Services 5/5/2016
2016 Hospital Conference Cremear Mims Division of Quality Assurance Bureau of Health Services, Director May 12, 2016 Objectives The audience will understand the role of the Bureau of Health Services. The
More informationNovember 16, Dear Dr. Berwick:
November 16, 2010 Don Berwick, MD Administrator Centers for Medicare and Medicaid Services Department for Health and Human Services Attn: CMS-6028-P P.O. Box 8020 Baltimore, MD 21244-8017 RE: Medicare,
More informationPatient Safety Audio Conference on Legal Issues in Quality of Care January 26, 2009
Patient Safety Audio Conference on Legal Issues in Quality of Care January 26, 2009 James G. Sheehan Medicaid Inspector General State of New York 518 473-3782 JGS05@OMIG.State.NY.US PATIENT-CENTERED CARE
More informationCONDUCTING A COMPLIANCE REVIEW OF HOSPITAL- PHYSICIAN FINANCIAL ARRANGEMENTS
CONDUCTING A COMPLIANCE REVIEW OF HOSPITAL- PHYSICIAN FINANCIAL ARRANGEMENTS Dennis S. Diaz Partner Davis Wright Tremaine LLP Los Angeles, California A. CMS has the Authority to Require Hospitals to Provide
More information15. Legal and Regulatory Issues. 1. Laws governing medicine and medical ethics complement and overlap each other.
15. Legal and Regulatory Issues A. General Ethical Legal Principals 1. Laws governing medicine and medical ethics complement and overlap each other. a. In the past, decisions were made by doctors and other
More informationUNIVERSITY OF ROCHESTER MEDICAL CENTER BILLING COMPLIANCE PLAN
UNIVERSITY OF ROCHESTER MEDICAL CENTER BILLING COMPLIANCE PLAN Revised December 31, 1998 INTRODUCTION This plan is an integral part of the University s ongoing efforts to achieve compliance with federal
More informationCONDUCTING A COMPLIANCE REVIEW OF HOSPITALPHYSICIAN FINANCIAL ARRANGEMENTS
CONDUCTING A COMPLIANCE REVIEW OF HOSPITALPHYSICIAN FINANCIAL ARRANGEMENTS Dennis S. Diaz, Esq. Shannon G. Dwyer, Esq. Partner Davis Wright Tremaine LLP Los Angeles, CA Sr. Vice President and General Counsel
More informationUsing Internal Audits for Successful Grant Administration
Using Internal Audits for Successful Grant Administration Welcome & Speakers Session Objectives Explain key rules and requirements for complying with CDBG-DR Internal Audit requirements Discuss role of
More informationAshland Hospital Corporation d/b/a King s Daughters Medical Center Corporate Compliance Handbook
( Medical Center ) conducts itself in accord with the highest levels of business ethics and in compliance with applicable laws. This goal can be achieved and maintained only through the integrity and high
More informationNew Patient Information
New Patient Information PATIENT INFORMATION M / F Last Name First Name Middle Name Suffix- Jr, Sr, etc. Mr, Mrs, Ms, Dr Sex Date of Birth Social Security Number Alias- Nickname (Last, First, Middle) Permanent
More informationAssessment. SMP Foundations Training Kit. Table of Contents
SMP Foundations Training Kit Assessment Table of Contents Participant Assessment Questions and Answer Form Assessment Questions... 10 Pages Answer Form... 2 Pages Trainer s Resources Answer Key... 2 Pages
More informationCompassionate Care Hospice
GOVERNING BODY AUTHORIZATION... 3 Compliance Program Introduction... 4 Compliance Officer Introduction... 5 COMPLIANCE POLICY... 6 COMPLIANCE PLAN... 7 COMPLIANCE PROGRAM... 8 Compliance officer... 8 Compliance
More informationMONTEREY BAY UNIFIED AIR POLLUTION CONTROL DISTRICT
MONTEREY BAY UNIFIED AIR POLLUTION CONTROL DISTRICT REQUEST FOR PROPOSAL INDEPENDENT AUDIT SERVICES Monterey Bay Unified Air Pollution Control District 24580 Silver Cloud Court Monterey, CA 93940 831-647-9411
More informationSTANDARDS OF CONDUCT SCH
STANDARDS OF CONDUCT SCH01242018 2018 LETTER FROM THE CEO Welcome, Thank you for choosing St. Croix Hospice. The care you provide impacts our patients, families, caregivers, and countless others every
More informationDEPARTMENT OF JUSTICE ELDER JUSTICE INITIATIVE
DEPARTMENT OF JUSTICE ELDER JUSTICE INITIATIVE November 17, 2014 False Claims Act Cases The Law 3 Worthless services is a viable theory for the United States to pursue against a skilled nursing facility
More informationNOTICE OF PRIVACY PRACTICES This Notice is effective September 23, 2013
NOTICE OF PRIVACY PRACTICES This Notice is effective September 23, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
More informationVIA ELECTRONIC MAIL
One Federal Street, 5 th Floor Boston, MA 02110 T 617-338-5241 888-211-6168 (toll free) F 617-338-5242 W www.healthlawadvocates.org Board of Directors Mala M. Rafik, President Brian P. Carey, Treasurer
More informationUNITED STATES DISTRICT COURT DISTRICT OF NEW JERSEY
UNITED STATES OF AMERICA et al v. OMNICARE, INC. et al Doc. 388 UNITED STATES DISTRICT COURT DISTRICT OF NEW JERSEY UNITED STATES OF AMERICA ex rel. Marc Silver, et al., v. Plaintiffs, HONORABLE NOEL L.
More informationThank you for your interest in volunteering with the Seton Angel Auxiliary.
VOLUNTEER APPLICATION Name: Thank you for your interest in volunteering with the Seton Angel Auxiliary. Love All - Serve All Today s Date: Mailing Address:: City/State/Zip Code Group/ Business you are
More informationComplaint Investigations of Minnesota Health Care Facilities
Complaint Investigations of Minnesota Health Care Facilities Report to the Minnesota Legislature explaining the investigative process and summarizing investigations from July 1, 2004 to June 30, 2007 and
More informationDISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Kendra O Bryan, RPN Chairperson Cheryl McMaster, RPN Member Grace Isgro-Topping Public Member Bill Dowson Public Member BETWEEN: NICK COLEMAN
More informationNeglect Critical Element Pathway
Use this pathway for concerns in structures or processes that have led to resident outcome such as unrelieved pain, avoidable pressure injuries, poor grooming, avoidable dehydration, lack of continence
More informationThe Importance of the Conditions of Participation for Hospitals
The Importance of the Conditions of Participation for Hospitals The Centers for Medicare & Medicaid Services (CMS) issued Transmittal R37SOMA (Transmittal 37) revising the Interpretive Guidelines to Hospitals
More informationOur Services Include. Our Credentials
is a healthcare consulting and education firm providing services such as: IRO services, practice management and assessment services, A/R management and oversight, new practice set up that includes lease
More informationUNITED STATES OF AMERICA CRIMINAL COMPLAINT CASE NUMBER: BRENDOLYN HART-GLOVER UNDER SEAL
AO 91 (REV.5/85) Criminal Complaint AUSA J. Gregory Deis (312) 886-7625 W44444444444444444444444444444444444444444444444444444444444444444444444444444444444444444 UNITED STATES DISTRICT COURT NORTHERN
More informationAbuse, Neglect & Exploitation
Abuse, Neglect and Exploitation Reporting and Investigation Department of Aging & Disability Services Presented by: Rosalind Nelson-Gamblin Policy, Rules, and Curriculum Development Unit DADS Regulatory
More informationINVESTIGATIONS. Division of Investigations and Law Enforcement
INVESTIGATIONS Division of Investigations and Law Enforcement ORGANIZATIONAL CHART INVESTIGATIONS INTEGRITY The Role of Ethics in Criminal Justice Agencies The success of any Criminal Justice Agency is
More informationCORPORATION FOR PUBLIC BROADCASTING
CORPORATION FOR PUBLIC BROADCASTING SEMIANNUAL REPORT OFFICE OF INSPECTOR GENERAL OPERATIONS CPB AUDIT RESOLUTION ACTIVITIES October 1, 2012 to March 31, 2013 FOREWORD Congress created the (CPB) in 1967
More informationDEPARTMENT OF HUMAN SERVICES AGING AND PEOPLE WITH DISABILITIES OREGON ADMINISTRATIVE RULES CHAPTER 411 DIVISION 069 LONG TERM CARE ASSESSMENT
411-069-0000 Definitions DEPARTMENT OF HUMAN SERVICES AGING AND PEOPLE WITH DISABILITIES OREGON ADMINISTRATIVE RULES CHAPTER 411 DIVISION 069 LONG TERM CARE ASSESSMENT Unless the context indicates otherwise,
More informationAccountable Care and Governance Challenges Under the Affordable Care Act
Accountable Care and Governance Challenges Under the Affordable Care Act The First National Congress on Healthcare Clinical Innovations, Quality Improvement and Cost Containment October 26, 2011 Doug Hastings
More informationCOMPLIANCE PLAN October, 2014
COMPLIANCE PLAN October, 2014 TABLE OF CONTENTS Introduction...3 I. Code of Conduct...3 A. University of Illinois at Chicago Code of Conduct...3 B. COD Standards of Conduct...4 II. Potential Risk Areas...4
More informationInspector General: Investigations
DCMA Instruction 931 Inspector General: Investigations Office of Primary Responsibility Office of Internal Audit and Inspector General Effective: November 22, 2017 Releasability: Cleared for public release
More informationFRAUD IN PERSONAL CARE PROGRAMS
FRAUD IN PERSONAL CARE PROGRAMS JAMES G. SHEEHAN CHIEF INTEGRITY OFFICER NEW YORK CITY HUMAN RESOURCES ADMINISTRATION sheehanj@hra.nyc.gov (212) 274-5600 LEARNING OBJECTIVES Identifying personal care services.
More informationREQUEST FOR PROPOSALS SERVICES FOR. [Federal Media Network Training] Prepared by. IOM Somalia. [Somalia Stabilization Initiative - SSI]
REQUEST FOR PROPOSALS SERVICES FOR [Federal Media Network Training] Prepared by IOM Somalia [Somalia Stabilization Initiative - SSI] [25 January 2018] REQUEST FOR PROPOSALS RFP No.: [MOG020] IOM Somalia
More informationThe Intersection of Health Care Fraud and Patient Safety
The Intersection of Health Care Fraud and Patient Safety Anthony Baize, Inspector General January 16, 2018 Wisconsin Department of Health Services Office of the Inspector General Overview The Wisconsin
More informationResidential Treatment Services Manual 6/30/2017. Utilization Review and Control UTILIZATION REVIEW AND CONTROL CHAPTER VI. Page. Chapter.
1 UTILIZATION REEW AND CONTROL CHAPTER 2 CHAPTER TABLE OF CONTENTS PAGE Financial Review and Verification... 3 Utilization Review (UR) - General Requirements... 3 Appeals... 4 Documentation Requirements
More informationHow to Overhaul your Internal Structure to be Prepared for the New Home Health CoPs. Program Objectives
How to Overhaul your Internal Structure to be Prepared for the New Home Health CoPs 2015 NAHC Annual Meeting 106 October 28, 4:30 5:30 p.m. Nashville, Tennessee Kathleen Spooner, RN, CMC Kathleen A. Hessler,
More informationYALE-NEW HAVEN HOSPITAL MEDICAL STAFF POLICY & PROCEDURE CONFLICT OF INTEREST
YALE-NEW HAVEN HOSPITAL MEDICAL STAFF POLICY & PROCEDURE CONFLICT OF INTEREST Definitions External financial interests can create conflicts when they provide an incentive to a Medical Staff member to affect
More informationPADONA DON CERTIFICATION PREP COURSE
PADONA DON CERTIFICATION PREP COURSE October 18-21, 2016 SHERATON HARRISBURG/HERSHEY 4650 Lindle Road Harrisburg, PA 17111 DON Certification Prep Course 2016 DAY 1 Tues. Oct. 18, 2016 ATTAINING & SUSTAINING
More informationPOLICIES AND PROCEDURES MANUAL
POLICIES AND PROCEDURES MANUAL OFFICE OF THE DISTRICT OF COLUMBIA LONG-TERM CARE OMBUDSMAN LEGAL COUNSEL FOR THE ELDERLY sponsored by the AARP FOUNDATION and AARP Part of the Senior Service Network funded
More informationSEMIANNUAL REPORT. Central Intelligence Agency Inspector General TO THE DIRECTOR OF CENTRAL INTELLIGENCE. John L. Helgerson Inspector General
SECRET, Central Intelligence Agency Inspector General (b)(1) (b)(2) (b)(3) (b)(5) (b)(6) SEMIANNUAL REPORT TO THE DIRECTOR OF CENTRAL INTELLIGENCE JULY - DECEMBER 2003 APPROVED FOR RELEASE DATE: 25-Feb-2010
More informationDiane Meyer, CHC (650) Agenda
The Road Ahead and How to Navigate It Kevin D. Lyles, Esq. kdlyles@jonesday.com (614) 281-3821 Diane Meyer, CHC DMeyer@stanfordmed.org (650) 724-2572 Frank E. Sheeder, Esq. fesheeder@jonesday.com (214)
More informationWhat Will Be Covered:
A View From New York: Compliance Mandates You May See in Your State Health Care Compliance Association (HCCA) April 23, 2013 National Harbor, Maryland Carol Booth, Compliance Specialist NYS Office of Medicaid
More informationHCCA Annual Institute
HCCA - 2013 Annual Institute University of Medicine and Dentistry of New Jersey (UMDNJ) Compliance after Deferred Prosecution Bret S. Bissey, FACHE, MBA, CHC, CMPE Senior Vice President, Chief Ethics and
More informationCORPORATE COMPLIANCE POLICY AUDIT & CROSSWALK WHERE ADDRESSED
QUALITY OF CARE Sufficient Staffing Inadequate staffing levels or insufficiently trained (inadequate clinical expertise) or insufficiently supervised staff providing medical, nursing, and related services
More informationPhysician Payments Disclosure and Aggregate Spend:
Physician Payments Disclosure and Aggregate Spend: Navigating Conflicting and Unclear State Laws and Regulations A Guide for Device Manufacturers October 26, 2010 Colin J. Zick Foley Hoag LLP czick@foleyhoag.com
More information