When You Need and Don’t Need Legal Representation for OMIG (Former) Compliance Officer’s Perspective Laurie G. Radler, CHFP

Disclaimer  These are my own opinions, not the opinions of my employer  In no means do I mean to say that our attorneys don’t provide us with great value  My comments pertain to seasoned compliance officers, not “newbies”

The Potter Stewart Perspective “I shall not today attempt to further define the kinds of material I understand to be embraced within (any OMIG audit); and perhaps I could never succeed in intelligibly doing so…But I know it when I see it…

What’s the Reality?  Hospitals are very resource constrained  Hospitals are addressing a plethora of audits all the time (RAC, OMIG, CMS, NGS to name a few)  For many, compliance budgets have been cut back while the needs have actually grown  Self-audits are expected as a part of any “effective” compliance audit  This all translates to a need to be very judicious about the decision to go to outside “experts” (attorneys and/or consultants)

What are the “Decision Points”?  CEO/Board directive  Results could be “material” to hospital financials (before fines and penalties)  When the audit findings will suggest that a voluntary self-disclosure will need to be made  For any Stark, physician contracting or anti- kickback allegations  Institution is the only target for this audit

What are the “Decision Points”? (continued)  When e-discovery is involved  When criminality is suspected  Possibly when there is a high level of reputational risk involved  When initial self-audit (run and controlled by Compliance with subject matter experts) shows poor or questionable results, and requires further review.

Compliance Officer’s Role (with or without counsel)  Attend all calls and meetings with your counsel  Extend audit deadline if necessary  Determine auditor’s knowledge of subject matter  CCO is the face of and the advocate for the organization

Key Points to Remember  Adverse audit can lead to an OIG referral  Verbal responses during the audit are inadequate… request everything in writing. Be careful!  Take every opportunity to promptly present your organization’s perspective in responding to the audit even if you are not requested to do so.  No audit should be considered routine. All must be taken seriously especially if audit letter alleges that you knew or should have known the regulatory requirements.

Key Points to Remember  Always ask for more time if needed  Fully understand the knowledge of the contractors conducting audits. Take the opportunity if needed to defend yourself as you educate them  Remember the 60 day overpayment window! Sometimes just paying the money back and learning from the audit is best  MOST IMPORTANTLY - treat the OMIG with respect, not fear!!

The Potter Stewart Perspective “I shall not today attempt to further define the kinds of material I understand to be embraced within (any OMIG audit); and perhaps I could never succeed in intelligibly doing so…But I know it when I see it…