Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance.

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Presentation transcript:

Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance

Topics Covered Regulator Behavior Compliance Response

REGULATOR BEHAVIOR How the OIG behaves and how HSC Compliance responds

2013 Enforcement Numbers $5.6B recovered 3,214 new excluded parties 960 criminal actions 472 civil actions How did we get here?

OIG Motivations Money – Protect the Medicare trust funds – Government budget – Medicare enrollment Headlines – Demonstrate effectiveness

OIG Behavior Looking beyond “fraud” – Quality – Waste and abuse – Exclusion authorities Data analytics Regulatory creep

Available Information Statutes and regulations Guidance documents Corporate Integrity Agreements (CIAs) Presentations at conferences News reports and press releases

PROTECTING THE HSC How we respond to all of this

Achievements HSC Code of Ethics and training Awareness Hired an Educator New hotline and incident management system

Coming Soon Consolidation Investigation processes Training calendar

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