Click to edit Master title style Compliance Plan Improvement For Health Systems Presented By: Scott Becker, Partner, McGuireWoods Healthcare Department Beckers Hospital Review 5 th Annual Meeting May 17, 2014

McGuireWoods | 2 CONFIDENTIAL Compliance Plan Improvement For Health Systems I.5 Things to Know as Background 1.Expansion of False Claims Act to Anti-Kickback and Stark Act 2.Increase in Self Disclosure 3.Fascinating Settlements and Cases in hospital sector A. Halifax - $85 million settlement, qui tam suit filed by an employee B.Tuomey – 8 years of litigation; $237.5 million award, based on a qui tam claim filed by a physician competitor C.Intermountain - $25.5 million settlement, based on a self- disclosure of improper payments to physicians

McGuireWoods | 3 CONFIDENTIAL Compliance Plan Improvement For Health Systems I.5 Things to Know as Background (continued) 4.OIG Core Focus on Hospitals A.45% of Medicare budget; $151 billion in 2011 B.OIG added 12 new hospital-related focus areas to its 2014 Work Plan 5.PPACA requires a satisfactory compliance plan – regulations not yet issued

McGuireWoods | 4 CONFIDENTIAL Compliance Plan Improvement For Health Systems II.5 Things Your System Must Do 1.Maintain or appoint a Chief Compliance officer who operates at a senior level 2.Review/Audit your compliance program focused on the OIG’s 7 Elements of a Compliance Program A.Written standards and procedures B.Oversight C.Education and training D.A process for reporting exceptions E.A system to respond to allegations of improper activities accompanied by appropriate discipline F.Auditing and monitoring G.Response and prevention

McGuireWoods | 5 CONFIDENTIAL Compliance Plan Improvement For Health Systems II.5 Things Your System Must Do (continued) 3.Start with the Basics and develop: A.A plan in place to audit billing and coding B.A core plan around physician relationships C.A core plan around HIPAA D.A broadcast education and communications plan E.Specific education regarding compliance topics for different staff groups

McGuireWoods | 6 CONFIDENTIAL Compliance Plan Improvement For Health Systems II.5 Things Your System Must Do (continued) 4.Next Steps A.Build a plan around your highest risk areas B.Determine the core exposure areas C.Develop a dashboard around such areas D.Develop a senior level compliance committee E.Understand inherent risk versus residual risk

McGuireWoods | 7 CONFIDENTIAL Compliance Plan Improvement For Health Systems II.5 Things Your System Must Do (continued) 5.An investigation commences or a complaint comes in or an employee or patient reports an issue A.Follow a thank you and follow up policy- no matter what B.Utilize a tracking system to track all reports C.Invite reporting of concerns D.No destroying documents (careful on “it’s the policy”); a hold notice E.Get legal team together asap - 2 perspectives on the legal team. Former government perspectives and a brilliant team. ACS - Always Consider Settlement F.Advise employees of rights in talking to government – but do not obstruct G.Establish early and ongoing communications with government. Use outside counsel to speak with government. Be transparent regarding government requests. H.Budget and prepare for expenses

McGuireWoods | 8 CONFIDENTIAL Compliance Plan Improvement For Health Systems III.3 Areas to Watch 1.In FY 2013, the federal government won or negotiated approximately $4.33 billion in judgments and settlements related to health care fraud cases and proceedings. 2.Increased transparency in Medicare payments to providers invites new public scrutiny in all health care sectors Proposed increase under the Medicare Incentive Reward Program from 10% to 15% of final amount collected (added to 15%-30% award for FCA qui tam realtors).

McGuireWoods | 9 CONFIDENTIAL Questions or Comments? Doc v 2