1. Legal, Regulatory & Compliance
John D. Whipple, Deputy General Counsel for Providence Health & Services
Gary Flaming, Senior Vice President, Chief Risk Officer

2. Department of Legal Affairs (DLA)
Health care is one of the most heavily regulated industries
The diagram below provides a pretty accurate description of the legal and regulatory issues PH&S deals with on a daily basis:

4. Department of Legal Affairs (DLA)
We are your in-house law firm
We ask that you start with us for any legal services and then we’ll engage external resources as needed

5. Department of Legal Affairs (DLA)
We have 15 attorneys with expertise in key areas including:
Stark
Anti-Kickback
Medical Staff Matters
Tax Exemption
EMTALA
False Claims Act
Medicare Billing Rules
HIPAA
Affordable Care Act

6. Department of Legal Affairs (DLA)
We have consolidated Providence, Swedish and Kadlec legal departments into a single department
We have attorneys licensed to practice in Washington, Oregon and California
May act as in-house counsel in each of the states we operate

7. Department of Legal Affairs (DLA)
We have an “on-call” attorney 24/7 for after-hours emergency legal issues
We’ve designated “Regional Point Persons” for each region/ministry for initial attorney contact
Department’s “Intranet” website great resource for our clients

8. Enterprise Risk Management Services (ERMS)
Background
Internal Audit (80-90% preplanned)
Integrity & Compliance (50-60% preplanned)
Information Security (40-50% preplanned)
Risk, Insurance & Claims (10-20% preplanned)
Both region and System Office presence
Report jointly to PH&S Operations President and Finance, Audit & Compliance Committee of
the Board

9. Indirect Support of Community Boards Internal Audit
Credentialing
Quality/Patient Care (biomedical equipment, Sepsis bundles, central line insertions, medication reconciliations, etc.)
IT Audit
Integrity & Compliance
Compliance education - boards and physicians
Monitoring medical staff for OIG/GSA list

10. Indirect Support of Community Boards Information Security
Standards for computer system protection
Risk, Insurance & Claims
Medical malpractice cases
Insurance placement

11. IRS Form 990 Compliance Requirements
Conflict of Interest (COI) policy
Officers, Directors or Trustees, and key employees complete COI disclosure
Written whistleblower policy
Document retention and destruction policy
YES TO ALL! 11

12. High-Risk Areas Cyber Attacks Medical Necessity Stark Regulations
False Claims Act
Conflict of Interest
Patient Privacy

13. Compliance – Local Support
Program overseen by System Board
Key elements:
Code of Conduct
Compliance and security education
24-hour hotline
Investigations
Policy development (non-retaliation, conflict of interest, etc.)
Conflict of Interest

14. Legal, Regulatory, Governmental, Licensing & Accrediting Requirements
Management - accountable for meeting regulatory, licensing and accrediting requirements
ERMS -provides the organizational structure to validate the achievement of mandate requirements
Providence
supports work and decisions of the Community Board
provides Directors and Officers Insurance Coverage

15. Legal, Regulatory, Governmental, Licensing & Accrediting Requirements
Community Board Responsibilities:
Understand the key policies for CB members and to conduct all interactions on behalf of PH&S within the guidelines of those directives
Hold management accountable for meeting or exceeding all mandated requirements
Complete and submit annual Conflict of Interest statement