1. CORPORATE COMPLIANCE Tim Timmons Vice President Compliance and Regulatory Services Health Future, LLC

2. PRESENTATION OUTLINE  WHAT IS A CORPORATE COMPLIANCE PROGRAM  WHY DO WE NEED ONE  RECOMMENDED PROGRAM ELEMENTS  WHAT MAKES A PROGRAM EFFECTIVE  PLAN FOR ASSISTING AWPHD HOSPITALS

3. WHAT IS A CORPORATE COMPLIANCE PROGRAM

4.  A program that articulates the hospitals’ commitment to the provision of health care services in full compliance with all federal, state and local laws and regulations, and that sets forth a plan for proactively preventing, detecting, and reporting violations of the laws and regulations which govern the services that they provide.

5. WHY DO WE NEED ONE?

6. REASONS TO DEVELOP A CORPORATE COMPLIANCE PROGRAM  Operationalizes the commitment to ethical and lawful behavior  Reduces the liklihood of violations and employee whistleblowing  Reduces exposure to civil and criminal liability  Enhances public credibility

7. REASONS TO DEVELOP A CORPORATE COMPLIANCE PROGRAM  Provides assurance of lawful behavior to Board and senior management  Provides for mitigation of sentences if convicted of criminal fraud  Protects Board members and officers - Caremark decision  Improves the speed and quality of responses to lawsuits or investigations

8. RECOMMENDED PROGRAM ELEMENTS

9. OIG PROGRAM GUIDANCE  Compliance policies and procedures  Oversight by high-level personnel  Discretionary authority vested in reliable individuals  Effective training and education  Auditing and monitoring  Consistent disciplinary mechanisms  Appropriate responses to detected violations

10. OIG PROGRAM GUIDANCE  The compliance program should include all seven of the elements required by the U.S. Sentencing Commission and OIG Guidelines  The recommendations of the OIG’s Compliance Program Guidance for Hospitals must be considered, depending upon their applicability to each particular hospital. The hospital should be prepared to justify non- compliance with any recommendations

11. WRITTEN POLICIES AND PROCEDURES  The Hospital Code of Ethics is the foundation of the compliance program  Each employee should sign an attestation that he/she will abide by the Code and the compliance program  Policies and procedures should be developed for the hospital as a whole, and for the high risk areas

12. OVERSIGHT BY HIGH- LEVEL PERSONNEL  Designation of a corporate compliance officer  May be a part-time responsibility  Responsible for coordinating the planning, implementation and monitoring of the program  Direct access to the CEO and the Board, regardless of his/her direct reporting relationship  Establishment of a compliance committee

13. EFFECTIVE EDUCATION AND TRAINING  Required of all hospital staff, employees, physicians, independent contractors and other significant agents  New employees must be educated early  Training in other languages for culturally diverse staff should be used  Number of hours of training should be specified High-risk areas should receive more training Training must be documented

14. EFFECTIVE LINES OF COMMUNICATION  Access to the compliance officer necessary  Develop non-retaliation and confidentiality policies  Advise employees that anonymity can’t be guaranteed  Employees should report all suspected misconduct  Document employee questions and answers, investigations and results  Use of hotlines is encouraged if needed

15. DISCIPLINARY ENFORCEMENT  Discipline should be consistently enforced  Background investigations should be conducted for new employees who have discretionary authority to make decisions that may involve compliance or who have compliance oversight

16. AUDITING/MONITORING  All OIG Work Plan risk areas should be reviewed over the course of the year  Additional high-risk areas should be reviewed based on priority  The effectiveness of the compliance program should be formally evaluated annually

17. AUDITING/MONITORING – OIG PROGRAM GUIDANCE  Hospitals  Laboratories  Home Health  Hospice  Long Term Care  DME  Physician Offices  Third Party Billing  Medicare + Choice  Rx Manufacturers

18. RESPONSES TO DETECTED VIOLATIONS  Steps should be taken to immediately correct problems detected  Report misconduct to the appropriate governmental agency not more than 60 days after discovering credible evidence of a violation  Investigate suspected violations ASAP  Overpayments should be promptly refunded

19. WHAT MAKES A PROGRAM EFFECTIVE?

20.  Support of board and executive staff  Ongoing education of staff, particularly in the high- risk areas  Monitoring and auditing (reviewing) high-risk areas  Consistency in enforcement  HCCA publishing effectiveness criteria

21. PLAN FOR ASSISTING AWPHD HOSPITALS

22. PLAN FOR ASSISTING MEMBER HOSPITALS  Provide a model comprehensive compliance program, addressing all high-risk areas  Provide compliance education to key hospital personnel  Update AWPHD hospitals on significant new compliance developments  Provide compliance tools for effective program implementation  Provide compliance consultation

23. QUESTIONS?