2. RISK MANAGEMENT IN THE TREATMENT OF OPIOID DEPENDENCE Presented by: Barbara A. M. Maloney, Esq.

3. GOALS 1.Introduce MMTP practitioners to the elements of a Risk Management Program and its application to a methadone treatment program. 2.Promote an appreciation of the need to make MMTP’s more attractive to the Insurance Market through the use of Risk Management tools.

4. WHEN ADVERSE EVENTS OCCUR Human Cost Threat To Corporate Reputation Loss Of Consumer Confidence Poor Employee Morale Time & Expense Of Defending A Claim Increase In Insurance Premiums

5. Patient Care Clinical Procedural SCOPE OF RISK MANAGEMENT

6. Medical Staff Credentialing Business Arrangements Peer Review/Quality Improvement Activities Scope Of Risk Management cont…

7. Employee Injury Discrimination/Harassment Workers’ Compensation Scope Of Risk Management cont…

8. Property Scope Of Risk Management cont…

9. Financial Director’s Liability Office’s Liability Corporate Liability Scope Of Risk Management cont…

10. Regulatory Compliance Scope Of Risk Management cont…

11. RISK IDENTIFICATION & ANALYSIS Incident/Occurrence Reports Patient Complaints Medication Incident Reports Audits Generic Outcome Screens Common Risk Identifiers

12. Risk Identification & Analysis cont… The Grape Vine/Word Of Mouth Pharmacy and Therapeutic Reports Medical Credentialing/Recredentialing Historical Claims Data Accreditation & Regulatory Agencies

13. SETTING PRIORITIES Facts To Consider Frequency Of Occurrence Severity Of Occurrence Annual Dollar Amount Of Loss

14. External Economic Factors Cost Of Defending Potential Claims Loss Of Reputation In The Community Setting Priorities cont.

15. RISK PREVENTION Strategic Planning Education - Competencies Contracts Review

16. Communication Risk Prevention cont…

17. Communication cont… Consent to treatment is not a piece of paper

18. Risk Prevention cont… Communication cont… It is a process that must adjust to each patient and includes an exchange of information.

19. Risk Prevention cont… Communication cont… It is the responsibility of the provider to be certain a patient gives consent before care is given.

21. Risk Prevention cont… Communication cont… Disclosure: The new mantra from regulatory agencies and the law.

22. Risk Prevention cont… Communication cont… Disclosure: Is it really different from other patient interactions? ????

23. Risk Prevention cont… Compliance HIPPA 1996: Fraud is the knowing and willful execution or attempt to execute a scheme to defraud a health care benefit program to obtain by means of false or fraudulent representations or promises, any money or other property owned by a health care benefit program.

24. Risk Prevention cont… Compliance cont… False claims and fraudulent billing Bribes, kickbacks, excessive or unreasonable discounts and rebates, and profit-sharing agreements Payment to induce referrals Medical neglect of a patient

25. Enforcement Laws Risk Prevention cont… 1977 Medicare-Medicare Anti-Fraud and Abuse Amendment to the Social Security Act, including the Anti-Kickback Provisions The Criminal False Claims Act The Civil False Claims Act The Civil Monetary Penalties Act Program exclusion of the Social Security Act

26. Risk Prevention cont… Enforcement Laws Federal Sentencing Guidelines: Provide for more lenient punishment for organizations that adopt effective programs for detecting and preventing criminal conduct.

27. Preventive Maintenance Claims Loss Analysis Risk Prevention cont…

28. RISK AVOIDANCE 1. Avoidance is a risk treatment strategy. If a given risk is too serious for the provider to manage or transfer, the procedure that gives rise to it may need to be avoided all together.

29. Risk Avoidance cont… 2. Minimization tries to reduce the severity of an event that has already occurred. For example, prompt incident investigation, duplicate records.

30. Risk Avoidance cont… 3. Transfer is shifting the risk of financial loss to another entity, either through contract or insurance.

31. CLAIMS MANAGEMENT Investigate Set Up Files Mandatory Reporting Secure Equipment & Records Set Up Reserves