BP - Health Care Compliance Association

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CEO: ...continued from page 18 probably auditing and monitoring, enforcement discipline, etc. supporting the ethical behavior. Golf is the only place where I see little enforcement and tremendous results. It doesn’t work in any other sport I know of. If a player called a foul on themselves in football, they would be gone in 60 seconds. Quality of Care March 5 and 13, 2009, Two Parts The Agency for Healthcare Research and Quality (AHRQ) Guide on Adoption of Health Care Innovations – What does mean? Where are we now? Lisa Murtha, Managing Director Health and Education Consulting Practice Huron Consulting Group, and Compliance Officer Cheryl Wagonhurst, Partner, Foley and Lardner Cory Flickinger, Huron Consulting Group. Conflict of Interest March 12, 2009 Kendra Diamond, Director, Daylight Forensic & Advisory LLC, Angelia Dorsey, Research Ccompliance Officer, MedStar Health Health Care IT Security – A Corporate Compliance Matter March 24, 2009 Carolyn Regen, Interim Chief Compliance Officer and Privacy Officer of the Corporate Compliance and Privacy Administration of Gwinnett Hospital System, Inc. Michele Madison, Partner Morris, Manning & Martin LLP J. Tom Jinks, Director, Moore Colson Bret Roy, Partner, Moore Colson To Register visit www.hcca-info.org Past Audio/Web conferences are available on CD at www.hcca-info.org/pastweb For instance, all four of my girls play(ed) volleyball. The coaches don’t teach the players to call fouls on themselves. I used to play volleyball in pick-up games without refs at the YMCA. We had to use the honor system, somewhat like golf. There were disagreements, but most of the players were pretty good about it. In volleyball, you can’t touch the net. The one rule that stood out the most was: If you touched the net, you would grab the net and shake it until the play stopped. My friends and I often called ourselves on the net when no one would ever have seen it. Some touches were so slight that the net hardly moved, but we knew and we would call it. I liked the integrity of those games at the YMCA. I want my daughters to play with integrity, but they don’t. They can’t. If they called a foul on themselves, nobody would accept it. The coach would blow a gasket. The players would ostracize them. The fans would boo them. In most cases, the refs wouldn’t even acknowledge the call. The system is set up to “get away with it if you can.” The system that works in golf is the only effective ethics system I know. I don’t think ethics alone will work. That is why the enforcement community requires compliance programs in some settlements and encourages them everywhere else. The US Sentencing Commission added ethics to the US Sentencing Guidelines recently, but judges still look for compliance programs to determine if a company is trying to find and fix problems. The judges don’t mandate ethics programs. Recently, a law was passed to mandate compliance programs for government contractors. The lobbyists got it reduced to a code of conduct, just before the regulation was published. The Department of Justice (DOJ) got mad and supported a “Contractors Fraud Loophole Act.” The Act said that government contractors had to implement the seven elements as described in the Sentencing Guidelines. The DOJ considered the last minute change from compliance to ethics to be a loophole. They want both, but they really are looking for compliance programs. I keep hearing the people who are horribly conflicted (they don’t want the pain and cost of compliance) or idealistic saying that ethics is enough. I keep hearing the people who are tired of chasing down cheaters (the enforcement community) say that if you want to be effective or if you want a break, put in a compliance program. Ethics works if every one is ethical. Everyone else needs a compliance program. Ethics is important. Having a code of ethics and telling everyone to do the right thing is important. However, if you want to get people to be ethical, you must establish standards and procedures, audit and monitor, investigate, discipline, train and educate, and report to the Board. n March 2009 24 Health Care Compliance Association • 888-580-8373 • www.hcca-info.org
ASK LEADERSHIP Compliance Today Needs You! The Health Care Compliance Association (HCCA) is seeking authors for Compliance Today. Every month Compliance Today offers health care compliance professionals information on a wide-variety of enforcement, regulatory, legal, and compliance program development and management issues. To do this we need your help! We are particularly interested in articles covering compliance concerns involving all segments of the health care industry, including Behavioral Health, Rehabilitation, Physician practices, Long-Term Care, Homecare and hospice, Ambulatory Surgery Centers, etc. For Details: E-mail Margaret Dragon with your topic ideas, format questions, etc. at margaret.dragon@hcca-info.org or call her at 781/593-4924. Articles generally run between 1,250 and 2,500 words; this is not a limit, just a guide. Compliance Today uses the Chicago Manual of Style. We require footnotes to be 10 or less. All references must appear at the end of the article. Please do not use the footnote feature in Word. The author’s contact information must be included in the article as well as the article title. Articles should be submitted as a Word document with very limited formatting. Anyone interested in submitting an article for publication in Compliance Today should send an email to margaret.dragon@hcca-info. org which includes the article topic and deadline selected from the list below. IMPORTANT: For those who are Certified In Healthcare Compliance (CHC), please note that CCB awards 2 CEUs to authors of articles published in Compliance Today. Upcoming Compliance Today Deadlines: n April 2 n April 20 n May 6 n May 18 n June 1 n June 15 John Falcetano John asks the leadership your questions Editor’s note: John Falcetano is Chief Audit/Compliance Officer for University Health Systems of Eastern Carolina and a long-time member of HCCA. This column has been created to give members the opportunity to submit their questions by e-mail to jfalcetano@suddenlink.net and have John contact members of HCCA leadership for their response. QUESTION: What are Red Flag Identity Theft Rules and do they apply to health care organizations? Answer: provided by John C. Falcetano, MA, CHC, CIA, Chief Audit & Compliance Officer, University Health Systems of Eastern Carolina Greenville, NC The FDIC, along with the other federal financial institution regulatory agencies and the Federal Trade Commission, issued the Red Flags provision of the Fair and Accurate Credit Transactions Act in October 2007. The final rules and guidelines on identity theft red flags took effect on November 1, 2008, although enforcement has been suspended until May 2009. The rules require financial institutions to establish reasonable procedures for identifying and preventing identity theft. The rules apply to health care providers because they use consumer reports to check for criminal backgrounds and credit histories as part of their employment process. In addition, many health care providers are considered creditors, because they do not require payment when services are rendered. Creditors in the health care field must also watch for signs of medical identity theft (i.e., someone obtaining medical services or benefits by using stolen health insurance information). Although the rules allow organizations flexibility in establishing their own internal compliance programs, there are some mandatory requirements that must be included in order to comply with the rules. For example, the rules require: n Each financial institution or creditor to develop and implement a written identity theft prevention program to detect, prevent, and mitigate identity theft in connection with the opening of certain accounts or certain existing accounts. n Credit and debit card issuers to assess the validity of notifications of changes of address under certain circumstances. n If there is a conflict between information provided on applications and credit reports, financial institutions must review discrepancies. Examples of identity theft red flags that financial institutions should consider as part of their identity theft prevention programs are also included in the rules. Information about the rules can be found at: http://www.fdic.gov/news/news/financial/2007/fil07100.html n Health Care Compliance Association • 888-580-8373 • www.hcca-info.org 25 March 2009
Page 1 and 2: Volume Eleven Number Three March 20
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Page 5 and 6: incrementally, and CMS has made cle
Page 7 and 8: New developments in payment and pub
Page 9 and 10: New developments in payment and pub
Page 11 and 12: of privacy and infliction of emotio
Page 13 and 14: Unauthorized access to protected he
Page 15 and 16: prescient steps we’ve taken. When
Page 17 and 18: tions anytime, anywhere. Third, und
Page 19 and 20: The Jones Day/HCCA iPod ® Nano Giv
Page 21 and 22: RAC demonstrations and inpatient re
Page 23: RAC program. The documentation of t
Page 27 and 28: YOUR INFORMATION FYIFOR Declining e
Page 29 and 30: sampling methodology is vital in de
Page 31 and 32: Health Care Compliance Association
Page 33 and 34: to earlier concerns over corporate
Page 35 and 36: Executive compensation in troubled
Page 37 and 38: independence for board members in t
Page 39 and 40: 2. The notice included sufficient i
Page 41 and 42: Upcoming Regional Conferences June
Page 43 and 44: operational decision-making process
Page 45 and 46: Standing at the crossroads ...conti
Page 47 and 48: prescription, and lab orders. The e
Page 49 and 50: Telemedecine equipment The technolo
Page 51 and 52: Mandatory Stark reporting: Is a den
Page 53 and 54: Charge Description Master complianc
Page 55 and 56: Increased government oversight of m
Page 57 and 58: Medicare Advantage plan sponsors ma
Page 59 and 60: any governmental guidelines for fra
Page 61 and 62: New HCCA Members The Health Care Co
Page 63 and 64: Case Management & Quality Coding, C

BP - Health Care Compliance Association

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