Compliance Oversight for Health Care Leaders

Uploaded by OIGatHHS on 27.06.2011

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>> Lori Vick: Hello.
I'm Lori Vick.
On behalf of the Health Care Compliance Association, welcome.
In today's environment of health care reform and an emphasis on the quality of health care,
the role of compliance is more critical than ever.
Today, we're going to explore that role with key government officials and leaders
of health care compliance who share their insight on implementing
and sustaining an effective compliance program.
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>> Lori Vick: Health care providers pay close attention to the activities and pronouncements
of the Office of Inspector General.
The OIG's mission, to prevent, detect, and correct fraud, waste, and abuse,
should be aligned with the goals of an effective compliance program.
Daniel Levinson, inspector general, U.S. Department of Health
and Human Services, explains the mission.
>> Daniel Levinson: We really have a two-fold mission.
One is to detect and prevent fraud, waste, and abuse, and we do that primarily
through our investigative mission, but we also have a very important co-equal obligation
to promote economy, efficiency, and effectiveness in the delivery of services
by health and human services, very important in both Medicare and Medicaid.
>> Lori Vick: Health care in America is facing unprecedented challenges.
While providers struggle to understand the impact of health care reform, the cost continues
to soar as does the number of people who rely on Medicare and Medicaid.
In preparing for the future of health care, organizations need to consider compliance
as an integral part of their business operations.
>> Daniel Levinson: As a result of health care reform and the focus that it places on value
and quality of health care that the compliance operation becomes really an integral part
of the health and welfare of the entire enterprise.
It's very important that the compliance function report directly to the board.
We need a relationship that is direct and that is personal so that the directors
of the operations are familiar with how the compliance process is actually being implemented
in their institutions.
>> Lori Vick: The governing body of the health care organization plays a key role
in ensuring there are adequate controls and systems in place
to identify misconduct and address emerging risks.
Let's hear some key questions board members consider in carrying out their fiduciary duties.
>> Daniel Levinson: The simplest way for a board to approach this is with TACT.
T-A-C-T. First, you want to ask the question about transparency.
Are we prepared to have systems that track and report data accurately.
Next, accountability.
Do we have systems in place that will allow us to identify and repay funds
that we should not have received?
Compliance, or the "C" in TACT.
Do my compliance officers and compliance team under the broad scope of what is now
in their responsibilities And, finally, "T", or training.
Do my clinicians understand that quality is part of compliance?
It is more important now than ever to have a compliance program.
Under the health care reform, all providers are going to be required to have compliance programs
in place, and even if that law didn't exist,
there's a very good common sense reason to have compliance.
A compliance program is like a seat belt.
You want to wear all the time, even if you intend never to get into an accident.
>> Lori Vick: Compliance programs had historically been voluntary
for companies not subject to a corporate integrity agreement.
With health care reform, having an effective compliance program is becoming a requirement.
Jim Sheehan, Medicaid inspector general for the State of New York
where compliance is a requirement, talks about the crucial role of the compliance officer.
>> Jim Sheehan: In New York, what we observed is that the,
the compliance officer makes a huge difference in assuring that compliance is,
is part of the DNA of the organization, but the other thing it does, they become the face
of the organization for us, and earning, earning the trust of, of regulatory agencies
on minor issues means when you face a major question that you start with that base of trust.
>> Lori Vick: Experts agree that the best compliance programs are woven
into an organization's culture and evident to employees, the public, and regulators alike.
>> Jim Sheehan: What is the public evidence that,
that the organization is committed to compliance?
Is there signs on the walls?
Are there people who are actively involved in this activity?
If, does your website show that you have a compliance program,
how it works and how to access it?
>> Jenny O'Brien: The best way to have a strong compliance program is to make sure it's worked
into the daily fabric of your organization.
You've got to do compliant things every day.
It's not a moment or an experience that you do every now and then.
You do compliant things every day, and our goal is really to,
to get to a place where our employees aren't even thinking
about it, where it becomes natural.
It, it becomes part of our business practice and our business model
to do things the right way the first time and every time.
>> Lori Vick: In this time of industry transformation,
companies who integrate compliance efforts
into their business planning are making a commitment to a healthy future.
Jenny O'Brien, chief Medicare compliance officer for United Health Care,
shares how the Health Care Compliance Association has created value
for her organization.
>> Jenny O'Brien: HCCA is a great organization to help the profession be ready
for this ever-changing health care environment.
An organization, such as a health care compliance organization, is a,
a great place to come to get resources, to get tools, to network with other professionals,
and to listen to other people share their stories and their lessons learned
about what works and about what hasn't worked and maybe a more effective way of getting there.
>> Lori Vick: Attracting and developing experienced compliance personnel is a
sound investment.
>> The best reason to continue a compliance program is quite simple.
You've demonstrated you know how to do it right.
You don't want to stop compliance.
You want to build on compliance.
>> Lori Vick: Health care is, indeed, an ever-changing environment,
and health care organizations must be flexible and responsive to that change.
By implementing the expert guidance we've heard today, your organization will be prepared
to develop and sustain a healthy, enduring compliance program.
Thank you.
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