Compliance Oversight for Health Care Leaders

[ Music ]>>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. [ Music ]>>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. [ Music ]

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