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Healthcare Compliance: 2014

Healthcare Compliance: 2014. Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance. Topics Covered. Regulator Behavior Compliance Response. How the OIG behaves and how HSC Compliance responds. Regulator behavior. 2013 Enforcement Numbers.

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Healthcare Compliance: 2014

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  1. Healthcare Compliance: 2014 Stuart Freedman, MPH HSC Chief Compliance Officer Monica Wilson, JD, CHC Manager, HSC Compliance

  2. Topics Covered Regulator Behavior Compliance Response

  3. How the OIG behaves and how HSC Compliance responds Regulator behavior

  4. 2013 Enforcement Numbers $5.6B recovered 3,214 new excluded parties 960 criminal actions 472 civil actions How did we get here?

  5. OIG Motivations • Money • Protect the Medicare trust funds • Government budget • Medicare enrollment • Headlines • Demonstrate effectiveness

  6. OIG Behavior • Looking beyond “fraud” • Quality • Waste and abuse • Exclusion authorities • Data analytics • Regulatory creep

  7. Available Information Statutes and regulations Guidance documents Corporate Integrity Agreements (CIAs) Presentations at conferences News reports and press releases

  8. How we respond to all of this Protecting the HSC

  9. Achievements HSC Code of Ethics and training Awareness Hired an Educator New hotline and incident management system

  10. Coming Soon Consolidation Investigation processes Training calendar

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