LifeBridge Health

1. LifeBridge Health Sinai Hospital Orientation

2. General Corporate Compliance and HIPAA

3. Need to Know • What is compliance and why do we need a compliance program? • Basic fraud and abuse regulations • HIPAA • Code of Conduct • Your responsibilities • Reporting – What and How!

4. Why do we need a Compliance Program? • Healthcare is one of the most regulated industries in the United States (over 40 Federal agencies) • The Government is getting tough! •  According to the National Health Care Anti- Fraud Association, estimates that financial losses due to health care fraud are in the tens of billions of dollars per year • Health care fraud inevitably translates into higher premiums and out of pocket costs for consumers • Self-reporting is expected • It is consistent with our Values and the right thing to do!

5. What does Fraud look Like • Billing for services that were not rendered • Billing for more expensive services or procedures than were actually provided or performed • Performing unnecessary services for the purpose of generating insurance payments • Accepting kickbacks for patient referrals • Billing a patient more than the copayment amount.

6. The Government’s Enforcement Toolkit • Federal False Claims Act • Anti-Kickback Statute • Civil Monetary Penalties • Exclusions • Stark …and then there’s - Health Insurance Portability and Accountability Act (HIPAA) Further defined in your regulatory compliance modules

7. Protected Health Information (PHI) We All See It! PHI is any information about health status, provision of health care, or payment for health care that can be linked to a specific individual: • Name • Address • DOB • Diagnosis • Medications • Insurance information • Social Security or Medical Record Number • Discussions between patient and provider • Notes written by providers and other staff

8. HIPAA Privacy - Dealing With Common Issues Guiding Principle: Think “WHY and HOW” does this information need to be shared! • Conversations- with another patient - NO • Sign-in sheets- left in a public place- NO • Sharing information with family/friends- NO • Social Media- identifies the facility and/or patient-NO • Leaving detailed messages on a voice mail- NO Sharing patient information is only acceptable when the information is needed to provide a service.

9. HIPAA Security – Basic Tips • Never share your login/password • Don’t write down passwords • Do log off your computer when you walk away! • Don’t open email attachments unless it is from a trusted source • Forward suspicious emails to spam@lifebridgehealth.org • Don’t click on links! • Don’t download software or utilize unencrypted flash drives • Utilize secure method to send PHI • Verify fax numbers (and verify again…) Note: Digital fraud is on the rise

10. Code of Conduct Policy& Expectations The Code addresses: • Our commitment to our patients, employees, and the community • Safeguarding information • Our commitment to fair and accurate billing • Personal accountability and use of corporate assets • Conflicts of interest • How and when to report

11. What do I Report? Identify - Have you identified a situation that you believe is a violation of a law, regulation, policy, procedure or the Code of Conduct? Instinct - Do you have a suspicion that something that you have been asked to do or some thing that you have witnessed just doesn’t seem right? Follow your intuition...and, Inform - Don’t look the other way! Tell someone about it!

12. Who Do I Tell? • Talk to your manager or supervisor • Call the Compliance Officer (Joyce Romans) • 410-871-6807 • Call the anonymous Compliance Hotline (1-844-732-6233) or file a confidential report via the web (link found on the intranet) • To discuss a privacy matter – call the Privacy Officer (Darlene Skinner) • 410-601-1554 (privacy hotline)

13. Compliance is EVERYONE’S Responsibility! • Complete assigned training – fraud & abuse, general compliance (IT’S REQUIRED!!) • Read and understand the Code of Conduct • Read and understand Human Resources and Departmental Policies and Procedures • Pay attention to Compliance articles/emails • Inform - know what to report and how to report concerns!!