Valuing Integrity Corporate Compliance October 2006 Anne Adams Chief Compliance Officer Emory Healthcare and Emory Me

1.  Valuing Integrity Corporate Compliance October 2006 Anne Adams Chief Compliance Officer Emory Healthcare and Emory Medical Care Foundation Sue Dale Administrator, Gynecology and Obstetrics Emory University School of Medicine and The Emory Clinic

2. What is Compliance ? Complying with applicable Federal and State laws and regulations. Following all Emory and departmental policies and procedures. Doing the right thing!

3. Compliance Program

4. Elements of a Compliance Program  Compliance Standards & Procedures Chief Compliance Officer Employee Training Monitoring & Auditing Reporting Process Response & Prevention Enforcement & Discipline To assist healthcare organizations with the process of compliance , the Office of the Inspector General of the Department of Health and Human Services has provided guidance in developing compliance programs. The government has outlined seven elements which it believes are the key to successful compliance program. These elements are:To assist healthcare organizations with the process of compliance , the Office of the Inspector General of the Department of Health and Human Services has provided guidance in developing compliance programs. The government has outlined seven elements which it believes are the key to successful compliance program. These elements are:

5. Role of the Compliance Office Establish, oversee implementation, and revise the Compliance Program Provide oversight for organization�s compliance activities Provide education Provide advice and guidance Develop compliance policies Investigate reports of non-compliance Monitor compliance with rules & regulations Coordinate response to external investigations Oversee corrective actions

6. Why Do Organizations Need a Compliance Program? Government focus/enforcement Risk of prosecution/penalties Protect system resources/reputation Health Insurance Portability and Accountability Act (HIPAA) Grants and Contracts Research/IRB/FDA/OHRP Sarbanes/Oxley Healthcare Industry Fraud and Abuse The federal government views the fight on health care fraud and abuse a top priority. Millions of dollars and considerable resources have been devoted to this fight. Some statistics: 1999 OIG Annual Report HHS - 12% increase in Fraud & Abuse enforcement budget $524 million in settlements and judgements 371 criminal indictments; up 16% from 1998 2976 exclusions (nearly 9,000 exclusions since 1997) Growth: In 1992, the FBI had 112 agents assigned to HC F & A, currently it has 493! Efforts to eliminate fraud and abuse are credited with limiting growth in Medicare spendingThe federal government views the fight on health care fraud and abuse a top priority. Millions of dollars and considerable resources have been devoted to this fight. Some statistics: 1999 OIG Annual Report HHS - 12% increase in Fraud & Abuse enforcement budget $524 million in settlements and judgements 371 criminal indictments; up 16% from 1998 2976 exclusions (nearly 9,000 exclusions since 1997) Growth: In 1992, the FBI had 112 agents assigned to HC F & A, currently it has 493! Efforts to eliminate fraud and abuse are credited with limiting growth in Medicare spending

10. Non-Retaliation Policy It is the policy of EMORY that individuals making good-faith reports of compliance concerns will not experience any form of retaliation. If you experience or witness retaliation, report it to the Compliance Office immediately. Incidents of retaliation will have serious consequences.

15. The Role of Management Management serves as the primary example and the primary source of information for our employees. Management fosters open communication regarding compliance and answers questions raised by employees. Management is accountable for their own actions as well as the actions of those they supervise.

21. Administrator�s Perspective Most difficult challenge is the task of influencing physicians to adopt compliance as an integral part of our standard operating procedures. This is not Monopoly � there is not a get out of jail free card �Teaching physicians suffer from mural dyslexia� (Fast Tracking Compliance Training in Academic Practices article MGMA) Cannot see the handwriting on the wall Why are we spending money on compliance? Compliance is a control program

22. Expecting Reactions To Compliance Typical Reactions to Compliance: Great men can�t be ruled What rules? When did this start? Glassed over eyes � asleep Must not be talking to me Administrator�s Reaction: Never react back or will be seen as the evil one Use positive arguments Use a physician champion

23. What are the Physicians� Expectations Communication: Communicate both good and bad news; communicate regularly Honor confidentiality Share data Allow venting of frustrations Stay on their side � avoid defensiveness Use examples Consistency And�..be cheerful, confident, and optimistic

24. Best Practice � Consistent Themes Physician-to-physician communication that compliance is not optional � based on integrity Staff need to hear and see that leadership has taken a stance in favor of ethnical business practices. Train physicians and staff in small specialty specific groups � more relevant and makes it practical application easier.

25. Best Practice � Consistent Themes Use numerous examples from their own notes and specialty to demonstrate the point and use as examples. Make the education and training interactive. Have a sense of humor. Recent documentation - The lab test indicated abnormal lover function; The patient is still under our car for physical therapy; The patient is numb from her toes down; Patient was alert and unresponsive; When she fainted her eyes rolled around the room; Patient seen in the ED, examined, x-rated and sent home.