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Seeing the Forest for the Trees

Co-presenter: Mark Garsombke

Understanding IT Purchase Transactions and Common Missteps in EHR Donation Arrangements

HCCA’s Indianapolis Regional Annual Conference

Provider-based Arrangements

Compliance Essentials in a High-Stakes Enforcement Era

The Power and Art of Self-Disclosure

The session will address why self-disclosure is a critical and proactive strategy for any effective compliance program in light of the current high stakes of government health care enforcement.  The session describes the many different self-disclosure options available to providers, and attendees will learn how to decide between self-disclosure options.  Attendees will also learn about the importance of internal investigations, factual verification and remediation as essential components of a credible self-disclosure.  Finally, the session will discuss the role of compliance counsel and common pitfalls that can occur in the self-disclosure process.

Compliance Essentials in a High-Stakes Enforcement Era

The Federal Government’s Top 10 Enforcement Hit List

In this session we will discuss the government’s current enforcement of health care laws and focus on those areas being aggressively pursued by government agencies to combat fraud, waste and abuse.  Some of the topic areas presented during this session will include medical necessity of cardiac and other procedures; hospital – physician arrangements, including physician compensation, physician leases and medical director agreements; and high risk areas prone to billing errors.  Stressing the importance of proactive identification and resolution of compliance issues, attendees will learn how a proactive compliance program can help prevent, identify and correct the situations discussed during the course of this presentation.

Compliance Essentials in a High-Stakes Enforcement Era

How to Oversee and Manage an Effective Compliance Program

This session will focus on how to incorporate the OIG’s 7 elements of an effective compliance program in creating a successful compliance program tailored to your organization.  Namely, the session will discuss: (1) the types of written standards of conduct and policies every compliance program should have; (2) the role of compliance officers and related committees; (3) the qualities of an appropriate training and education program; (4) how to maintain effective lines of communication within your organization and with the Board of Directors; (5) creating a work plan that includes effective auditing and monitoring; (6) publicizing disciplinary guidelines; and (7) responding to detected offenses and taking corrective action.  This session aims to provide the tools necessary to develop a compliance program that addresses issues before they escalate.  Attendees will learn how to promote best practices within their organization to prevent compliance violations and mitigate risks in the event of a government investigation.

Compliance Essentials in a High-Stakes Enforcement Era

The “Big Four” Federal Health Care Enforcement Laws: Why We Need to Be Concerned About Compliance

This session will begin with a brief overview of the current health care enforcement environment, including discussion of recent enforcement trends and significant enforcement actions.  We will then provide a summary of the key laws relevant to health care compliance including: (1) the Anti-Kickback Statute; (2) the Stark Law; (3) the False Claims Act; and (4) Private Inurement/Excess Benefits prohibitions.  Specifically, this session aims to build basic knowledge of the laws and their related safe harbors/exceptions, as well as an understanding of the magnitude of potential penalties associated with violations.  Finally, the session will conclude with an interactive discussion of a number of case scenarios to help participants identify potential fraud and abuse risk areas.

Assessing Viability of System Affiliation: A Game Plan to Respond

Contract Law 101

  • What makes a contract a contract?
  • How do you negotiate a contract?
  • Things to watch out for- evergreen clauses, arbitration provisions, and grounds for termination

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