the gentiva compliance program
DESCRIPTION
The Gentiva Compliance Program. Introduction. Corporate criminal liability Federal sentencing guidelines Compliance program protection Background Requirements Effect of program HIPPA Introduction Closing comments/questions. Corporate Criminal Liability. - PowerPoint PPT PresentationTRANSCRIPT
The Gentiva Compliance Program
© Gentiva Health Services, 2002 2
Introduction
Corporate criminal liabilityFederal sentencing guidelinesCompliance program protectionBackgroundRequirementsEffect of programHIPPA IntroductionClosing comments/questions
Corporate criminal liabilityFederal sentencing guidelinesCompliance program protectionBackgroundRequirementsEffect of programHIPPA IntroductionClosing comments/questions
© Gentiva Health Services, 2002 3
Corporate Criminal Liability
A corporation is liable for any act committed by an employee which has the actual or intended effect of benefiting the company
The act must be within the scope of the employee’s actual or apparent authority
A corporation is liable for any act committed by an employee which has the actual or intended effect of benefiting the company
The act must be within the scope of the employee’s actual or apparent authority
© Gentiva Health Services, 2002 4
Department of Justice/CMS
New audit approach focusing on fraud and abuse issues
Operation restore trust
Auditor focus: recovering funds
New emphasis on closing down agencies
New audit approach focusing on fraud and abuse issues
Operation restore trust
Auditor focus: recovering funds
New emphasis on closing down agencies
OIG permitted to refer cases directly to DOJ
FBI involvement/ health care fraud teams
Health care #3 national priority
Increased criminal prosecution
OIG permitted to refer cases directly to DOJ
FBI involvement/ health care fraud teams
Health care #3 national priority
Increased criminal prosecution
© Gentiva Health Services, 2002 5
Federal Sentencing Guidelines
© Gentiva Health Services, 2002 6
Sentencing Guidelines
Comprehensive crime control act of 1984 enacted guidelines for individuals
Proposed guidelines for sentencing organizations became law in November 1991
Philosophy : carrot and stick approach
Just punishment
Adequate deterrence
Comprehensive crime control act of 1984 enacted guidelines for individuals
Proposed guidelines for sentencing organizations became law in November 1991
Philosophy : carrot and stick approach
Just punishment
Adequate deterrence
© Gentiva Health Services, 2002 7
Purpose
Incentives for organizations to maintain internal mechanisms Preventing
Detecting
Reporting criminal conduct
Standard requirements
Customized to each organization
Each step is valued towards demonstrating effectiveness of program
Incentives for organizations to maintain internal mechanisms Preventing
Detecting
Reporting criminal conduct
Standard requirements
Customized to each organization
Each step is valued towards demonstrating effectiveness of program
© Gentiva Health Services, 2002 8
Mitigating Factors
Compliance program
An effective compliance program to prevent and detect violations of the law, within the meaning set out in the guidelines, is the only mitigating element that can be implemented by a corporation prior to the criminal acts that give rise to prosecution
Compliance program
An effective compliance program to prevent and detect violations of the law, within the meaning set out in the guidelines, is the only mitigating element that can be implemented by a corporation prior to the criminal acts that give rise to prosecution
© Gentiva Health Services, 2002 9
Compliance Program
0
20
40
60
80
100
$ M
illi
on
s
With a Program Without a Program
© Gentiva Health Services, 2002 10
Compliance Standards
Medicare fraud and abuse laws
Federal false claims act Anti-kickback act Stark I & II (III?) Conditions of Participation Wedge audits Licensure Labor/ wage and hour Anti-trust
– Etc.
Medicare fraud and abuse laws
Federal false claims act Anti-kickback act Stark I & II (III?) Conditions of Participation Wedge audits Licensure Labor/ wage and hour Anti-trust
– Etc.
© Gentiva Health Services, 2002 11
Program Oversight
C O M P L IA N C E P R O G R A M S TR U C TU R EG en tiva H ea lth S ervices
B oard o f D irec to rsA u d it C om m ittee
C h ie f C om p lian ce O ffice r
F in an ce /R e im b u rsem en t
C h ie f F in an c ia l O ffice r
O p era tin g D irec to rs
C h ie f O p era tin g O ffice r
P res id en t/C E O
© Gentiva Health Services, 2002 12
Employee Training
Compliance policies must be distributed to all employees
Mandatory compliance training: VP’s, Branch Directors, Field Staff
Additional training through in-services, flyers, memorandum, bulletins, newsletters, Gentiva University, etc.
Compliance testingManagers training series
© Gentiva Health Services, 2002 13
Delegation of Authority
Monitoring of employees with respect to compliance standards
Employee screenings (in accordance with applicable laws)
Performance evaluation including adherence to compliance standards
© Gentiva Health Services, 2002 14
Enforcement & Discipline
Penalty matches offense
Range of sanctions
“Due process”
Self-disclosure (mitigating factor)
Management responsible for misconduct of subordinates
See progressive disciplinary policy
© Gentiva Health Services, 2002 15
Response & Corrective Action
Who’s involved?
What happened?
Who follows up?
Plan of action
Legal counsel?
Notify authorities
Corrective action
Preventive measures
© Gentiva Health Services, 2002 16
Effect of Program
Reduced risks and exposures
Reduce corporate liabilities
Enhances image with intermediaries
Public image
Increase quality
Increase profitability
Reduced risks and exposures
Reduce corporate liabilities
Enhances image with intermediaries
Public image
Increase quality
Increase profitability
© Gentiva Health Services, 2002 17
COMPLIANCE
QUALITY
Compliance IS Quality in ACTION
Compliance Circle
© Gentiva Health Services, 2002 18
Closing Comments/Questions
Additional Questions
1-631-501-7390 – Chris Anderson
Additional Questions
1-631-501-7390 – Chris Anderson