Legal, Regulatory & Compliance John D. Whipple, Deputy General Counsel for Providence Health & Services Gary Flaming, Senior Vice President, Chief Risk Officer
Department of Legal Affairs (DLA) Health care is one of the most heavily regulated industries The diagram below provides a pretty accurate description of the legal and regulatory issues PH&S deals with on a daily basis:
Department of Legal Affairs (DLA) We are your in-house law firm We ask that you start with us for any legal services and then we’ll engage external resources as needed
Department of Legal Affairs (DLA) We have 15 attorneys with expertise in key areas including: Stark Anti-Kickback Medical Staff Matters Tax Exemption EMTALA False Claims Act Medicare Billing Rules HIPAA Affordable Care Act
Department of Legal Affairs (DLA) We have consolidated Providence, Swedish and Kadlec legal departments into a single department We have attorneys licensed to practice in Washington, Oregon and California May act as in-house counsel in each of the states we operate
Department of Legal Affairs (DLA) We have an “on-call” attorney 24/7 for after-hours emergency legal issues We’ve designated “Regional Point Persons” for each region/ministry for initial attorney contact Department’s “Intranet” website great resource for our clients
Enterprise Risk Management Services (ERMS) Background Internal Audit (80-90% preplanned) Integrity & Compliance (50-60% preplanned) Information Security (40-50% preplanned) Risk, Insurance & Claims (10-20% preplanned) Both region and System Office presence Report jointly to PH&S Operations President and Finance, Audit & Compliance Committee of the Board
Indirect Support of Community Boards Internal Audit Credentialing Quality/Patient Care (biomedical equipment, Sepsis bundles, central line insertions, medication reconciliations, etc.) IT Audit Integrity & Compliance Compliance education - boards and physicians Monitoring medical staff for OIG/GSA list
Indirect Support of Community Boards Information Security Standards for computer system protection Risk, Insurance & Claims Medical malpractice cases Insurance placement
IRS Form 990 Compliance Requirements Conflict of Interest (COI) policy Officers, Directors or Trustees, and key employees complete COI disclosure Written whistleblower policy Document retention and destruction policy YES TO ALL! 11
High-Risk Areas Cyber Attacks Medical Necessity Stark Regulations False Claims Act Conflict of Interest Patient Privacy
Compliance – Local Support Program overseen by System Board Key elements: Code of Conduct Compliance and security education 24-hour hotline Investigations Policy development (non-retaliation, conflict of interest, etc.) Conflict of Interest
Legal, Regulatory, Governmental, Licensing & Accrediting Requirements Management - accountable for meeting regulatory, licensing and accrediting requirements ERMS -provides the organizational structure to validate the achievement of mandate requirements Providence supports work and decisions of the Community Board provides Directors and Officers Insurance Coverage
Legal, Regulatory, Governmental, Licensing & Accrediting Requirements Community Board Responsibilities: Understand the key policies for CB members and to conduct all interactions on behalf of PH&S within the guidelines of those directives Hold management accountable for meeting or exceeding all mandated requirements Complete and submit annual Conflict of Interest statement