HEALTHCARE TRUSTEES OF NEW YORK STATE Compliance and Governance Update August 8, 2012.

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Presentation transcript:

HEALTHCARE TRUSTEES OF NEW YORK STATE Compliance and Governance Update August 8, 2012

Realities Renewed Federal Interest in Governance Health Reform Brings Governance Challenges State Government’s Reach May Exceed Its Grasp Board Oversight of Issues is Expanding

A Few of the Issues Executive Compensation OMIG Compliance Guidance Recovery Audit Contractor (RAC) and Other Audits Expanded Surveillance Focus – Quality Conflicts of Interest Increased IRS Scrutiny

Executive Compensation Executive Branch Process Limits on Reimbursement, Compensation and Use of State Revenue Very Expansive Reach “Covered Executive” Definition “Related Entity” Definition Hospitals are Not Focus But are Covered

Aggressive Government Audits Carried Out by Contractors Often Paid on Contingency Basis RACs, MACs, ZPICs, CERTs, Comprehensive Medicare Compliance – To Name a Few Very Burdensome Document Demands Clinical Judgment Calls

Government Audits (cont) All-or-Nothing Recoveries Hundreds of Millions of $$ At Issue Post-Payment Reviews Pre-Payment Reviews Lengthy Appeals Process Comprehensive Medicare Audits – OIG Internal Controls Process from Patient to Claim Submission

Office of Medicaid Inspector General (OMIG) Compliance OMIG Now Organized by Teams Hospital Compliance Guidance - May ’12 Compliance Audits Will Increase as “Gotcha” Decreases Document Request Includes Board Minutes Expectation of Broad Board Oversight Directors Interviewed During Audit

Governance and Quality Increased Regulatory Focus on Quality Oversight Prompted by Feds; Implemented by State Focus on Full Board Awareness Reports to Board Committee May Be Inadequate Dovetails with OMIG Compliance Program Expectations

Conflicts of Interest Doing Business with Hospital Trustee Joint Venturing State – Attorney General, Governor Federal – IRS, Fraud Agencies Board Minutes Should Reflect Transparency

Internal Revenue Service Proposed Rules – Community Benefit Reports Providing Charity Care Not Enough Mandatory Reporting of Financial Arrangements – Directors With Each Other & With the Facility