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HEALTHCARE TRUSTEES OF NEW
YORK STATECompliance 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