Corporate compliance in the healthcare industry: What every healthcare professional needs to know

Angela Mattie, JD, MPH, Management Department/MHA program, Quinnipiac University, 275 Mount Carmel Avenue, Hamden, CT 06518-1949, (203) 641-2630, angela.mattie@quinnipiac.edu

Compliance with Federal and State regulatory agencies has become a major focus for all health care organizations. All areas, from patient referrals to billing and documentation, have become focused target points for State and Federal investigations. In 1997, $1.2 billion was assessed as criminal fines, civil settlements and judgments in fraud cases.

As Federal and State governments are placing more emphasis and resources on the investigation of health care fraud, false claims, and other types of noncompliance, the need for health care administrators’ and Boards’ knowledge of and ability to mitigate these issues has increased.

Despite this increased significance to the health care field, compliance training and education remains in its infancy. This presentation will address both the managerial and legal aspects of health care corporate compliance. Essential elements of a compliance program will be presented. Special focus will be placed on various pieces of federal legislation and enforcement initiatives conducted by the U.S. Department of Justice and the Office of Inspector General (OIG) in the Department of Health and Human Services.

Learning Objectives:

At the conclusion of the session, the participant should be able to

1. Articulate the key elements in the development, management, monitoring, evaluation and enhancement of a compliance program;
2. Identify a health care employee’s responsibilities in maintaining compliance including accuracy of record keeping, conflicts of interest, duty to report, business ethics, and billing and coding integrity;
3. Recognize the elements of the False Claims Act, Anti-Kickback Statute, and Stark Law;
4. Develop an understanding of Corporate Integrity Agreements and recent litigation in this area;
5. Analyze a Board of Director's fiduciary obligations for compliance.

Keywords: Ethics, Management

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation

The Challenge of Leadership in Public Health

The 132nd Annual Meeting (November 6-10, 2004) of APHA