Meet Urton Anderson

76 Pages·2012·5.74 MB·English

Compliance
TODAY
November 2012

a publication of the health care compliance association . - .
wwwhcca infoorg
Meet Urton Anderson
Clark W. Thompson Jr. Professor
in Accounting Education
McCombs School of Business
The University of Texas at Austin
16
See page
24 30 34 38
Using comparative Bake Medicaid Developing
data to support compliance deficiencies engaging
compliance efforts into the as conditions and impactful
business of payment? compliance training
Kimberly Hrehor,
for stakeholders
Marianne Lundgren Josh Axelrod Susan E. Nance
and Dan McCullough Laura Wenzel
Announcing the new
It’s never been easier to take
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It’s easier than ever to read the
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Letter from the Ceo
Announcing the new
by Roy Snell, CHC, CCEP-F
Are we advisory
It’s never been easier to take
HCCA
Compliance Today with you, share or are we the solution?
an article, or fi nd what you’re
looking for.
Magazine Please don’t hesitate to call me about anything any time. department or leader who knew about the
Now you can enjoy reading
612 709-6012 Cell • 952 933-8009 Direct problem felt it was their job to fix it.
Compliance Today on your favorite
roy.snell @ corporatecompliance.org That is why the press, the public, politi-
handheld device. The new HCCA
cians, and prosecutors have decided that there
Magazine App puts the entire
Many people think their job is done must be someone assigned to actually do some-
App
magazine in the palm of your
when they advise people to do thing more than advise. They want someone
hand, and soon, even past issues the right thing. Many corporate to actually fix the problem. They want a com-
going back to January 2012. departments consider themselves “advisory.” pliance officer. And they want the compliance
They feel it is their duty to inform someone
It’s easier than ever to read the of an ethical or legal infraction, and that is
My message to you is simple.
articles, email them to a colleague, the extent of their responsibility.
I have often referred to these people If you are a compliance officer,
or search the magazine for that
as the pointer sisters. They point
important piece of text you were do not fall into the trap all of
to where a problem might be. They
looking for. Best of all, there’s no the other departments have.
point to where a problem is. But then
charge to HCCA members. Just
they smugly declare their job done, Our profession is at great risk
download the app and use your and occasionally the problem goes
if you just advise people
existing HCCA login information. Snell unresolved. They like the “advisory”
title because they don’t have to clean to fix a problem.
So, start taking advantage of up difficult problems. Enron, HealthSouth,
this new membership benefi t and Penn State University all had several
people who knew of a problem but did noth- officer to be independent of those who are con-
today. Download the new HCCA
ing except advise someone else that there flicted and to have access to the board (much
Magazine app. Simply visit
was a problem. They were more concerned like audit). Society wants the compliance officer
the app store for your favorite
about themselves than the organization. They to have an avenue to pursue if everyone they
device and use the search term
wanted to keep their pristine political noses advise to fix the problem refuses to do so.
“Compliance Magazine.”
clean. This is why the compliance profession So my message to you is simple. If you are
was created. a compliance officer, do not fall into the trap all
For years Congress has been interview- of the other departments have. Our profession
ing the pointer sisters during congressional is at great risk if you just advise people to fix a 2
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hearings. The pointer sisters at Tyco, Enron, problem. If you don’t fix the problem, our pro- er 2
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PSU, and more would say, “Yes, I knew about fession will become a cost center. And unlike m
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the problem, and I told somebody about the legal, audit, and risk, we will not have another N

problem.” When asked why they didn’t do job to fall back on if we become merely advi- y
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something about the problem, they would sory. If no one is willing to fix a problem, we o
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say it was not their job. They were advi- must escalate the issue up through the organi- c
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sory. Congress was dumbfounded that no zation until it is fixed. pli
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HCCAMagazineApp_1pageCTad.indd 1 10/5/12 1:53 PM
Contents
November 2012
features CoLumns
16 Meet Urton Anderson 3 Letter from the CEO
an interview by John falcetano roy sneLL
24 [Ceu] Using comparative data
23 Exhale
to support compliance efforts
shaWn DeGroot
by Kimberly hrehor, marianne Lundgren,
and Dan mcCullough
43 Social networking
PEPPER, a billing statistics report, can help identify vulnerabilities
for improper Medicare payments before it’s too late. John faLCetano
30 Bake compliance into the business
by Josh axelrod
All the stakeholders should know the what/why/how of
Departments
compliance and how it applies to them in particular.
34 Medicaid deficiencies
6 News
as conditions of payment?
by susan e. nance 12 People on the move
States that fail to meet Medicaid payment rules and regulations
may find themselves reimbursing the federal government for 68 HCCA congratulates
overpayments.
newly certified designees
38 Developing engaging and impactful
70 HCCA welcomes new members
compliance training for stakeholders
by Laura Wenzel 73 Takeaways
Tips for designing attention-grabbing compliance training meant
specifically for the board and senior management that will help 74 Events calendar
engage them in the partnership.
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Compliance Today is printed with 100% soy-based, water-soluable inks on recycled paper. Interior pages are double-coated
y sheets made from 80% recycled content, which includes 60% post-consumer waste. The remaining 20% is virgin fiber that
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od comes from responsibly managed forests and is FSC certified. Cover stock is made from 10% post-consumer waste and is
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e produced near the printing facility in Minnesota. The energy used to produce the paper is 100% renewable. Certifications for
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an the paper include The Forest Stewardship Council (FSC), Sustainable Forestry Initiative (SFI), and Green-e.org.
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4 www.hcca-info.org 888-580-8373
Compliance
Recent studies in the area of
Internal Audit have found a number
TODAY
“ ”
of benefits to certification from the
Editorial Board
organizational perspective. Gabriel Imperato, Esq., CHC, CT Contributing Editor,
Managing Partner, Broad and Cassel
See page 18 Ofer Amit, MSEM, CHRC, Research Compliance Administrator,
Baptist Health South Florida
Janice A. Anderson, JD, BSN, Shareholder, Polsinelli Shughart, PC
Christine Bachrach CHC, Chief Compliance Officer,
University of Maryland
Dorothy DeAngelis, Managing Director, FTI Consulting
artiCLes
Gary W. Herschman, Chair, Health and Hospital Law
Practice Group, Sills Cummis & Gross P.C.
David Hoffman, JD, President, David Hoffman & Associates
Richard P. Kusserow, President & CEO, Strategic Management
44 [Ceu] What do you do when a ZPIC
F. Lisa Murtha, JD, CHC, CHRC, SNR Denton US LLP
comes knocking? Robert H. Ossoff, DMD, MD, CHC, Assistant Vice Chancellor for
Compliance and Corporate Integrity, Vanderbilt Medical Center
by Kristen p. mcDonald
Jacki Pemrick, Privacy Officer, Mayo Clinic
When faced with a ZPIC pre-payment or post-payment review, it is imperative Deborah Randall, JD, Law Office of Deborah Randall
to prepare a defense and meet the appeal deadlines. Emily Rayman, General Counsel and Chief Compliance Officer,
Community Memorial Health System
48 Do we really lie that easily? Rita A. Scichilone, MSHA, RHIA, CCS, CCS-P, Director of Practice
Leadership, American Health Information Management Association
a book review by adam turteltaub James G. Sheehan, JD, Chief Integrity Officer,
New York City Human Resources Administration
A new book by Dan Ariely provides insights into human behavior and how
Lisa Silveria, RN, BSN, Home Care Compliance,
we make economic decisions.
Catholic Healthcare West
Jeffrey Sinaiko, President, Sinaiko Healthcare Consulting, Inc.
51 Recovery Audit Contractor (RAC) audits:
Debbie Troklus, CHC-F, CCEP-F, CHRC, CHPC,
Are plan sponsors ready? Managing Director, Aegis Compliance and Ethics Center
Cheryl Wagonhurst, JD, CCEP, Partner,
by susan W. Berson and roy m. albert Law Office of Cheryl Wagonhurst
CMS has expanded its payment audits to include Medicare Advantage (Part C) Linda Wolverton, CHC, CPHQ, CPMSM, CPCS, CHCQM, LHRM,
RHIT, Vice President Compliance, Team Health, Inc.
and Prescription Drug Plan (Part D) sponsors, but the appeals process has
ExEcutivE Editor: Roy Snell, CHC, CCEP-F, CEO, HCCA,
been streamlined.
roy.snell @ hcca-info.org
58 Compliance 101: Seven elements NEws aNd story Editor/advErtisiNg: Margaret R. Dragon,
781-593-4924, margaret.dragon @ hcca-info.org
of an effective compliance program
copy Editor: Patricia Mees, CHC, CCEP, 888-580-8373,
by eugene y.C. ngai patricia.mees @ hcca-info.org
copy Editor: Brook Matthiesen, 888-580-8373,
Compliance programs are not yet mandatory for all types of providers,
brook.matthiesen @ hcca-info.org
but proactively using the seven elements is still a good idea.
dEsigN & layout: John Goodman, 888-580-8373,
john.goodman @ hcca-info.org
61 [Ceu] Paying for intangible assets:
compliance today (ct) (ISSN 1523-8466) is published by the
Developing a defensible acquisition policy Health Care Compliance Association (HCCA), 6500 Barrie Road,
Suite 250, Minneapolis, MN 55435. Subscription rate is $295 a
by alex Kajan and Curtis Bernstein year for nonmembers. Periodicals postage-paid at Minneapolis, MN
55435. Postmaster: Send address changes to Compliance Today,
Current valuation theory and health care regulations can help establish the
6500 Barrie Road, Suite 250, Minneapolis, MN 55435. Copyright 12
value of goodwill and other intangibles when a physician practice is sold © 2012 Health Care Compliance Association. All rights reserved. 20
Printed in the USA. Except where specifically encouraged, no part er
or acquired. b
of this publication may be reproduced, in any form or by any means m
e
without prior written consent of the HCCA. For Advertising rates, ov
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call Margaret Dragon at 781-593-4924. Send press releases to M.

Dragon, 41 Valley Rd, Nahant, MA 01908. Opinions expressed are y
not those of this publication or the HCCA. Mention of products and a
d
services does not constitute endorsement. Neither the HCCA nor CT o
T
is engaged in rendering legal or other professional services. If such e
c
assistance is needed, readers should consult professional counsel n
a
or other professional advisors for specific legal or ethical questions. pli
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VOLUME 14, ISSUE 11 o
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Investigation suggests costs from upcoding,
other abuses likely top $11 billion
The Center for Public Integrity reported on more complex and time-consuming, both due
September 15, 2012 that “thousands of doctors to new technology and declining health status.
and other medical professionals have steadily The rise in fees may also be a reaction, they say,
billed higher rates for treating elderly patients on to years of under-charging, and reflect more
Medicare over the last decade—adding $11 billion accurate billing. The fees are based on a system
or more to their fees and signaling a possible rise of billing codes that is structured to make
in medical billing abuse, an investigation by the higher payments for treatments that take more
Center for Public Integrity has found. time and effort.” For more: www.publicintegrity.org/
“Medical groups argue that the fee hikes 2012/09/15/10810/how-doctors-and-hospitals-have-collected-
are justified because treating seniors has grown billions-questionable-medicare-fees
Study finds corporate directors pursue change,
drive to accelerate progress; challenges persist
A September 12, 2012 PricewaterhouseCoopers The press release revealed that “In the
press release noted that “Significant changes in summer of 2012, 860 public company directors
corporate governance are impacting boardroom responded to the survey. Of those, 70 percent
dynamics, compelling directors to spend more serve on the boards of companies with more
time on board work and prompting them to than $1 billion in annual revenue. PwC struc-
reconsider their oversight approach, according tured this year’s survey to provide actionable
to the 2012 Annual Corporate Director Survey feedback directors can use as benchmarks
issued by PwC US. Directors acknowledge that to help evaluate their performance in core
challenges remain and expect to increase their areas that are ‘top of mind’ to today’s boards.”
focus on critical areas including board composi- www.pwc.com/us/en/press-releases/2012/pwc-study-finds-
tion, risk management and IT oversight.” corporate-directors-pursue-change.jhtml
Report reveals 80 percent of employees plan
to stay with current employer
A September 2012 press release from Deloitte significant increase from 2011, when nearly 65%
reported that “As high unemployment persists were planning to leave. Forty-six percent of the
2 and the global economic recovery remains halt- survey respondents indicate they are less inclined
1
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er 2 ing and uneven, the ‘resume tsunami’ appears to move because, in the last 12 months, they have
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m to have been reduced to a ‘resume riptide.’” changed jobs (9%), were promoted (22%), or have
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No According to Deloitte’s new global talent survey, taken new positions (15%) with their current

y Talent 2020, four out of five employees plan to employers.” www.deloitte.com/view/en_US/us/press/Press-Rel
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News from CMS
2012 annual report: works in conjunction with the responsibly and to comply
rate review saves estimated 80/20 rule, which requires with confidentiality laws and
$2.1 billion for consumers insurance companies to gen- regulations among provid-
According to a report issue erally spend 80 percent of ers using electronic health
on September 11, 2012 by premiums on health care or records (EHRs). The dem-
U.S. Department of Health provide rebates to their cus- onstration also showed how
and Human Services, the tomers. Insurance companies sensitive information can
Affordable Care Act has that did not meet the 80/20 be tagged so that when it is
saved consumers an esti- rule will provide nearly 13 sent to another provider with
mated $1 billion on health million Americans with more the patient’s permission, the
insurance premiums and pro- than $1.1 billion in rebates receiving provider will know
vided $1.1 billion in rebates. this year. Americans who that they need to obtain the
Beginning Sept. 1, 2011, receive the rebates will benefit patient’s authorization to fur-
the health care law imple- from an average rebate of $151 ther disclose the information
mented federal rate review per household. with others.
standards. These rules ensure The rate review report The demonstration was
that, in every state, insurance is available at: developed as part of the Data
companies are required to www.healthcare.gov/law/resources/ Segmentation for Privacy
publicly submit their rates reports/rate-review09112012a.html (DS4P) Initiative created
for review and justify their Information on how states in response to the work of
actions if they want to raise are using their rate review the President’s Council of
rates by 10 percent or more, grant funds is available at: Advisors on Science and
according to the government www.healthcare.gov/law/resources/ Technology and supported by
press release. reports/rate-review09202011a.pdf HHS’s Office of the National
To assist states in this General information about Coordinator. Using stan-
effort, the Affordable Care Act rate review is available at: dards identified in the DS4P
provides states with Health www.healthcare.gov/law/features/ Initiative, HHS’s Substance
Insurance Rate Review Grants costs/rate-review Abuse and Mental Health
to enhance their rate review Services Administration
programs and bring greater hhs, Va demonstrate (SAMHSA) and the VA safely
transparency to the process. secure sharing of and securely transmitted
So far, 42 states have used sensitive health information a mock patient’s substance
their rate review grant funds The Department of Health abuse treatment records
to make the rate review and Human Services (HHS) tagged with privacy metadata
process stronger and more and the Department of from one EHR to a different 2
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This initiative is one of September announced a dem- cally verifying that the mock m
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many in the health care law onstration of the standards patient had consented to the No

aimed at saving money for to allow sensitive health transmission. www.hhs.gov/news/ y
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consumers and specifically information to be shared press/2012pres/09/20120917c.html o
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888-580-8373 www.hcca-info.org 7
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CCB awards 2 Ceus to authors of articles published in Compliance Today
Compliance Today needs you!
Every month Compliance Today offers health care Articles are generally between Compliance
compliance professionals information on a wide variety 1,000–2,500 words (not a limit). TODAYNovember 2012
A PUBLICATION OF THE HEALTH CARE COMPLIANCE ASSOCIATION WWW.HCCA-INFO.ORG
of enforcement, regulatory, legal, and compliance Submit your article as a Word
program development and management issues. .doc with limited formatting. Meet Urton Anderson
Clark W. Thompson Jr. Professor
in Accounting Education
McCombs School of Business
2 The article title and author’s TSehee p aUgne i1v6ersity of Texas at Austin
01 We are particularly interested in articles covering
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