Healthcare Compliance Presentation

CINNTI – “confirmation of workplace protection for everyone”
Presenter: Kendall Brune, PhD, MBA, LNHA
Fellow – American College of Healthcare Administrators
Compliance and Beyond
It does not matter how small
or LARGE your complex is
12 room ILF- VA
276 bed SNF
It is a Scary Proposition~!

Healthcare companies have seen the development of mandatory compliance
requirements increase over the past few years. The sources of these
requirements include:
• US Sentencing Guidelines
• OIG/Health and Human Services Guidance
• Medicare Part C & D Mandatory Compliance Guidelines
• Affordable Care Act
• FAR Acquisition Regulations.

Recently, mandatory compliance requirements were enacted through statute in
the Affordable Care Act (Sections 6102 and 6401). Under the ACA, companies are
prohibited from participating in Federal heath care programs unless their
compliance programs contain certain core elements.
The ACA sets out required core elements. The HHS regulations are likely to draw
from the statute and from earlier regulatory proceedings which solicited input on
the basic compliance program requirements.
Nursing homes will be expected to have operational compliance programs that
are effective in preventing criminal and civil health care violations, and
promoting quality of care by March 23, 2013.
What does this NH regulation have to do with my ALF?

Healthcare and Long Term Care Compliance
What is a ―sanctioned entity ?
Entity convicted of any criminal offense that triggers a mandatory exclusion
under Section 1128(a), including:
• Felony conviction for health care fraud;
• Conviction related to patient abuse and/or neglect;
• Failure to repay Health Education Assistance Loans;
• Conviction related to fraud against non‐health care programs;
• Misdemeanor conviction for controlled substances;
• License revocation or suspension; and
• Misdemeanor health care fraud conviction.
Share FBI and OIG cards –
Welcome to my ALF~!

Fact Sheet
ALF and Wrongful Deaths?
Public defender Kathryn Benson, left,
talks with Richard Allen Williams
following his arraignment in Boone
County (Mo.) Circuit Court. Williams, 36,
pleaded innocent Monday to 10 counts of
first-degree murder for allegedly killing
patients a decade ago while working as a
nurse at the Truman Memorial Veterans
Hospital in Columbia, Mo. Boone County
Prosecutor Kevin Crane told the court he
would seek the death penalty in the case.
(July 23, 2002)
An investigation by the FBI and the Office of Inspector General in the
Department of Veterans Affairs determined that 41 people died on Ward 4E
between May and August 1992 while Williams was on duty. Investigators
concluded patients were 20 times more likely to die while Williams was working
than while 11 other nurses were on duty.

Owners did not check out his Background?
 His license was not suspended….
 The VA did not report any problems….
 The Administrator was glad an RN applied….
 Meanwhile, the number of deaths increased at Ashland during the
time Williams was there. From June 1993 to June 1994, more than
half the home's 55 residents died - nearly triple the average death
rate for nursing homes in Missouri. The Boone County medical
examiner's office focused on 30 deaths that occurred during the
year Williams worked at Ashland.
 Six residents died in the 10 months after Williams' dismissal from
the home on July 13, 1994. No charges resulted. Williams was
removed after state inspectors found that he had failed to
adequately supervise staff to ensure the safety, treatment and care
of residents.
 http://murderpedia.org/male.W/w/williams-richard-allen.htm

Affordable Care Act (ACA) core requirements should include:
1. Written policies, procedures and standards of conduct to prevent and detect inappropriate behavior.
2. Designation of a chief compliance officer.
3. Effective education and training programs for the governing body for all employees.
4. Maintenance of a hotline and anonymous reporting procedures to protect the anonymity of
complainants and to protect whistleblowers from retaliation.
5. A system to respond to allegations of improper conduct and the enforcement of appropriate
disciplinary action against employees who have violated internal compliance policies, applicable
statutes, regulations or Federal health care program requirements.
6. The use of audits and/or other evaluation techniques to monitor and track compliance and
assist in the reduction of identified problem areas.
7. The investigation and remediation of identified systemic problems including making any necessary
modifications to the organization’s compliance and ethics program.

What are you doing about your compliance and how comfortable are
you that your current licensed staff / vendors?
• Are properly licensed
• Have no Sanctions or Disciplinary Actions
• Maintain required Certificates
• Are not Excluded or Debarred by OIG/GSA
• Maintain proper Continuing Education
• Files are ready for Joint Commission or State audits
Rooting out health care fraud is central to
the well-being of both our citizens and the
overall economy. http://www.fbi.gov/about-
us/investigate/white_collar/health-care-fraud

Recommended program levels for current licensed staff and vendors:
Compliance Plans Minimum Medium Maximum
General Services Administration Excluded Parties List System (GSA) X X X
Office of the Inspector General List of Excluded Individuals/Entities (OIG) X X X
Office of Foreign Assets Control Specially Designated Nationals (OFAC) X X X
State exclusions, sanctions, and debarment X X X
Instant SSN (social security number) Trace X X X
National Practitioner Data Bank (NPDB) X X
Professional License Verification X X
Nationwide Federal Criminal Record Search X X
Statewide Criminal Records Search X X
Registered Sex Offender Search X X
Ethics Training X
Continuing Education Training X

Licensed Employees Only?
Do you have one place to go to determine the compliance for your entire
organization?
2012, American Senior Communities recently settled with the OIG for $376,000
for employing 7 excluded providers. Fines included CNA's and kitchen staff.
Housekeepers?
Drivers?
Transporters?
Dietary Staff – OH Yes
VOLUNTEERS?
My Dietary Manager

Recommended program levels for non-licensed staff and vendors:
Compliance Plans Minimum Medium Maximum
Instant SSN (social security number) Trace X X X
Nationwide Federal Criminal Record Search X X X
Statewide Criminal Records Search X X X
Registered Sex Offender Search X X X
Ethics Training X X X
Employment & I9 Verification X X
W-9 Verification X X
Workers Compensation Insurance Verification X X
General Liability Insurance Verification X X
Business Partner / Owner Search X X
County Civil / Lawsuit Search X

The cost of not knowing?
Medicare/Medicaid Billing Participation
1. Up to $10,000 fine for each item/service billed
2. Treble (3x) damages
3. Possible exclusion
4. Charges under Federal False Claims Act
Legal Liability
1. Negligent hire or retention
2. Loss of CMS Reimbursement Privileges (PPACA 6502)
3. State fines for practicing without a license
 Has it effected you, it has me~! RN & LPN story

The cost of not knowing? – 2 examples
Example #1 - The U.S. Justice Department has accused RehabCare Group Inc. of paying more than $10
million in kickbacks to gain access to Medicare and Medicaid patients in Missouri nursing homes.
RehabCare began making payments in 2006 to induce a Missouri nursing home chain to grant
RehabCare a contract to provide therapy services.
RehabCare’s revenue-sharing arrangement with the nursing home owner -- Sikeston, Mo.-based Health
Systems Inc. -- defrauded the federal Medicare and Medicaid programs of millions of dollars, federal
investigators allege.
Example # 2 - California’s Attorney General announced that the former director of nursing at a hospital
in the Kern Valley Healthcare District was sentenced to three years in state prison for the “convenience
drugging” of elderly patients, including one who ended up dying.
Gwen D. Hughes, the former nursing director, was charged with the deaths of three patients in the
original lawsuit. She pled no contest to a single felony count of elder abuse last October, with a special
allegation that the abuse resulted in the death of a patient.

The cost of not knowing?
OIG also excluded 3,131
individuals and entities from
participation in Federal health
care programs in FY 2012. OIG
reported 778 criminal actions
against individuals or entities
that engaged in crimes against
HHS programs; and 367 civil
actions.
The OIG reported $6.9 billion
in expected recoveries which
consisted of $923.8 million in
audit receivables and $6 billion
in investigative receivables for FY
2012.
Date Provider Self-
Disclosure?
Amount of CMP
Assessed
11/13/12 Hospital Yes $248,362.78
10/12/12 Hospital & Cardiology
Practice
Yes $172,604.00
10/12/12 Physician d/b/a Physician’s
Medical Clinic
Yes $43,014.80
10/07/12 Home Health Agency Yes $81,102.06
10/07/12 Hospital Yes $150,000.00
09/26/12 Hospital Yes $120,580.25
09/25/12 Treatment Center Yes $105,794.24
09/19/12 Neighborhood Health Clinic Yes $103,485.79
09/19/12 Hospital Yes $417,440.78
08/22/12 Hospital Yes $138,452.00
08/02/12 Hospital Yes $206,669.53
07/13/12 Community Clinic Yes $207,440.19
Sample listing

GCT Advantages
• More than just a background check
• Each compliance package is customized
• Employee and vendor screening
• No Cost for certifying outside vendors
• International capabilities
• Our system monitors monthly for changes
• Nationwide databases
• Secure documentation management
• State of the art security to protect all data
• On-site user interface for security or visitor center
GCT is a simple, efficient, cost-effective solution to manage your compliance with
confidence. We also recognize that your operations must always remain audit ready.
Why? We’ve been there as licensed Administrators~!...been there with Federal Surveyors,
with FBI and OIG. It is NOT pretty or a cake walk.

For any questions contact:
GCT – Healthcare and Long Term Care Compliance Expert
Kendall Brune PhD, MBA, LHNA, FACHCA
Kendall.brune@kaegem.com
Phone: 314-757-0131
Global Compliance Tracker
a KAEGEM division
2800 West Higgins Road, Suite 980
Hoffman Estates, Illinois 60169
Toll Free:1-888-327-6067
E-mail: info@gct-cinnti.com

Healthcare Compliance Presentation

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