Transcript Document 7302611

Compliance Plans
KINNEY MANAGEMENT SERVICES, LLC
January 20, 2010
Compliance Plans
What are they?
Why do I need one?
Got one, what next?
Excluded who?
Compliance Plans
What Are They?
Compliance plan: The implementation of a
systematic process to ensure the organization is
performing functions in compliance with prevailing
federal and state laws concerning health care
billing practices and fraud detection and/or
prevention. These regulations include HIPAA, stark
I and II, Medicare/Medicaid anti-kickback
statute,the false claims act, state false claims act,
and other state statutes.
Compliance Plans
Two Separate Requirements
Often Confused



New York state
compliance
agreement – July
2009
Goes on for 3 years
until July, 2012.
State compliance
officer



NYS part 521
provider
compliance
programs
Billing of $500,000
in any 12 months
District compliance
officer
Compliance Plans
Why You May Need One



Exceeded, or will exceed, $500,000 –
any 12 months.
Have known issues with Medicaid
claims.
Recommendation of state education
and OMIG (Hussar & Matott)
12/17/2009.
Compliance Plans
Why You May Need One
The BOCES – Part 521 Title 18
“When a person, provider or affiliate claims or
orders, or has claimed or has ordered, or
should be reasonably expected to claim or
order at least five hundred thousand dollars
($500,000) in any consecutive twelve-month
period from the medical assistance program;
Compliance Plans
Got One, What Next?
Training


OMIG due to federal settlement compliance agreement will run
fraud/false claims training.
District must train staff members on
district's compliance plan – how it
works.
Compliance Plans
Got One, What Next?

Review past audits – not just yours.

Talk to whomever is doing your billing.

Periodically sample your claims.

If you do nothing? You're in trouble!!
Compliance Plans
Got One, What Next?
Some known issues

IEP system's meeting dates are wrong.

Service documentation not signed.

Under the direction is not clinical
supervision.
Compliance Plans
Got One, What Next?
Some known issues - continued

Staff not registered.

Can't find documentation 5 years later.

Systems allow changes - not tracked.
Compliance Plans
Excluded Who?
An excluded persons or entity is one that
has been barred from any participation, in
any way, in plans and programs
providing health benefits funded directly
or indirectly by the united states (other
than the federal employees health
benefits plan).
Compliance Plans
Excluded Who?
Includes:

Patient abuse

Things like taking nude picture of patient.

Many clerks, aides, office staff, etc.

It could be anyone applying for a job or
currently working for district.
Compliance Plans
Excluded Who?
Student Loan Default
Health Education Assistance Loans
Discontinued
9/30/1998.
Compliance Plans
Excluded Who?
Medical Disciplines Included
Allopathic medicine
Chiropractic
Clinical psychology
Dentistry
Health administration
Optometry
Osteopathy
Pharmacy
Podiatry
Public health
Compliance Plans
Excluded Who?
Student loan default
New York count of defaulted individuals
NEW YORK - 95 people - $15,495,233
Http://www.Defaulteddocs.Dhhs.Gov/discipline.Asp
Compliance Plans
Excluded Who?
How often should you check?
Federal and State data continuously updated.
HHS recommends monthly checking.
OMIG say periodically.
Compliance Plans
Questions?
Casey Usher - [email protected]
Joe Kinney - [email protected]
518-371-0176
Compliance Plans
Resources

OMIG exclusion information http://www.Omig.State.Ny.Us/data/content/view/72/52/

HHS exclusions -

Http://oig.Hhs.Gov/fraud/exclusions.Asp

Compliance plan reference material

Http://www.Kinneyassoc.Com/nycomplianceplan/cpinfo.Htm