1. CMS to release EMTALA final rule
2. Hospital pays $1.2 million for kickbacks
3. Pay-per-view article: Clinical trials: 10 easy steps to assess your risk
4. Hospital passes outlier audit
5. Tip: How to find your compliance return on investment

A Nebraska hospital learned the hard way that it shouldn't ignore the Stark II regulations. Good Samaritan Hospital must now pay the government $1.2 million to settle charges that it provided pharmaceuticals and supplies, medical equipment, guaranteed loans, and consulting fees to a physician, with the expectation that the physician would refer patients to the hospital in return.

Stark II prohibited the hospital from billing Medicare for items or services referred or ordered by Rajitha Goli, a physician with whom the hospital had a financial relationship, the government said. These payments also violated the anti-kickback statute.

The case goes back three years. Goli was indicted in March 2000 for operating a health care fraud scheme involving administering unnecessary therapy, false billing practices, and kickback activities. She was sentenced to a term of 12 months and one day in federal prison, a 3-year term of supervised release, and restitution of $642,858.21.

Auditing and monitoring clinical trials is a must for any organization that performs clinical research. Since human subjects participate in this research, it is critical to have systems in place to prevent errors and omissions, says Lisa Murtha, JD, vice president of audit and compliance at Children's Hospital of Philadelphia.

The government is actively pursuing research organizations for compliance violations, says Murtha. The media are also spotlighting ethics concerns. With stakes this high, help your organization put a top-notch auditing and monitoring plan in place . . .

A medical center in Chicago has nearly mastered billing outlier payments. There were only a few hiccups, according to an Office of Inspector General (OIG) audit. The OIG found $7,726 in outlier overpayments at Rush-Presbyterian-St. Luke's Medical Center (Rush), but these overpayments are attributable to an outlier pricing issue at a fiscal intermediary's (FI) claim processing system.

The OIG ordered Rush to refund these overpayments to its FI. Rush was also underpaid for some services. The OIG found $7,752 in underpayments, as a result of Rush improperly coding and billing Medicare for implantable devices.

Your compliance program has probably been around for several years, so now it's time to show stakeholders that the money you spend on compliance is paying off.

Convincing your board of directors, shareholders, trustees, management, and employees that your compliance program is effective is a daunting task. Help is on the way. Leaders from the Health Care Compliance Association are developing national performance measurement standards for health care compliance programs. These standards will allow you to measure your compliance program's effectiveness and quantify its return-on-investment. However, it is important to start measuring your program's effectiveness now.

Make simple changes
Tracking performance indicators, for some providers, is as simple as renaming periodic compliance reports that you already provide to stakeholders. Change the "Quarterly Compliance Report" to the "Compliance Effectiveness Quarterly Report." This report might indicate that you have trained 98% of employees on the code of conduct, up 8% from the prior quarter.

Another change: Research the performance indicators your peers are measuring and tracking; then incorporate the indicators into your reports.

The time has come to move your compliance program to the next level. It is not enough anymore that you have a program: stakeholders need to know that it is effective.

Source: Hank Vanderbeek, MPA, CIA, CFE of IRP, Inc., an innovative health solutions company.

Editor's note: For more information on assessing the effectiveness of your compliance program, click here The book and CD-ROM set, Hospital Compliance Program Assessment: Your Tool for Measuring Effectiveness, will help your facility conduct thorough compliance program assessments. It provides standards based on the OIG Compliance Program Guidance for Hospitals and a rating system for determining your level of compliance with each standard, both developed by the author. There's also an explanation of how to meet the standard, and a list of documents you need to prove that you meet each one.