Corporate Compliance

HCCA New England Regional Conference Roundup: Part 1

Compliance Monitor, September 22, 2010

On Monday, September 13, healthcare compliance experts met at the Health Care Compliance Association’s (HCCA) New England Regional Conference.

Timothy Hogan, JD, CHFP, Corporate Compliance and Privacy Officer for Elliot Health System opened the conference with a presentation about the risks and benefits of prospective and retrospective audits. Prospective audits, Hogan said, give compliance officers the ability to identify and fix errors before submission. On the other hand, a prospective audit must be complete before the claims filing deadline, which causes time constraint issues. A retrospective audit assesses complete billing history, but it can be challenging for compliance officers to determine a starting point and adjust claims that have already been paid.

Hogan said the government has not expressly stated a preference on audits, but the trend in the compliance field leans towards prospective audits. 

Lawrence Vernaglia, JD, MPH, Chair, Health Care Industry team, for Foley & Lardner LLP followed with a presentation on the new overpayment refund and disclosure rules under the Patient Protection and Affordable Care Act (PPACA).

Under the PPACA, the False Claims Act and qui tam provisions are substantial revenue generators as well as tools to combat fraud, waste, and abuse. The PPACA requires a facility to report an overpayment by the later of 60 days after the overpayment is “identified” or the date cost report is due. Vernaglia argued that the government underestimates how quickly an organization is able to identify an overpayment.

Vernaglia suggests providers establish a work plan that identifies overpayments within a short time-line. Before Vernaglia exited, Hogan added that retrospective audits help identify overpayments.

During the Physician Relationships with Industry panel, three speakers with different backgrounds discussed Massachusetts’ Gift Ban—a bill that bans pharmaceutical companies from engaging in providing gifts to physicians, limiting when companies can pay for doctors' meals, and requiring companies to publicly disclose payments to doctors over $50 for certain types of consulting and speaking engagements.

View the full set of regulations here.

Bill Mckenzie, CPA, MBA, Director of Healthcare Compliance for Depuy, an orthopedic implants manufacturer owned by Johnson & Johnson Co., opened the discussion by expressing how device companies depend on physician relations for success. A point the lone physician of the group, Thomas P. Stossel, MD, Director of Translational Medicine Unit at Brigham and Women’s Hospital and the American Cancer Society Professor at Harvard Medical School sees changing due to the ban.

During the panel, Stossel playfully grabbed a vendor’s promotional Tyrannosaurus Rex toy and pondered if he was legally able to accept the promotional item. Stossel lamented the loss of fellowship grants from large pharmaceutical companies after Massachusetts passed the Gift Ban. He stated that even a simple work dinner with a pharmaceutical representative is suspect and possibly a violation of the anti-kickback statute.

The panelists ended the session with an attempt to establish an appropriate code of conduct for interactions between physicians and pharmaceutical representatives. Christopher Clark, JD, Director of the Office for Interactions with Industry, for Partners Healthcare commented that the Gift Ban is a “huge problem” in monitoring conflicts of interest. And Stossel admitted that designing a mandatory, uniform code of conduct would be difficult considering all physicians and facilities perform duties differently.

Compliance Monitor will cover the second half of HCCA’s regional conference in next week’s issue.

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