The Intersection of Quality and Compliance: Avoiding a Collision with Fraud
Failure To Comply With Regulatory Standards Will Result In Government Enforcement Actions!
The risk of “collision” is already high—extensive federal and state regulatory standards govern health care providers, and enforcement authorities are increasingly focusing on the quality of care provided to determine the provider’s reimbursement. Moreover, the OIG, the U.S. Department of Justice, and the Attorney Generals of each state are working collaboratively with the health care regulatory agencies to address these standards in relation to the quality of care provided by the individuals and the institutions. Failure to demonstrate “quality” has translated into liability for inadequate care, worthless or unnecessary services, and failure to comply with standards, leading to large paybacks to the government. Further, sanctions may range beyond monetary penalties to exclusion from federal and state health care programs and even incarceration for the most serious offenses.
These new approaches raise the stakes for health care organizations, both financially and legally. Poor quality and value— or the failure to demonstrate good quality and value—may affect the financial viability of health care providers, as well as lead to negative consequences for failing to comply with regulatory standards. As a result, the lines between the previously distinct disciplines of “Quality” and "Compliance" have blurred, ensuing developments such as payment incentives, payment disincentives, serious adverse events/NCDs, and government enforcement actions based on quality issues.
This 60 minute session will enlighten you on the crucial intersection of these disciplines, and provide recommendations for compliance. You'll learn operational best practices, specific considerations for boards and leadership when evaluating the quality-compliance link, and questions that hospitals and providers should ask regarding their quality and compliance processes.
Highlights of the session:
- Overview of quality initiatives.
- Summary of payment reform elements.
- Operational challenges related to quality processes.
- Illustration of recent government enforcement actions related to quality and compliance.
- Practical “tips” hospital and/or practice leaders can employ.
- Key “takeaways” to ensure a more compliant quality process.
Ask a question in the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.
Who should attend? Hospital and Practice Compliance Officers, Board members, Physicians, Chief Medical Officers, Chief Nursing Officers, Nursing Management, Chief Operations Officers, other Operational Leaders, Risk Managers, and Care/Case Managers. Our presentation assumes that the attendees have a basic understanding of the elements of quality and compliance.
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- Kim Garner-Huey, MJ, CPC, CCS-P, PCS
- Jim Sheldon-Dean,
- Ester Horowitz,
- Charlotte Kohler and Linda Pilla, Esquire,
- Arlene Maxim, RN
About Our Speaker
Charlotte Kohler, RN, CPA, CVA, CPAM, CPC, CHBC is the president of Kohler HealthCare Consulting with over 30 years of healthcare. She has served as the Chief Operating Officer of a hospital based emergency department and multi-specialty primary care medical practice, as a compliance officer of a five hospital integrated delivery system, and as the CFO for ancillary services in a multi hospital system. Ms. Kohler...
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- Save money on travel.
- Meet your specific training needs.
- Keep learning after the event.
- Save time training your whole staff.