This article summarizes an interview with Kim Lansford, the Chief Compliance Officer of Shriners Hospitals for Children. In the interview, she discusses how her background in nursing has helped her in her compliance career. She also describes how the compliance field has evolved significantly since she entered it in 1998, with increased laws, government expectations, and scrutiny of compliance programs. Lansford believes compliance is earning greater acceptance from doctors and administrators as the focus on transparency and regulations has increased. She sees risk assessment and the connection between compliance and quality as growing areas for the future of the compliance profession.
This article summarizes an interview with Emmy Matthews, a sales consultant for Wolters Kluwer. In the interview, Matthews discusses her role supporting healthcare compliance professionals and the tools and solutions they need. She notes that compliance officers are facing growing regulatory requirements and need enterprise tools to effectively manage complex compliance processes. Officers seek real-time guidance, reporting capabilities, and workflow management to help identify and mitigate risks. Matthews recommends compliance professionals invest in integrated solutions to manage their entire compliance program.
This document describes the McDermott Health Speakers Bureau, which is a program run by the law firm McDermott Will & Emery to provide educational sessions on hot healthcare topics to their health system clients. The summaries are designed to be brought onsite at the client's convenience. The document provides an overview of the program, lists current topic options and faculty, and describes McDermott's healthcare advisory practice group. Key details include the topics cover emerging issues like digital health, hospital collaborations, and fraud and abuse. Continuing education credits may be available depending on the session. Clients can request sessions or suggest new topics.
Building on the Foundation of Ethics and Compliance to Achieve SustainabilityEthisphere
This document summarizes a webinar discussing how leading companies build upon the foundations of ethics and compliance to achieve sustainability. Speakers from Microsoft, Petco, and Voya Financial discuss their company's ethics and compliance programs and how their ethics/compliance and sustainability teams collaborate. They address increasing transparency expectations and challenges in global supply chains. The webinar aims to demonstrate how sustainability teams can learn from ethics/compliance and identify shared systems and controls.
This document summarizes a live webinar on compliance strategy and performance. The webinar featured speakers from Ethisphere and Convercent discussing key data and benchmarks, emerging best practices, and predictions for 2016. Topics included budget and visibility trends in compliance, the impact of mergers and acquisitions on misconduct, challenges in accessing and centralizing compliance data, and measuring return on investment and culture of compliance. State of the program reporting was also covered, noting variation in frequency, content, format and audiences.
Provider/payor convergence: A prescription for growth?Grant Thornton LLP
As bottom lines shrink, payors and providers are beginning to see convergence, or vertical integration, as the path to growth, Panelists from Johns Hopkins Institutions, Buchanan Ingersoll & Rooney PC and Grant Thornton LLP share their experience.
In a post-Financial Services Royal Commission (Hayne Royal Commission) world, the
regulatory landscape has changed fundamentally. The twin peaks model remains, but
the approach to enforcement is now summed up by the phrase, ‘adequate deterrence of
misconduct depends upon visible public denunciation of misconduct’.
ASIC has a new, more intensive supervisory approach—close and continuous monitoring
involves regularly placing ASIC staff onsite in major financial institutions to closely monitor
governance and compliance with laws. If successful, this program may be rolled out more
broadly. Its supervisory initiative, the Corporate Governance Task Force is undertaking
targeted reviews of corporate governance practices in large listed entities to allow it to
shine a light on ‘good’ and ‘bad’ practices observed across these entities.
Following a review of its enforcement strategy APRA has adopted a ‘constructively tough’
enforcement appetite. The Government has foreshadowed an extension of the Banking
Executive Accountability Regime (BEAR) beyond the banking sector
eHI privacy and security DC roundtable_April 2014Barbara Gabriel
This document discusses challenges that healthcare organizations face in protecting patient privacy and security when working with third party vendors. Representatives from healthcare companies expressed that their third party vendors often lack understanding of privacy and security regulations. Additionally, integrating third party risk controls into enterprise risk management frameworks remains a challenge. One healthcare organization described their process for identifying and assessing risks posed by third party vendors in order to minimize these risks.
This article summarizes an interview with Emmy Matthews, a sales consultant for Wolters Kluwer. In the interview, Matthews discusses her role supporting healthcare compliance professionals and the tools and solutions they need. She notes that compliance officers are facing growing regulatory requirements and need enterprise tools to effectively manage complex compliance processes. Officers seek real-time guidance, reporting capabilities, and workflow management to help identify and mitigate risks. Matthews recommends compliance professionals invest in integrated solutions to manage their entire compliance program.
This document describes the McDermott Health Speakers Bureau, which is a program run by the law firm McDermott Will & Emery to provide educational sessions on hot healthcare topics to their health system clients. The summaries are designed to be brought onsite at the client's convenience. The document provides an overview of the program, lists current topic options and faculty, and describes McDermott's healthcare advisory practice group. Key details include the topics cover emerging issues like digital health, hospital collaborations, and fraud and abuse. Continuing education credits may be available depending on the session. Clients can request sessions or suggest new topics.
Building on the Foundation of Ethics and Compliance to Achieve SustainabilityEthisphere
This document summarizes a webinar discussing how leading companies build upon the foundations of ethics and compliance to achieve sustainability. Speakers from Microsoft, Petco, and Voya Financial discuss their company's ethics and compliance programs and how their ethics/compliance and sustainability teams collaborate. They address increasing transparency expectations and challenges in global supply chains. The webinar aims to demonstrate how sustainability teams can learn from ethics/compliance and identify shared systems and controls.
This document summarizes a live webinar on compliance strategy and performance. The webinar featured speakers from Ethisphere and Convercent discussing key data and benchmarks, emerging best practices, and predictions for 2016. Topics included budget and visibility trends in compliance, the impact of mergers and acquisitions on misconduct, challenges in accessing and centralizing compliance data, and measuring return on investment and culture of compliance. State of the program reporting was also covered, noting variation in frequency, content, format and audiences.
Provider/payor convergence: A prescription for growth?Grant Thornton LLP
As bottom lines shrink, payors and providers are beginning to see convergence, or vertical integration, as the path to growth, Panelists from Johns Hopkins Institutions, Buchanan Ingersoll & Rooney PC and Grant Thornton LLP share their experience.
In a post-Financial Services Royal Commission (Hayne Royal Commission) world, the
regulatory landscape has changed fundamentally. The twin peaks model remains, but
the approach to enforcement is now summed up by the phrase, ‘adequate deterrence of
misconduct depends upon visible public denunciation of misconduct’.
ASIC has a new, more intensive supervisory approach—close and continuous monitoring
involves regularly placing ASIC staff onsite in major financial institutions to closely monitor
governance and compliance with laws. If successful, this program may be rolled out more
broadly. Its supervisory initiative, the Corporate Governance Task Force is undertaking
targeted reviews of corporate governance practices in large listed entities to allow it to
shine a light on ‘good’ and ‘bad’ practices observed across these entities.
Following a review of its enforcement strategy APRA has adopted a ‘constructively tough’
enforcement appetite. The Government has foreshadowed an extension of the Banking
Executive Accountability Regime (BEAR) beyond the banking sector
eHI privacy and security DC roundtable_April 2014Barbara Gabriel
This document discusses challenges that healthcare organizations face in protecting patient privacy and security when working with third party vendors. Representatives from healthcare companies expressed that their third party vendors often lack understanding of privacy and security regulations. Additionally, integrating third party risk controls into enterprise risk management frameworks remains a challenge. One healthcare organization described their process for identifying and assessing risks posed by third party vendors in order to minimize these risks.
Approaches in Implementing the Mental Health and Addiction Equity Act.Best Pr...Mariel Lifshitz
This document describes best practices used by seven states to implement and monitor compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). The states identified five key components of effective implementation: 1) open communication with health insurers, 2) standardized materials and terms, 3) templates and tools for assessing compliance, 4) market conduct exams and network adequacy reviews, and 5) collaboration across agencies and stakeholders. The states developed various templates, guides and other resources to promote consistent application of parity rules. They also analyzed complaints, conducted on-site exams of insurers, and collaborated closely with multiple groups to identify and address any compliance issues.
State of Compliance 2021 at Mid-Market Firms - NimonikNimonik
Nimonik.com recently conducted a survey of 100 compliance and risk professionals in the US, USA and in China. The participants were from mid-market firms (500-15,000 employees) and were leaders within their organization. These insights show that there remains much work to be done to achieve comprehensive compliance across mid-market firms.
Instilling a Culture of Compliance and Knowing Your CustomerJay Postma
Presentation of October 10, 2014 during the Financial Service Centers of America (FiSCA) Annual Conference's BSA/AML Certification Course. Covering Culture of Compliance, Understanding your market, and Knowing your customers.
What can industry stakeholders learn from the findings of Deloitte’s 2014 survey of young adults and health insurance to help increase enrollment of this population during special enrollment periods in 2014 and during the 2015 open enrollment season?
For more information, please visit https://www.deloitte.com/view/en_US/us/Insights/centers/center-for-health-solutions/755bca14ef416410VgnVCM1000003256f70aRCRD.htm
NEMEA Compliance Center - the most powerful survey creation, management, and reporting solution available. It intuitively collects responses, writes, and produces standardized regulatory compliance reports. In fact, it even supports the use of many different standards at once. Our compliance software has a fully featured user-interface that lets you rapidly compare the laws and regulations that govern your industry and business.
An Internship at the Centers for Medicare and MedicaidToni Williams
The author completed an internship at the Centers for Medicare and Medicaid Services (CMS) in the Region III office. They worked in the Consortium for Financial Management and Fee for Service Operations branch on various projects applying their public health skills and knowledge. This included projects related to workers' compensation Medicare set asides, quality assurance of Medicare Administrative Contractors, and hospital provider-based status determinations. The internship provided real-world experience applying legislation and regulations. It also allowed the author to network and gain a deeper understanding of healthcare finance and economics.
A leading home healthcare provider implemented MetricStream's governance, risk, and compliance platform to strengthen audit management and regulatory compliance while protecting confidential patient information. The platform centralized audit tracking, improved RAC audit preparation, and automated workflows to ensure compliance with various healthcare regulations. It provided collaboration tools and reporting capabilities to help different teams conduct thorough audits and resolve issues efficiently. With MetricStream's solution, the organization now has stronger compliance controls and security of sensitive data.
Regulatory Compliance, Risk Management, and the Trustee's RolePYA, P.C.
PYA Principal Shannon Sumner and Consulting Manager Susan Thomas presented “Regulatory Compliance, Risk Management, and the Trustee’s Role.” In this presentation, they will:
Describe the evolving compliance and risk management landscape, including government agencies’ expectations for compliance oversight. This presentation will:
- Outline recent government investigations and settlements.
- Provide key takeaways regarding responsibilities for ensuring an effective compliance program.
- Connect trustee duties to specific elements of enterprise risk management.
- Empower trustees with questions to ask leadership teams in preparation for playing a more active role in the compliance program.
This document provides a lesson plan for a Bahasa Inggeris (English language) class for 2nd grade students focusing on myths. The lesson objectives are for students to complete a word find task, unjumble words, listen to a story called "Wishes", and say dialogues aloud with correct pronunciation. Teaching methods include using PowerPoint slides, word find task sheets, and a card game. Keywords include mermaid, seagull, fly, sea, swim, sky, rock, sit. The lesson plan outlines distributing worksheets, completing the word find task, playing a matching card game in groups, and going through dialogues from the "Wishes" story.
La industria del cine ha evolucionado desde la creación de la primera cámara capaz de capturar el movimiento en 1880 hasta convertirse en una industria digital globalizada. Algunos hitos clave incluyen la creación del primer estudio de cine en 1893, el desarrollo del cinematógrafo en 1895 y la apertura del primer cine en 1902. Más recientemente, la revolución digital ha democratizado la producción cinematográfica y ha diversificado las formas de distribución y consumo de películas.
This curriculum vitae is for Clifford Katunansa, a Zambian male born in 1982. He has obtained qualifications including a Zambia Institute of Chartered Accountants National Accounting Technician certificate and is currently a third year student pursuing a Bachelor of Accountancy degree. His work experience includes positions at PMS Investments Ltd from 2008-2012 and Audit Control and Expertise Global from 2012-2014 where he performed accounting and auditing tasks. His skills include taxation, financial analysis and statement preparation, cash management, and audit-related activities. He provides three referees to contact.
Este documento describe diferentes tipos de redes inalámbricas, incluyendo WPAN (redes de área personal inalámbrica), WMAN (redes de área metropolitana inalámbrica), y WWAN (redes de área amplia inalámbrica). También discute tecnologías como Bluetooth, Wi-Fi, WiMAX y redes celulares. Explica aplicaciones como comunicaciones domésticas, televisión y comunicaciones a larga distancia. Además, cubre temas de seguridad en redes inalámbricas.
1) La celebración de Halloween se originó en la fiesta celta de Samhain, que se celebraba el 31 de octubre y marcaba el fin del verano y el comienzo del invierno.
2) Los celtas creían que en la noche de Samhain, el velo entre el mundo de los vivos y los muertos se tornaba delgado y los espíritus podían regresar.
3) Con la llegada de los romanos y la iglesia católica, la tradición celta se fusionó con las celebraciones romanas
O documento dá conselhos sobre como evitar disputas prejudiciais e manter a paz interior, sugerindo que é melhor perder pequenas batalhas do que se envolver em lutas maiores que trarão danos, e que a sabedoria e a cordura trazem felicidade ao invés de medo ou perturbações.
O documento discute a importância do planejamento e estratégia para empreendedores. Aborda tópicos como análise SWOT, análise de mercado, alternativas estratégicas, acompanhamento da execução dos planos e questões fundamentais para análise de novos negócios.
This very short document appears to contain the name of an artist "f.k.a twigs" followed by the word "vector" and then a website URL "www.nusambo.com.br". It provides minimal information in just a few words and letters.
Este documento presenta información sobre brigadas de rescate y seguridad en minas a cielo abierto. Explica conceptos como comportamiento del fuego, incendios forestales, medidas preventivas, métodos de extinción, equipos de extinción como extintores y mangueras. También cubre temas de cuerdas, nudos, equipos y herramientas de rescate, y maniobras de rescate para derrumbes, gases, primeros auxilios y transporte de víctimas. El objetivo es capacitar a los estudiantes trabajadores de la empresa
Approaches in Implementing the Mental Health and Addiction Equity Act.Best Pr...Mariel Lifshitz
This document describes best practices used by seven states to implement and monitor compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). The states identified five key components of effective implementation: 1) open communication with health insurers, 2) standardized materials and terms, 3) templates and tools for assessing compliance, 4) market conduct exams and network adequacy reviews, and 5) collaboration across agencies and stakeholders. The states developed various templates, guides and other resources to promote consistent application of parity rules. They also analyzed complaints, conducted on-site exams of insurers, and collaborated closely with multiple groups to identify and address any compliance issues.
State of Compliance 2021 at Mid-Market Firms - NimonikNimonik
Nimonik.com recently conducted a survey of 100 compliance and risk professionals in the US, USA and in China. The participants were from mid-market firms (500-15,000 employees) and were leaders within their organization. These insights show that there remains much work to be done to achieve comprehensive compliance across mid-market firms.
Instilling a Culture of Compliance and Knowing Your CustomerJay Postma
Presentation of October 10, 2014 during the Financial Service Centers of America (FiSCA) Annual Conference's BSA/AML Certification Course. Covering Culture of Compliance, Understanding your market, and Knowing your customers.
What can industry stakeholders learn from the findings of Deloitte’s 2014 survey of young adults and health insurance to help increase enrollment of this population during special enrollment periods in 2014 and during the 2015 open enrollment season?
For more information, please visit https://www.deloitte.com/view/en_US/us/Insights/centers/center-for-health-solutions/755bca14ef416410VgnVCM1000003256f70aRCRD.htm
NEMEA Compliance Center - the most powerful survey creation, management, and reporting solution available. It intuitively collects responses, writes, and produces standardized regulatory compliance reports. In fact, it even supports the use of many different standards at once. Our compliance software has a fully featured user-interface that lets you rapidly compare the laws and regulations that govern your industry and business.
An Internship at the Centers for Medicare and MedicaidToni Williams
The author completed an internship at the Centers for Medicare and Medicaid Services (CMS) in the Region III office. They worked in the Consortium for Financial Management and Fee for Service Operations branch on various projects applying their public health skills and knowledge. This included projects related to workers' compensation Medicare set asides, quality assurance of Medicare Administrative Contractors, and hospital provider-based status determinations. The internship provided real-world experience applying legislation and regulations. It also allowed the author to network and gain a deeper understanding of healthcare finance and economics.
A leading home healthcare provider implemented MetricStream's governance, risk, and compliance platform to strengthen audit management and regulatory compliance while protecting confidential patient information. The platform centralized audit tracking, improved RAC audit preparation, and automated workflows to ensure compliance with various healthcare regulations. It provided collaboration tools and reporting capabilities to help different teams conduct thorough audits and resolve issues efficiently. With MetricStream's solution, the organization now has stronger compliance controls and security of sensitive data.
Regulatory Compliance, Risk Management, and the Trustee's RolePYA, P.C.
PYA Principal Shannon Sumner and Consulting Manager Susan Thomas presented “Regulatory Compliance, Risk Management, and the Trustee’s Role.” In this presentation, they will:
Describe the evolving compliance and risk management landscape, including government agencies’ expectations for compliance oversight. This presentation will:
- Outline recent government investigations and settlements.
- Provide key takeaways regarding responsibilities for ensuring an effective compliance program.
- Connect trustee duties to specific elements of enterprise risk management.
- Empower trustees with questions to ask leadership teams in preparation for playing a more active role in the compliance program.
This document provides a lesson plan for a Bahasa Inggeris (English language) class for 2nd grade students focusing on myths. The lesson objectives are for students to complete a word find task, unjumble words, listen to a story called "Wishes", and say dialogues aloud with correct pronunciation. Teaching methods include using PowerPoint slides, word find task sheets, and a card game. Keywords include mermaid, seagull, fly, sea, swim, sky, rock, sit. The lesson plan outlines distributing worksheets, completing the word find task, playing a matching card game in groups, and going through dialogues from the "Wishes" story.
La industria del cine ha evolucionado desde la creación de la primera cámara capaz de capturar el movimiento en 1880 hasta convertirse en una industria digital globalizada. Algunos hitos clave incluyen la creación del primer estudio de cine en 1893, el desarrollo del cinematógrafo en 1895 y la apertura del primer cine en 1902. Más recientemente, la revolución digital ha democratizado la producción cinematográfica y ha diversificado las formas de distribución y consumo de películas.
This curriculum vitae is for Clifford Katunansa, a Zambian male born in 1982. He has obtained qualifications including a Zambia Institute of Chartered Accountants National Accounting Technician certificate and is currently a third year student pursuing a Bachelor of Accountancy degree. His work experience includes positions at PMS Investments Ltd from 2008-2012 and Audit Control and Expertise Global from 2012-2014 where he performed accounting and auditing tasks. His skills include taxation, financial analysis and statement preparation, cash management, and audit-related activities. He provides three referees to contact.
Este documento describe diferentes tipos de redes inalámbricas, incluyendo WPAN (redes de área personal inalámbrica), WMAN (redes de área metropolitana inalámbrica), y WWAN (redes de área amplia inalámbrica). También discute tecnologías como Bluetooth, Wi-Fi, WiMAX y redes celulares. Explica aplicaciones como comunicaciones domésticas, televisión y comunicaciones a larga distancia. Además, cubre temas de seguridad en redes inalámbricas.
1) La celebración de Halloween se originó en la fiesta celta de Samhain, que se celebraba el 31 de octubre y marcaba el fin del verano y el comienzo del invierno.
2) Los celtas creían que en la noche de Samhain, el velo entre el mundo de los vivos y los muertos se tornaba delgado y los espíritus podían regresar.
3) Con la llegada de los romanos y la iglesia católica, la tradición celta se fusionó con las celebraciones romanas
O documento dá conselhos sobre como evitar disputas prejudiciais e manter a paz interior, sugerindo que é melhor perder pequenas batalhas do que se envolver em lutas maiores que trarão danos, e que a sabedoria e a cordura trazem felicidade ao invés de medo ou perturbações.
O documento discute a importância do planejamento e estratégia para empreendedores. Aborda tópicos como análise SWOT, análise de mercado, alternativas estratégicas, acompanhamento da execução dos planos e questões fundamentais para análise de novos negócios.
This very short document appears to contain the name of an artist "f.k.a twigs" followed by the word "vector" and then a website URL "www.nusambo.com.br". It provides minimal information in just a few words and letters.
Este documento presenta información sobre brigadas de rescate y seguridad en minas a cielo abierto. Explica conceptos como comportamiento del fuego, incendios forestales, medidas preventivas, métodos de extinción, equipos de extinción como extintores y mangueras. También cubre temas de cuerdas, nudos, equipos y herramientas de rescate, y maniobras de rescate para derrumbes, gases, primeros auxilios y transporte de víctimas. El objetivo es capacitar a los estudiantes trabajadores de la empresa
Este documento discute la relación entre el cine y la historia. Algunos historiadores ven el cine como poco fiable para reflejar los hechos pasados con precisión, mientras que otros creen que puede generar empatía y reconstruir épocas. Aunque las películas siempre son subjetivas, se considera que pueden ser útiles para enseñar historia si se estudian de manera crítica, considerando factores como el director, país, género e intencionalidad.
This document describes a study that uses discrete event simulation combined with multi-criteria decision analysis to help plan the logistics system of a new steel plant in Brazil. The study evaluates different configurations for the size of the plant's private iron ore vessel fleet and storage capacities. Ten scenarios are simulated and evaluated based on criteria like plant stoppages and investment costs. The results help determine the best fleet size and storage capacities to avoid interruptions in steel production.
The QA Corporate Compliance Corner newsletter highlights changes within the QA department and agency programs. The QA department merged their review teams so all staff review all programs, using a more person-centered approach with observations and interviews. Proper documentation is important for quality of care, compliance, and reimbursement. The Justice Center process for incidents can be intimidating, but the QA department provides a guide to help understand the process. Self-advocacy among individuals served by the agency is growing, with some becoming lobbyists to affect positive change for others.
This document provides an overview of a quarterly research eBook from the Human Capital Institute (HCI) called Talent Pulse. It explores trends and challenges in managing talent in areas like HR strategy and analytics, talent acquisition, learning and development, and management and leadership. Each quarterly issue focuses on one of these areas and includes statistically rigorous data analysis, expert interviews, and discussion of key topics determined by a survey of HR and business professionals. This particular issue focuses on the implications of the Affordable Care Act, use of HR data analytics, and workplace agility. It finds that while many organizations have addressed preparing for the Affordable Care Act, concerns remain regarding its unknown future impacts. It also reports that most
CASE STUDY VENDOR RISK MANAGEMENT HEALTHNEXT CARE SY.docxketurahhazelhurst
CASE STUDY: VENDOR RISK
MANAGEMENT
HEALTHNEXT CARE SYSTEM
ASSIG NME NT OVERVIEW
Summary: As a team, students should present their proposed solution to the case. Your
presentation should lay out clear recommendations for how management should
address the problem.
Presentation
Deliverable1:
Case study presentation (in Microsoft PowerPoint format).
Executive Briefing
Deliverable:
Single page case study executive briefing (in Microsoft PowerPoint format).
BACKGRO UND
A series of business incidents, due to internal and external factors, have revealed significant gaps in
HealthNext Care System’s Vendor Risk Management (VRM) practices. As a result, Samantha Currie, the
VP of the Vendor Management group, has come under scrutiny from senior level executives including the
CFO, Legal, Compliance, Enterprise Risk Management and Internal Audit. In a presentation to the senior
executives and stakeholders, Currie was given approval to launch a VRM Improvement Program to address
the noted gaps and strengthen their capabilities. You have been engaged by Currie to help improve the
way HealthNext manages its vendor risks.
HE ALT HNEXT CARE SYST EM
Founded in 1946, HealthNext Care System prides itself on providing quality medical care to its patients. It
quickly grew to a $16 billion national healthcare provider and currently operates as a hospital system as
well as a research facility and education center for medical students.
HOSPIT ALS
HealthNext serves over 1.5 million patients on an annual basis and offers a comprehensive array of medical
services. The doctors and practitioners are paid a lucrative salary that is consistently 20% above market
and their salary does not vary based on the amount of service provided. As a result, practitioners prefer to
spend more time attending to patient needs versus opposed to taking on more cases. This results in
customized and specialized care for patients and is the primary reason why HealthNext is consistently rated
as one of the best hospital systems in the United States by both patients and employees alike.
1 Presentation Deliverables are due only if your team is assigned this case. All others should read the case and complete the
Executive Briefing Deliverable assignment.
Professors Matt Stoltz and Meera Kesari Case Study: VRM (HealthNext Care System)
Master of Science in Information Systems: IT Governance, Risk and Controls (IT GRC) Page 2
HealthNext has over 100,000 employees and includes physicians, scientists, doctors, residents, fellows,
researchers, corporate staff and administrative staff. HealthNext is headquartered in Los Angeles,
California. Shown below is a location chart for HealthNext.
Facility Location Hospital Research Facility Education Center
Los Angeles, CA (HQ)
Boise, ID
Honolulu, HI
Tucson, AZ
...
Working with Regulators: A Focus on CMS | Took Kit: A Guide for Patient AdocatesCancerSupportComm
The Affordable Care Act (ACA) is the tip of a very large, multi-faceted iceberg, one that is moving inexorably forward and will result in broad, deep changes in the way that health care in this country is understood and delivered. These changes are already exerting a significant impact on cancer research and care, and will continue to do so for the foreseeable future. This is also an era in which the patient voice and genuine, active patient participation have become integral to the process of developing and implementing biomedical research and health care policy.
That process is complex and multidimensional—but also well defined and transparent. The ability to influence the outcomes requires that an organization have a working knowledge of how the process works, which agencies are responsible and who makes the decisions. It is also critical to understand the ways in which electoral politics at both the national and state level impact health care policy. While that sounds straightforward, the regulatory process often can appear impenetrable to the organizations who seek to make their voices heard and influence the outcomes.
This Tool Kit is intended as a practical guide for patient advocacy organizations in their efforts to educate themselves about the regulatory process, develop appropriate staff expertise and responsibility for this area, and ultimately make a difference.
This document discusses the importance of efficiently managing credentialing, privileging, and enrollment processes in the evolving healthcare environment. It notes that market pressures are forcing healthcare organizations to consider integrating these processes to improve customer service, support quality efforts, reduce costs, and minimize regulatory risk. The document outlines key questions organizations are asking around streamlining these processes, having a single source of truth for provider data, preparing for increased regulatory scrutiny, and leveraging technology. It then provides an overview of Deloitte's credentialing, privileging and enrollment service offering which can help clients improve provider satisfaction, reduce costs, and enhance transparency.
CHC Questions Answers PDF Dumps - Your Path to CHC CertificationAliza Oscar
Start your journey to CHC certification in 2023 with our PDF dumps. Access a comprehensive collection of questions and answers for effective exam preparation
The document discusses different approaches to compliance and ethics programs. It argues that a dynamic approach using behavioral science, data, and positive language is more effective than a traditional prescriptive approach. A dynamic approach frames compliance in a rational, scientific context and emphasizes the benefits of compliance rather than penalties of non-compliance. It also tailors messaging to different levels in an organization by understanding their unique motivations and objectives. An effective program requires understanding an organization's business and adapting to motivate long-term, meaningful change.
The document discusses different approaches to compliance and ethics programs. It argues that a dynamic approach using behavioral science, data, and positive language is more effective than a traditional prescriptive approach. A dynamic approach frames compliance in a rational, scientific context and emphasizes the benefits of compliance rather than penalties of non-compliance. It also tailors messaging to different levels in an organization by understanding their unique motivations and objectives. An effective program requires understanding an organization's business and adapting to motivate long-term, meaningful change.
This document provides an overview of Synergetics' "Industry in Focus" series highlighting trends in the healthcare and life sciences industry and how Synergetics is positioned to help clients in this sector. It discusses the challenges facing third party administrators in healthcare, including balancing costs and provider reimbursement rates. It also identifies factors driving increasing healthcare costs and provides examples of ways Synergetics has helped healthcare clients improve efficiency and profitability through process improvements and technology optimization.
This document discusses best practices for assessing and improving the maturity of a compliance and ethics program. It outlines a framework using five key elements adapted from guidelines like the US Federal Sentencing Guidelines. These elements are risk identification, policies and procedures, training and communication, monitoring and auditing, and evaluation and improvement. The document advises using a maturity curve approach to evaluate where a program's elements fall along a spectrum from basic to best practices. Understanding the current status helps organizations prioritize steps to advance their program.
COnverting an Academic Medical Center to NIAHO/ISO 9001: Charleston Area Medi...Wes Chapman
This is the first in a series looking at the motivations, methods and outcomes from our efforts at Charleston Area Medical Center (CAMC) to build a “best-in-class” patient centered quality management system (QMS) including accreditation via NIAHO/ISO 9001. These articles are designed to be quick reads, and capture the realities that we encountered in this quest.
Leading in the 21st century an interview with hca ceo richard bracken.pdfDimitris Timotheatos
Richard Bracken, CEO of HCA, one of the world's largest healthcare companies, discusses leading in an environment of rapid change in the healthcare industry. He emphasizes the need to balance short-term performance with long-term strategic positioning. Key leadership skills include setting a tone that embraces change, having a clear operating plan, and empowering teams. HCA is responding by leveraging innovation, clinical data, and personalized care through patient portals. Bracken manages HCA's complex structure by gathering input from operations and maintaining relationships across the organization.
Computer Forensics Group ProjectAssignment AssignmentLynellBull52
This document describes a computer forensics group project assignment. The company lacks a well-established cybersecurity and forensics team after experiencing cyber attacks. The goal is to develop a comprehensive risk management strategy to implement defense-in-depth across all office locations. Key attributes include offices in multiple countries, some using on-premise systems and some using cloud-based systems, lack of security awareness among employees, and lack of centralized management and inventory systems.
The Board's Evolving Role in Quality Oversight August 2015Karma Bass
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ESG and Compliance: Where do we go from here?Nimonik
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Engage Front-line Care Team Using Clinical Audit Checklists
ct-2015-12-turteltaub-lansford[1]
1. 27
Clean claims:
There
are no
shortcuts
Janet Marcus
33
Kane v. Healthfirst
and the concept of
prosecutorial
discretion
Jared M. Barnes
45
Final rule for
Accountable Care
Organizations: Enabling
technologies, Part 2
Paul R. DeMuro
38
Lessons
learned from
DSH 340B
audits
Aletheia Lawry
a publication of the health care compliance association www.hcca-info.org
ComplianceTODAY December 2015
The importance of
teamwork during a crisis
an interview with Kim Lansford
Chief Compliance Officer
Shriners Hospitals for Children
See page 18
The importance of
teamwork during a crisis
an interview with Kim Lansford
Chief Compliance Officer
Shriners Hospitals for Children
See page 18
This article, published in Compliance Today, appears here with permission from the Health Care Compliance Association. Call HCCA at 888-580-8373 with reprint requests.
2. 18 www.hcca-info.org 888-580-8373
ComplianceToday December2015 FEATURE
an interview by Adam Turteltaub
Meet Kim Lansford
Adam Turteltaub (adam.turteltaub@corporatecompliance.org), HCCA and
SCCE Vice President of Membership Development, conducted this interview
with Kim Lansford (klansford@shrinenet.org) in the autumn of 2015.
AT: You’ve had a Compliance career longer
than most, first entering the profession in
1998. What led you to make the move into
Compliance?
KL: As I transitioned from my clinical role
as a registered nurse into healthcare man-
agement, I began overseeing areas that had
a regulatory compliance component. At that
time, it was primarily OSHA (occupational
safety) and EPA (environmental) compliance,
because the corporate compliance program
was led from our system’s corporate affili-
ate. A short time later, I was asked to take
on additional compliance responsibilities
and be designated the compliance liaison for
our health system. The corporate affiliation
broke apart around 2002, and I was asked to
develop and oversee the corporate compliance
program for the health system. I have been
leading and integrating compliance programs
ever since.
AT: Was your background in nursing
helpful?
KL: I believe my nursing background has
been extremely helpful as a healthcare compli-
ance officer. As a backbone to the compliance
work I do, I have a strong understanding of
patient care, medical terminology and docu-
mentation in the medical record. Because
I served as a clinical leader, I developed a
solid understanding of healthcare operations.
Kim Lansford, chc
Chief Compliance Officer at
Shriners Hospitals for Children
Tampa, FL
3. 888-580-8373 www.hcca-info.org 19
ComplianceToday December2015
FEATURE
In my experience, the combination of these
has provided me with instant credibility
with clinicians. This has made some of those
difficult discussions I need to have with our
clinicians a bit easier.
AT: The field has obviously grown and
changed a great deal since you started. What
are some of the key changes in how the profes-
sion has evolved?
KL: Since I started in Compliance, several
laws have changed and many more have been
added, which greatly increases the need for an
effective compliance program. While the entire
organization and each of its workforce members
is responsible for compliance, the compliance
officer and Compliance department are integral
to ensuring that an effective compliance pro-
gram is implemented and maintained.
Government expectations and scrutiny
of compliance programs have increased tre-
mendously since I began in the Compliance
field. For example, the 2010 Patient Protection
and Affordable
Care Act introduced
mandatory com-
pliance programs
as a Condition of
Enrollment for
Medicare, Medicaid,
and CHIP providers.
This was a signifi-
cant change for the
Compliance industry.
At the time of this interview, CMS has yet to
issue implementing regulations, which detail
the required elements of an “effective compli-
ance program,” but the industry was put on
notice that the government views effective
compliance programs as a Medicare Condition
of Enrollment.
In addition, government investigations and
enforcement initiatives have increased signifi-
cantly over the years and, in my experience,
the government often wants to understand
a provider’s compliance program efforts
surrounding the alleged underlying con-
duct. Importantly, the Department of Justice
(DOJ) announced over the summer that it
is retaining “compliance counsel” to assist
the DOJ with the evaluation of an organi
zation’s compliance program in connection
with investigative efforts. Further complicat-
ing this compliance landscape, timelines for
investigations, reporting, and refunding of
federal healthcare program overpayments
(e.g., 60-day rule) have been shortened.
The United States Federal Sentencing
Guidelines, Chapter 8, Part B and Corporate
Integrity Agreement (CIA) requirements have
also been amended, which further demon-
strates the evolving compliance landscape.
For example, there have been significant devel-
opments with respect to OIG’s CIA model,
including a fluid claims review designed to test
potentially risky claims, a comprehensive risk
assessment process, and enhanced management
and board certifica-
tions. Importantly,
OIG views CIAs as
best practices for com-
pliance program design
and related compliance
initiatives.
All of this, com-
bined with a highly
complex, rapidly
changing healthcare
delivery system and an increase in technology,
make today’s role as compliance officer much
different than in the late 1990s. It is impera-
tive that providers have effective compliance
programs in place in order to meet today’s
government expectations.
AT: Do you find that compliance is earn-
ing greater acceptance from doctors and
administrators?
Government expectations
and scrutiny of compliance
programs have increased
tremendously since I began
in the Compliance field.
4. 20 www.hcca-info.org 888-580-8373
ComplianceToday December2015 FEATURE
KL: In my experience, I do believe compli-
ance is earning greater acceptance from doctors
and administrators. The well-published focus
on increased government and payer scrutiny,
transparency, and the highly competitive
environment in healthcare has led our admini
strators and physicians to reach out to their
compliance officer as a trusted advisor.
I use lots of case studies and regularly
share press releases to help our administrators
and physicians understand their role, as well
as our roles as compliance officers, and I think
this has led to greater acceptance.
Finally, as our profession has grown and
leading practices have been developed and
shared through associations like HCCA,
doctors and administrators seem to be gaining
better clarity into our positions as compliance
officers, which has certainly helped.
AT: Where do you think we could be
doing more?
KL: We need to work smarter while stress-
ing less, and this starts with prioritization.
Healthcare is in an unprecedented time of
change. As compliance professionals, we are
bombarded by never-ending changes in laws,
regulations, poli-
cies, and procedures.
Headlines capture
our attention and
the attention of our
leadership teams.
Everything seems to
be a priority and at
times is simply chaotic. Conducting appropri-
ate and relevant compliance risk assessments
allow us to prioritize our work plans, so we
can focus on the areas of greatest impact and
vulnerability to our organizations.
We understand from OIG’s recent revi-
sions to its CIA model that OIG expects a
provider’s compliance program to include a
comprehensive risk assessment and internal
review process. OIG is clear that a comprehen-
sive risk assessment cannot be pursued by the
Compliance department alone, and involve-
ment from key business leaders (including
Legal) is critical to the effectiveness of the risk
assessment process. Accordingly, providers
should evaluate their current risk assessment
process to confirm whether it meets OIG’s
expectations and whether it facilitates the
organization’s ability to identify and prioritize
potential risks.
If a comprehensive risk assessment has
not been completed recently, an organization
should consider whether it would be prudent
to conduct certain portions of it under privi-
lege (to foster open communication regarding
certain risks). An organization might also
benefit by involving Legal in the identifica-
tion and prioritization of potential risks.
Analysis of potential risks should take place,
because documentation obtained during the
risk assessment process could be subject to
disclosure to the government (or potentially
whistleblowers) in connection with investiga-
tions and litigation.
In addition to this, we need to be experts
in communication, by being highly visible and
approachable, setting
clear expectations,
and holding individ-
uals accountable.
AT: Where do
you see Compliance
going next in its evo-
lution? We’re already getting into areas like
privacy and data security. What else is next?
KL: Over the years, the importance of the
connection between compliance and quality
has been emphasized, but with the change in
payment methodology, the compliance officer’s
role in quality is going to be more critical.
I also believe compliance officers are very
well situated to lead or hold a significant role
We need to work smarter
while stressing less, and this
starts with prioritization.
5. 888-580-8373 www.hcca-info.org 21
ComplianceToday December2015
FEATURE
in the strategic or enterprise risk manage-
ment initiatives within their organizations.
Strategic or enterprise risk management
engages all workforce members in the prac-
tice of identifying, managing, monitoring,
and communicat-
ing risks across the
organization. We
are already doing
this with regard to
our compliance risks
in our compliance
programs!
AT: I want to shift
gears and talk about
April 2012. You were
getting ready to
come to the Compliance Institute when you
got some very bad news. Can you tell people
what had happened to your son?
KL: Sure. In April 2012, my son, Justin,
while serving in the Army in Afghanistan on
his second deployment to the Middle East, was
severely injured when a roadside bomb struck
his vehicle. Justin was in the gun turret when
the vehicle was hit, throwing it through the
air. When the vehicle landed, he was trapped
underneath and it was on fire. Justin suffered
significant injuries. To name a few, his left
leg was amputated, right leg and ankle were
fractured in multiple locations, thoracic spine
was broken, spleen ruptured, liver lacerated,
arm and side burned, and his lungs were col-
lapsed. He was flown to a field hospital, then
to Baghram Airbase and finally to Germany.
Instead of going to the HCCA Compliance
Institute, I flew to Germany with my husband
and younger son to be with Justin.
AT: It’s a “drop everything” kind of
moment, but there are obvious logistics issues.
That’s when you learned about America’s
Fund. Because of what they did for you and
for Justin, the HCCA was proud to support
America’s Fund with a silent auction at the
2015 Compliance Institute and will be doing so
again in 2016. How did they help?
KL: First of all, I cannot thank HCCA and
its wonderful mem-
bers enough for the
outpouring of support
they demonstrated for
this great organiza-
tion. Our introduction
to America’s Fund
(Semper Fi Fund)
was while we
were in Germany.
America’s Fund
provided me with
warm apparel — hats,
gloves, scarf, sweatshirt — to wear on the flight
from Germany to Washington DC as I was
approved to accompany Justin on the military
medical flight.
Upon arrival at Walter Reed National
Military Medical Center, we were introduced
to our America’s Fund case manager, Karen.
We were hesitant to accept any assistance, but
Karen insisted. She said, “You need to focus
on Justin and his recovery. Let us worry about
your home.” And they did. My mother had
to drop everything and drive from Florida
to Pennsylvania to take care of our pets.
America’s Fund covered her travel expenses.
They also assisted with our lawn mainte-
nance while we were at Walter Reed National
Military Medical Center.
In addition to the support they provided
to maintain our home while we were away,
they played a key role in Justin’s recovery
and rehabilitation. America’s Fund provided
educational grants, adaptive equipment,
and sponsored therapeutic trips to aid in
his recovery.
The case managers at America’s Fund are
onsite at Walter Reed every day. They meet
I also believe
compliance officers are
very well situated to lead
or hold a significant role in
the strategic or enterprise
risk management initiatives
within their organizations.
6. 22 www.hcca-info.org 888-580-8373
ComplianceToday December2015 FEATURE
with the wounded warriors and their fami-
lies and offer to assist with any needs they
have. Even though it’s been more than three
years since Justin’s injuries, America’s Fund
continues to reach out to him to see if he has
any needs.
AT: It was great to have Justin join us at
the 2015 Institute. He’s obviously doing great.
And his service dog Gabe was a huge hit
at the meeting. How did your colleagues in
Compliance help?
KL: Justin is doing fantastic and Gabe
loves the attention!
My compliance colleagues helped in
numerous ways, both professionally and
personally.
First, the support I received from my col-
leagues at Catholic Health East, played a
significant role, and I will never be able to
thank them enough. On a personal level, my
boss, our CEO, told me to focus only on Justin
and to not worry about my job. Upon learning
about Justin’s injuries, she sent an email across
the organization. One of our board members
reached out to me to tell me that a former
Catholic Health East physician colleague left
the organization to become a Department of
Defense physician contractor. I emailed this
physician, who responded to me within a few
hours. Unbelievably and miraculously, he was
the physician in charge of the intensive care
unit in Germany and had just left Justin’s bed-
side. I had worked closely with this physician
during my early years at Catholic Health East
and felt significant relief knowing that I per-
sonally knew him and that he was managing
Justin’s care.
On a professional note, my compliance and
internal audit colleagues at Catholic Health
East took control of the situation and focused
on the goals and work plan we established
for the year. We held weekly conference calls
during the four months I was away. In the end,
not only did we achieve our goals for 2012, we
surpassed them! This would not have hap-
pened without their overwhelming support,
hard work, and dedication.
Second, I received tremendous support
from my HCCA compliance colleagues. I got
regular cards, well wishes, and goodies from
all across the country. Many colleagues made
donations in Justin’s honor to a variety of won-
derful not-for-profit organizations that help
our wounded warriors. I would like to person-
ally thank everyone for what they did to help
us get through those difficult times. It did not
go unrecognized and it was so very much
appreciated.
My family and I received so much sup-
port and it is time for us to give back. I am so
honored to have such wonderful compliance
colleagues who are helping us do this. I am
forever grateful and I’m sure our wounded
warriors are too!
AT: Finally, what advice would you give
other parents and family members when
they hear that their loved one has been badly
injured?
KL: Stay focused and remain positive.
Make the best of the situation that has been
handed to you, and be kind to those helping
you get through it. Accept assistance that is
offered to you. Be a healthcare advocate for
your loved one. Don’t be afraid to ask for clari-
fication and stand up for what is right. (We are
compliance officers after all, and this is what
we do, right?) Know that recovery is going to
be an uphill battle with lots of setbacks and
it will take time; think marathon instead of
sprint. Take care of yourself, as it is a physi-
cally, mentally and emotionally challenging
process. And, in the end, always remember
those who helped you, and give back in any
way you can to help those in need.
AT: Thank you, Kim.