Shannon Sumner, managing principal of PYA’s Compliance Advisory Services and Firm Compliance Officer and David W. Ogden, former Deputy Attorney General of the United States discussed The Role of Compliance in Government Enforcement.
Managing Costs Related to Increasing Banking RegulationCognizant
With banks' regulatory compliance challenges only increasing, they must find ways to reduce the associated legal costs, such as by using legal process services providers with experience in handling Know Your Customer (KYC), eDiscovery, foreign bank organizations, Deferred Prosecution Agreements (DFAs), non-prosecution agreements (NPAs), the Dodd-Frank Act and much more.
Tax Health Check Services, We provide the customer with the tax health check program that focus very much on the compliance position and tax filing procedures of your company
Doanh Duc Tax Consulting Corporation
www.doanhduc.com
Recent Trends in Regulatory Actions Impacting Banks and Financial InstitutionsWinston & Strawn LLP
This presentation addresses recent trends in regulatory actions impacting banks and financial institutions. It focuses on how attendees can minimize their impact on their respective organizations as a lawyer, leader of a line of business, member of the Board of Directors, or a risk management, compliance, finance, and internal audit professional.
The presentation also addresses trends in formal enforcement actions, observations related to recent regulatory agency matters, and noteworthy recent public enforcement matters. It includes lessons learned in preventing matters requiring attention from turning into formal actions and best practices in conducting lookback reviews.
More information, including an audio recording, is available here: https://www.winston.com/en/thought-leadership/recent-trends-in-regulatory-actions-impacting-banks-and-financial-institutions.html.
Managing Costs Related to Increasing Banking RegulationCognizant
With banks' regulatory compliance challenges only increasing, they must find ways to reduce the associated legal costs, such as by using legal process services providers with experience in handling Know Your Customer (KYC), eDiscovery, foreign bank organizations, Deferred Prosecution Agreements (DFAs), non-prosecution agreements (NPAs), the Dodd-Frank Act and much more.
Tax Health Check Services, We provide the customer with the tax health check program that focus very much on the compliance position and tax filing procedures of your company
Doanh Duc Tax Consulting Corporation
www.doanhduc.com
Recent Trends in Regulatory Actions Impacting Banks and Financial InstitutionsWinston & Strawn LLP
This presentation addresses recent trends in regulatory actions impacting banks and financial institutions. It focuses on how attendees can minimize their impact on their respective organizations as a lawyer, leader of a line of business, member of the Board of Directors, or a risk management, compliance, finance, and internal audit professional.
The presentation also addresses trends in formal enforcement actions, observations related to recent regulatory agency matters, and noteworthy recent public enforcement matters. It includes lessons learned in preventing matters requiring attention from turning into formal actions and best practices in conducting lookback reviews.
More information, including an audio recording, is available here: https://www.winston.com/en/thought-leadership/recent-trends-in-regulatory-actions-impacting-banks-and-financial-institutions.html.
This presentation by Márcio Issao Nakane, Professor at the Economics Department, University of São Paulo, was made during the discussion on "Addressing competition challenges in financial markets" held at the 2017 Latin American and Caribbean Competition Forum (4-5 April 2017 – Managua, Nicaragua). More papers and presentations can be found at oe.cd/laccf.
This on-demand webinar covers the basics of Stark Law for those who need a refresher or are new to the compliance arena.
In this webinar we:
- Cover Stark Law basics
- Review penalties for non-compliance
- Discuss strategic and tactical best practices for your physician contracting program
Presented by Jerry Sogoli at the 4th Annual East Africa Finance Summit
A comparative analysis of the independent regulatory agency approach vis-à-vis direct government oversight and the appropriateness of the former in regulating today’s insurance sector
Procurement & Government Contracting Compliance (Series: Corporate & Regulato...Financial Poise
The volume and complexity of transactions related to procurement are some of the reasons that transactions with the government are most vulnerable to corruption. State and federal regulatory compliance can be tough to navigate and the process can make even routine sales and marketing practices vulnerable to civil and criminal liability. This webinar analyzes the regulatory framework, including identification of some of the legal risks in solicitations, pre- and post-award bid protests, contract compliance, change orders, and contract claims and disputes. The webinar also discusses defense strategies of a company that is accused of fraud or civil non-compliance.
To view the accompanying webinar, go to: https://www.financialpoise.com/financial-poise-webinars/procurement-government-contracting-compliance-2020/
Ομιλία: Βασίλειος Βίζας, Tax & Legal Partner, PwC Greece
Τίτλος παρουσίασης: "Corporate Governance and the law: trends and increased requirements in light of the new corporate law framework in Greece"
Equitable Growth’s Director of Tax Policy and Senior Economist Greg Leiserson on August 6 gave a presentation to the Office of Management and Budget’s Office of Information and Regulatory Affairs on the cost benefit analysis of tax regulations. In the presentation, Leiserson argues that the traditional “A-4 framework” for conducting cost benefit analyses does not provide useful guidance in the evaluation of tax regulations, yet a new framework for tax regulations would unavoidably implicate deeply political questions. As a result, Leiserson proposes that the analysis should emphasize transparency rather than a definitive conclusion. The focus of the quantitative analysis should be revenues, avoidance and evasion behavior, compliance costs, and distributive impacts.
**Presented by Robin Singh**
Common Pitfalls While Implementing an Anti-corruption Program
1. Management's today, in their hunger for success and appreciation of shareholders equity tend to forget the core essence behind the words in their vision and mission statements, corporate social responsibilities, duties towards employees, third parties etc.
2. Today companies around the world plagued with challenges associated with corruption. While strong leadership from the top is necessary. It has to be one joint effort.An Anti-corruption program success requires changes in behaviour from your senior and middle managers, employees, contractors, suppliers, and all related parties that play a part in forming a living entity.
3. This presentation describes several reasons why anti-corruption programs often fail and provides practical recommendations to strengthen and improve an anti-corruption practice that needs to be incorporated.
This presentation by Prof. Hwang LEE from the Korean University School of Law was made during the discussion on "Sanctions in Anti-trust cases" held at the 15th Global Forum on Competition on 2 December 2016. More papers and presentations on the topic can be found out at www.oecd.org/competition/globalforum/competition-and-sanctions-in-antitrust-cases.htm
Legal Security: Co-Operative Compliance in The United KingdomQUESTJOURNAL
ABSTRACT: This paper explores the co-operative compliance approaches implemented by the Netherlands. The OECD principles on co-operative compliance are the paper’s framework. The Dutch approach on cooperative compliance is analysed with the OECD framework. It is concluded that the Dutch co-operative compliance approach is not creating legal security. This research has created the legal framework for comparing the co-operative compliance approach between countries.
An overview of state and federal laws, rules and regulations that govern how boards and staff of community development corporations may influence public policy.
During this briefing we looked at two distinct hot topics, Deferred Prosecution Agreements and Correspondent Banking. The discussion focused on the evolving challenges and practical compliance tips
This presentation by Márcio Issao Nakane, Professor at the Economics Department, University of São Paulo, was made during the discussion on "Addressing competition challenges in financial markets" held at the 2017 Latin American and Caribbean Competition Forum (4-5 April 2017 – Managua, Nicaragua). More papers and presentations can be found at oe.cd/laccf.
This on-demand webinar covers the basics of Stark Law for those who need a refresher or are new to the compliance arena.
In this webinar we:
- Cover Stark Law basics
- Review penalties for non-compliance
- Discuss strategic and tactical best practices for your physician contracting program
Presented by Jerry Sogoli at the 4th Annual East Africa Finance Summit
A comparative analysis of the independent regulatory agency approach vis-à-vis direct government oversight and the appropriateness of the former in regulating today’s insurance sector
Procurement & Government Contracting Compliance (Series: Corporate & Regulato...Financial Poise
The volume and complexity of transactions related to procurement are some of the reasons that transactions with the government are most vulnerable to corruption. State and federal regulatory compliance can be tough to navigate and the process can make even routine sales and marketing practices vulnerable to civil and criminal liability. This webinar analyzes the regulatory framework, including identification of some of the legal risks in solicitations, pre- and post-award bid protests, contract compliance, change orders, and contract claims and disputes. The webinar also discusses defense strategies of a company that is accused of fraud or civil non-compliance.
To view the accompanying webinar, go to: https://www.financialpoise.com/financial-poise-webinars/procurement-government-contracting-compliance-2020/
Ομιλία: Βασίλειος Βίζας, Tax & Legal Partner, PwC Greece
Τίτλος παρουσίασης: "Corporate Governance and the law: trends and increased requirements in light of the new corporate law framework in Greece"
Equitable Growth’s Director of Tax Policy and Senior Economist Greg Leiserson on August 6 gave a presentation to the Office of Management and Budget’s Office of Information and Regulatory Affairs on the cost benefit analysis of tax regulations. In the presentation, Leiserson argues that the traditional “A-4 framework” for conducting cost benefit analyses does not provide useful guidance in the evaluation of tax regulations, yet a new framework for tax regulations would unavoidably implicate deeply political questions. As a result, Leiserson proposes that the analysis should emphasize transparency rather than a definitive conclusion. The focus of the quantitative analysis should be revenues, avoidance and evasion behavior, compliance costs, and distributive impacts.
**Presented by Robin Singh**
Common Pitfalls While Implementing an Anti-corruption Program
1. Management's today, in their hunger for success and appreciation of shareholders equity tend to forget the core essence behind the words in their vision and mission statements, corporate social responsibilities, duties towards employees, third parties etc.
2. Today companies around the world plagued with challenges associated with corruption. While strong leadership from the top is necessary. It has to be one joint effort.An Anti-corruption program success requires changes in behaviour from your senior and middle managers, employees, contractors, suppliers, and all related parties that play a part in forming a living entity.
3. This presentation describes several reasons why anti-corruption programs often fail and provides practical recommendations to strengthen and improve an anti-corruption practice that needs to be incorporated.
This presentation by Prof. Hwang LEE from the Korean University School of Law was made during the discussion on "Sanctions in Anti-trust cases" held at the 15th Global Forum on Competition on 2 December 2016. More papers and presentations on the topic can be found out at www.oecd.org/competition/globalforum/competition-and-sanctions-in-antitrust-cases.htm
Legal Security: Co-Operative Compliance in The United KingdomQUESTJOURNAL
ABSTRACT: This paper explores the co-operative compliance approaches implemented by the Netherlands. The OECD principles on co-operative compliance are the paper’s framework. The Dutch approach on cooperative compliance is analysed with the OECD framework. It is concluded that the Dutch co-operative compliance approach is not creating legal security. This research has created the legal framework for comparing the co-operative compliance approach between countries.
An overview of state and federal laws, rules and regulations that govern how boards and staff of community development corporations may influence public policy.
During this briefing we looked at two distinct hot topics, Deferred Prosecution Agreements and Correspondent Banking. The discussion focused on the evolving challenges and practical compliance tips
DeStefano, Compliance, Transparency, Visibility: A U.S. Perspective: Cloudy A...Michele DeStefano
Based in part on 70 interviews with General Counsels and Chief Compliance Officers of the S&P 500 along with secondary research, this presentation provides an overview of the compliance function, role of and challenges faced by the chief compliance officer, and the trend towards departmentalization of the compliance department from the legal department. It hypothesizes that departmentalization may not increase actual compliance, increase external and internal transparency, or increase visibility and entrenchment of compliance. It concludes by recommending a more inward as opposed to structural focus to better identify internal stop gaps that prevent corporations from creating a pervasive culture of compliance.
FTI Consulting is a global business advisory firm that is uniquely positioned to provide holistic expert advice to businesses that are facing financial distress due to the impact of COVID-19 and companies seeking government support through the CARES Act.
Audit Smart: A Best Practices Webinar for Physician Contracting MD Ranger, Inc.
Organizations routinely audit physician contracts to comply with federal regulations, practice good financial management, and maintain relationships with key physicians.
Our compensation benchmarks and online analytics offer unparalleled insights into physician compensation. MD Ranger empowers executives to be able to analyze, negotiate, and document physician contracts. Executives and their teams can determine appropriate compensation rates, negotiate competitive contracts, comply with federal regulations, and identify opportunities for cost savings with MD Ranger.
You can contact the MD Ranger team with questions or for more info at inquiries@mdranger.com.
"In the times where acquisitions and buyouts are trending, the field of due diligence emerges as one of the most relevant fields. Prima facie, without delving in"
TaxGuru is a platform that provides Updates On Amendments in Income Tax, Wealth Tax, Company Law, Service Tax, RBI, Custom Duty, Corporate Law , Goods and Service Tax etc.
To know more visit https://taxguru.in/corporate-law/process-due-diligence.html
"In the times where acquisitions and buyouts are trending, the field of due diligence emerges as one of the most relevant fields. Prima facie, without delving in"
TaxGuru is a platform that provides Updates On Amendments in Income Tax, Wealth Tax, Company Law, Service Tax, RBI, Custom Duty, Corporate Law , Goods and Service Tax etc.
To know more visit https://taxguru.in/corporate-law/process-due-diligence.html
What is the procedure for financial statement audit.pdfRathnakarReddy17
The purpose of a financial statement audit is to add credibility to the reported financial condition and business performance. Annual reports must be submitted by all publicly traded corporations and are subject to SEC audits.Similarly, lenders typically require audits of the financial statements of the companies they finance. Suppliers may also require audited Financial Statement Preparation in New York before granting trade credit (usually only if the amount of credit requested is substantial).
Presentation by Mohammad Zayyad, Regulatory Improvement Committee, United Kingdom, at the Workshop on the Elaboration and Evaluation of RIA at sub-national Level, Cuernavaca Morelos, Mexico, 11-12 November 2014, Session 3. Further information is available at http://www.oecd.org/gov/regulatory-policy/
Physician Contracting Compliance Risk ChecklistMD Ranger, Inc.
How does your organization ensure its financial relationships with physicians are compliant with federal regulations? To help determine whether or not they might have a physician contracting compliance risk, we created a checklist.
This webinar will cover all elements of our checklist, and integrate best practices from other healthcare organizations. Key topics discussed will be:
--Current regulations and penalties
--Contract organization, analysis
--FMV documentation processes
Uncovering Best Practices from Corporate Integrity AgreementsMD Ranger, Inc.
A CIA is a tool used by the OIG to address violations at healthcare organizations through policies and procedures designed to enforce compliance with regulations. A CIA is usually coupled with a civil settlement between the provider and the government to avoid exclusion from federal health programs.
In this presentation, we will discuss how to use recent CIAs to derive best practices that can benefit your organization.
We will cover:
-Common guidelines found in multiple CIAs
-Best practices from CIAs for specific types of healthcare entities
-Easy ways to improve your physician contracting compliance
-And more!
Presentation by Bob Carberry, Assistant Secretary Regulatory Cooperation Council Secretariat Privy Council Office, at the joint meeting of the OECD Regulatory Policy Committee and Trade Committee on 5 November 2015, Session 1: Learning more about IRC mechanisms, Paris, 5 November 2015. Further information is available at http://www.oecd.org/gov/regulatory-policy/irc.htm.
How to Prepare Your Firm for a Visit from the SRALegl
The SRA regularly visit law firms to monitor their compliance with AML regulations. In this session, we cover the areas that will put you ahead of the game should you receive notice that your firm will receive a visit.
Visit https://legl.com/events/webinar-how-to-prepare-your-firm-for-a-visit-from-the-sra-view/ to watch the full webinar.
Chris Coxon - Evidence informed policy making - 26 June 2017OECD Governance
Presentation by Cris Coxon, Head of Civil and Administrative Justice Research, Ministry of Justice, United Kingdom, at the event on Governing better through evidence-informed policy making, 26-27 June 2017. The event was organised by the OECD Directorate for Public Governance in cooperation with the European Commission’s Joint Research Centre (JRC), the Campbell Collaboration and the International Network for Government Science Advice (INGSA). For further information please see http://www.oecd.org/gov/evidence-informed-policy-making.htm
Similar to The Role of Compliance in Government Enforcement (20)
“CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting”PYA, P.C.
PYA Principal Martie Ross spoke at the virtual North Carolina Healthcare Association Critical Access Hospital Statewide Meeting. The two-day event, “Quality Focus is a Finance Focus,” provided critical access hospital leaders with the opportunity to network and review data-informed strategies as well as updates to the Medicare Flexibility Program Project. It also provided guidance on federal compliance and tracking of Provider Relief Funds.
In “CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting,” Martie gave an overview of the history of distribution of those funds as well as regulations and guidelines including:
Statutory Language
Reporting Requirements
Use of Funds Calculation
Expenses
Risk Management
Martie presented Thursday, March 4, 2021.
If you would like guidance related to Provider Relief Fund regulations, or for assistance with any matter related to strategy and integration, compliance, or valuation, contact one of our PYA executives at (800) 270-9629.
PYA Presented on 2021 E/M Changes and a CARES Act Update During GHA Complianc...PYA, P.C.
The Georgia Hospital Association (GHA) Compliance Officers Roundtable, an active GHA group that meets quarterly and includes educational sessions featuring government representatives, industry experts, and other thought leaders speaking about compliance-related issues, conducted their latest meeting virtually. PYA Principals Lori Foley, Tynan Kugler, and Valerie Rock were among the presenters at this quarter’s event. In their session, they:
Described key elements associated with 2021 E/M changes, and strategies for preparation and implementation.
Explained the impact of 2021 E/M changes on physician compensation and contracting, including potential mitigation approaches.
Presented key components of Stark Law and Anti-Kickback Statute final rules.
Provided an update on the CARES Act.
The Compliance Certification Board offered CEUs for this event, which took place on Friday, December 4, 2020.
Webinar: “Trick or Treat? October 22nd Revisions to Provider Relief Fund Repo...PYA, P.C.
On October 22nd, the Department of Health and Human Services released revised Provider Relief Fund (PRF) reporting requirements. Under HHS’ September 19 directive, “lost revenue” was defined narrowly as a negative change in year-over-year patient care operating net income. Now, HHS will permit providers to use PRF funds to cover the difference between their 2019 and 2020 actual patient care revenue with some adjustments for COVID-related expenses. The October 22nd notice is available here.
PYA Principals Martie Ross and Michael Ramey hosted a complimentary 30-minute webinar, “Trick or Treat? October 22nd Revisions to Provider Relief Fund Reporting Requirements” on Thursday, October 29th.
“Regulatory Compliance Enforcement Update: Getting Results from the Guidance” PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Senior Manager Susan Thomas presented “Regulatory Compliance Enforcement Update: Getting Results from the Guidance” at the virtual 2020 Montana Healthcare Conference. They reviewed the sources of regulatory enforcement and investigation information—guidelines, statutory updates, best practices, settlements, case studies, etc.—available to healthcare organizations. They will also discuss how to interpret and implement the guidance in order to strengthen the compliance function and protect the organization. The presentation covered:
Compliance regulatory requirements for healthcare organizations.
Guidance available for consideration in organizational compliance programs.
Internal and external reporting to ensure regulatory requirements are met.
Best practices for implementation of guidance.
Case studies for illustration of guidance implementation.
“Federal Legislative and Regulatory Update,” Webinar at DFWHCPYA, P.C.
The Dallas Fort Worth Hospital Council (DFWHC) and PYA co-hosted an exclusive complimentary webinar, “Federal Legislative and Regulatory Update,” on Wednesday, September 23.
DFWHC President/CEO Stephen Love hosted a discussion with PYA Senior Manager Kathy Reep about concerns that have dropped from the radar during the last four months of COVID-19, addressing issues for which hospitals must prepare in approaching 2021. This session focused on these key areas:
Appropriate use criteria
Transparency
Site neutral payments
The future of the Medicare Trust Fund
The federal budget
Key provisions of the final rule for the inpatient prospective payment system for FY2021 and the proposed outpatient rule for CY2021
On-Demand Webinar: Compliance With New Provider Relief Funds Reporting Requir...PYA, P.C.
On September 19, the Department of Health and Human Services (HHS) published its Post-Payment Notice of Reporting Requirements. The Notice details the reporting requirements for all Provider Relief Fund (PRF) recipients that have received $10,000 or more in aggregate payments.
Under the PRF Terms and Conditions, a recipient may use the funds only for healthcare-related expenses and lost revenue attributable to coronavirus. The Notice provides the clearest direction to date regarding permissible uses of PRF funds.
PYA offered a 45-minute complimentary webinar that explained the new reporting requirements and delved into permissible uses. While many questions remain, we provided practical advice on the next steps in the reporting process.
The webinar took place Monday, October 5 at 11 a.m. EDT.
Webinar: “While You Were Sleeping…Proposed Rule Positioned to Significantly I...PYA, P.C.
You likely know from the headlines that the 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule slashes payments for surgical specialists. But the impact of the Proposed Rule is far broader, reflecting a fundamental realignment driven by the transition to value-based payments. In our webinar, “While You Were Sleeping…Proposed Rule Positioned to Significantly Impact Physician Compensation,” PYA experts addressed these proposals, helping you understand and prepare for the changes ahead.
Following this presentation, attendees were able to:
Understand how a handful of wRVU changes would alter Medicare reimbursement for nearly all physicians.
Appreciate the operational impact of these changes.
Recognize the challenges to existing physician compensation models.
Identify strategies and tactics to prepare for and manage these impacts.
Presenters include PYA Principals Angie Caldwell, Martie Ross, and Valerie Rock. The webinar took place Thursday, September 10 and was hosted in conjunction with the Florida Hospital Association.
If you have additional questions about the MPFS Proposed Rule and its impact on physician compensation or need assistance with any matter involving physician compensation, valuation, strategy and integration, or compliance, contact a PYA executive below at (800) 270-9629.
Webinar: “Cybersecurity During COVID-19: A Look Behind the ScenesPYA, P.C.
Cybersecurity breaches have been in the news almost daily for some time now. COVID-19 has amplified the problem, as “bad actors” seize upon the opportunity to take advantage of hospitals at their most vulnerable time. Given this climate and an aging HIPAA rule, it is difficult to anticipate and prepare for the future.
PYA Principal Barry Mathis presented “Cybersecurity During COVID-19: A Look Behind the Scenes,” on Wednesday, August 12, 2020. This one-hour, complimentary webinar was hosted by PYA in conjunction with the Montana Hospital Association as Part 2 of the Frontier States Town Hall Meeting.
Barry covered information related to HIPAA, cybersecurity, and a special behind-the-scenes view into the tradecraft of bad actors. This unique presentation included:
Recent enforcement trends by the Office for Civil Rights.
The current environment for ransomware.
An opportunity to watch as Barry logs onto the Dark Web and shows you first-hand how bad actors operate.
Ideas for managing cybersecurity threats.
On Friday, August 21, 2020, a webinar co-hosted by PYA prepared hospitals for a new rule taking effect on January 1, 2021, to address price transparency in healthcare. The Centers for Medicare & Medicaid Services published a rule in November 2019 requiring hospitals to establish, update, and make public a list of their standard charges for items and services they provide. In addition to the current requirement to post standard charges on their websites, the Final Rule requires hospitals to publish online, in a machine-readable format, their payer-specific negotiated rates for 300 “shoppable” services and their standard charges for all items and services provided, defined as the gross charge, payer-specific negotiated charges, discounted cash price, and the de-identified minimum and maximum charges.
As we approach January 2021, it is vital that hospitals understand the requirements of the pricing transparency rule and options for compliance. It is unlikely that this rule will “go away”–court decisions are always subject to appeal, and there is even concern that Congress is considering action that would transform these requirements from regulation to legislation.
During the complimentary webinar, PYA Senior Manager Kathy Reep discussed hospital requirements related to pricing transparency, and Chris Kenny, Partner in the Washington, D.C., office of King & Spalding, addressed concerns related to compliance and the legal challenges associated with the final transparency rule.
This webinar was presented in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Georgia Hospital Association
Kansas Hospital Association
Louisiana Hospital Association
Montana Hospital Association
Not a surprise to most — healthcare is making headlines on an international level. Though not front and center, still of importance to the hospital community are issues working their way through government agencies and the legislature.
As one of the keynote speakers of this year’s virtual Florida Institute of CPAs Health Care Industry Conference, PYA Senior Manager Kathy Reep presented a “Federal Legislative and Regulatory Update.” She covered a number of current issues affecting healthcare providers, including:
Price transparency.
Congressional action on surprise billing.
The Administration’s budget for 2021.
Medicare proposed rules related to hospital inpatient payments and post-acute care for FY2021.
The virtual event took place June 23-24, 2020.
Webinar: Post-Pandemic Provider Realignment — Navigating An Uncertain MarketPYA, P.C.
The COVID-19 pandemic will materially affect U.S. provider industry structure, as financial weaknesses are exposed, risk tolerances are tested, and uncertainties persist. As a result, provider mergers-and-acquisitions (M&A) activities across industry sectors will likely spike in the short- to medium-term future. Providers of all types need to be aware of, and prepared for, the changes they will face.
In this 45-minute joint webinar, PYA Principal Brian Fuller and Juniper Advisory Managing Director Jordan Shields provided a real-time assessment of the COVID-19 pandemic, as well as shared predictions for what the extending crisis means in coming years for M&A activity in the provider space.
The webinar took place Thursday, August 6, 2020, at 11 a.m. EDT.
Since March, PYA experts have closely tracked and carefully evaluated the pandemic’s impact on employed physician compensation. During this complimentary one-hour webinar, PYA Principals Angie Caldwell and Martie Ross highlighted five immediate considerations for hospitals and health systems to manage the storm. They also explored five longer-term considerations impacting future planning.
This webinar took place Friday, July 24, 2020, at 11 a.m. EDT, and was held in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Kansas Hospital Association
Montana Hospital Association
The COVID-19 pandemic has exposed organizational and industry weaknesses. To build a more resilient delivery system, leaders now must engage their governing boards in re-calibrating strategic plans, re-evaluating investments, and re-imagining hospitals’ and health systems’ roles in their communities.
In this 45-minute webinar, PYA Principals Martie Ross and Brian Fuller provided a framework for these critical discussions including root-cause analysis, market assessment, new realities, guiding principles, and strategic and operational priorities.
This webinar originally took place on Wednesday, June 24, 2020.
Webinar: Free Money with Strings Attached – Cares Act Considerations for Fron...PYA, P.C.
PYA, in conjunction with the Montana Hospital Association, recently co-hosted a Frontier States Town Hall Meeting webinar, “Free Money With Strings Attached: CARES Act Considerations for Frontier States’ Healthcare Provider Organizations.” Principals Lori Foley, Martie Ross, and David McMillan introduced the CARES Act Provider Relief Fund including distribution formulas, the attestation process, the verification and application process, and ongoing recordkeeping requirement. They also answered attendees’ numerous questions regarding these matters.
Webinar: “Got a Payroll? Don’t Leave Money on the Table”PYA, P.C.
Under the CARES Act, every employer with a payroll has an opportunity to retain cash–whether they have a PPP loan or not. What employers need to know right now.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) along with the Payroll Protection Program (PPP) offer all business owners relief, but the details can be confusing or overlooked.
Perhaps you don’t fully understand how the deferral of the employer’s share of Social Security taxes works. Maybe you wonder if the deferral even applies to you—good news, it does if you have a payroll!
Failure to fully understand your options could cost you money, at a time when “cash is king.”
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined issues and opportunities within the CARES Act, and answered questions during a one-hour webinar that originally aired on Wednesday, May 20, 2020.
Webinar: So You Have a PPP Loan. Now What?PYA, P.C.
The CARES Act provides relief to small businesses through Paycheck Protection Program (PPP) loans, but receiving the loan is only the first part of the equation. PYA discussed what businesses need to know and do next.
Failure to fully understand the requirements for PPP loan forgiveness could cost employers money, at a time when every penny counts. Employers need to stay up-to-date on recent activities regarding the PPP loan forgiveness application, necessary documentation, and other best practices to ensure they are well-prepared for the next steps under the PPP.
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined PPP loan forgiveness requirements and answered questions during a one-hour webinar on Wednesday, June 3, 2020.
Webinar: “Making It Work—Physician Compensation During the COVID-19 Pandemic”PYA, P.C.
What to do with your physician compensation plan in the face of the COVID-19 pandemic? It’s a question that leaves administrators searching for answers.
PYA Principal Angie Caldwell and Senior Manager Katie Culver introduced several key considerations for provider compensation during and after the COVID-19 pandemic. In PYA’s complimentary webinar, they:
Summarized the current environment impacting physician compensation associated with the pandemic.
Provided an overview of the Stark Blanket Waivers and opportunities created for physician compensation.
Described restoration and recovery strategies for physician resources.
PYA hosted this one-hour webinar Tuesday, April 28, 2020, at 11 a.m. EDT in conjunction with the Florida Hospital Association.
Webinar: “Provider Relief Fund Payments – What We Know, What We Don’t Know, W...PYA, P.C.
The federal government is now making CARES Act Relief Fund payments to Medicare providers. These payments are not loans—they do not have to be repaid or forgiven. However, this money comes with strings attached.
During PYA’s 30-minute webinar, Provider Relief Fund Payments—What We Know, What We Don’t Know, What To Do Now, PYA Principals Martie Ross and Lori Foley discussed:
The source of the funds.
The required attestation process.
Compliance, tax, and audit concerns.
The webinar took place Friday April 17, 2020.
Webinar: “Hospitals, Capital, and Cashflow Under COVID-19”PYA, P.C.
Hospitals and providers need to think creatively, strategically, and long-term about capital and cashflow under the pressures of the COVID-19 pandemic. A one-hour webinar hosted by PYA discussed the current state of capital markets for non-profit healthcare systems, and considerations for capital management, including the role of real estate assets.
PYA Principal Michael Ramey joined Realty Trust Group Senior Vice-President Michael Honeycutt and Ponder & Company Managing Director Jeffrey B. Sahrbeck to present “Hospitals, Capital, and Cashflow, Under COVID-19” In this webinar, they covered:
Hospital industry capital market updates and trends, including how the capital markets are responding to the crisis.
Access to capital under recent regulations.
Cash preservation techniques for hospitals considering real estate operations and assets.
The webinar took place Thursday, April 9, 2020, at 11 a.m. EDT.
PYA Webinar: “Additional Expansion of Medicare Telehealth Coverage During COV...PYA, P.C.
Late on March 30, CMS released an interim rule which, among other things, significantly expands Medicare telehealth coverage, even beyond the initial Section 1135 waivers. PYA’s complimentary one-hour webinar explained these changes and how they make telehealth an even more attractive option in response to the COVID-19 pandemic.
PYA Principals Martie Ross and Valerie Rock addressed the latest developments, including:
New reimbursement for telephone-only services.
Broader coverage for remote patient monitoring.
New payments for rural health clinics and federally qualified health centers.
Use of telehealth to meet supervision requirements.
New rules regarding coding and billing as well as the changed payment rates for telehealth services.
The webinar took place Friday April 3, 2020, at 11 a.m. EDT.
El Puerto de Algeciras continúa un año más como el más eficiente del continente europeo y vuelve a situarse en el “top ten” mundial, según el informe The Container Port Performance Index 2023 (CPPI), elaborado por el Banco Mundial y la consultora S&P Global.
El informe CPPI utiliza dos enfoques metodológicos diferentes para calcular la clasificación del índice: uno administrativo o técnico y otro estadístico, basado en análisis factorial (FA). Según los autores, esta dualidad pretende asegurar una clasificación que refleje con precisión el rendimiento real del puerto, a la vez que sea estadísticamente sólida. En esta edición del informe CPPI 2023, se han empleado los mismos enfoques metodológicos y se ha aplicado un método de agregación de clasificaciones para combinar los resultados de ambos enfoques y obtener una clasificación agregada.
04062024_First India Newspaper Jaipur.pdfFIRST INDIA
Find Latest India News and Breaking News these days from India on Politics, Business, Entertainment, Technology, Sports, Lifestyle and Coronavirus News in India and the world over that you can't miss. For real time update Visit our social media handle. Read First India NewsPaper in your morning replace. Visit First India.
CLICK:- https://firstindia.co.in/
#First_India_NewsPaper
‘वोटर्स विल मस्ट प्रीवेल’ (मतदाताओं को जीतना होगा) अभियान द्वारा जारी हेल्पलाइन नंबर, 4 जून को सुबह 7 बजे से दोपहर 12 बजे तक मतगणना प्रक्रिया में कहीं भी किसी भी तरह के उल्लंघन की रिपोर्ट करने के लिए खुला रहेगा।
An astonishing, first-of-its-kind, report by the NYT assessing damage in Ukraine. Even if the war ends tomorrow, in many places there will be nothing to go back to.
03062024_First India Newspaper Jaipur.pdfFIRST INDIA
Find Latest India News and Breaking News these days from India on Politics, Business, Entertainment, Technology, Sports, Lifestyle and Coronavirus News in India and the world over that you can't miss. For real time update Visit our social media handle. Read First India NewsPaper in your morning replace. Visit First India.
CLICK:- https://firstindia.co.in/
#First_India_NewsPaper
Acolyte Episodes review (TV series) The Acolyte. Learn about the influence of the program on the Star Wars world, as well as new characters and story twists.
Here is Gabe Whitley's response to my defamation lawsuit for him calling me a rapist and perjurer in court documents.
You have to read it to believe it, but after you read it, you won't believe it. And I included eight examples of defamatory statements/
1. The Role of Compliance
in Government Enforcement
Speakers: Shannon Sumner, CPA, CHC
Principal PYA, P.C.
David Ogden, Partner
Wilmer Cutler Pickering Hale and Dorr LLP
2. Agenda
•Government Perspectives on Corporate Enforcement
•Overview of Deferred Prosecution Agreements, Non-
Prosecution Agreements, and Corporate Integrity
Agreements
•What Can We Learn From NPAs, DPAs, and CIAs
Regarding Compliance Programs?
•Wrap-Up/Key Takeaways
4. Recent Developments in Compliance
•This year has witnessed several notable
developments in corporate enforcement
• “Granston Memo”
• Provides defense counsel and relators’ counsel guidance on which
cases are candidates for a government motion to dismiss and a
basis to argue that the government should (or should not) move to
dismiss meritless claims over a relators’ objection.
• “Brand Memo”
• Makes clear that guidance documents “lack the force of the law,”
and emphasizes that DOJ lawyers should not treat them as though
they are mandatory.
5. Recent Developments in Compliance (cont’d)
•Increased Coordination
• May 2018 Memorandum discouraging “piling on”
• So-called “piling on” occurs when one agency starts an
investigation, and other agencies join in to seek punishment for
the same alleged misconduct
• July 2018 Establishment of the Working Group on
Corporate Enforcement and Accountability
• President Trump issued an Executive Order establishing a new
Working Group on Corporate Enforcement and Accountability to
promote consistency in white collar efforts
6. Moving Toward Greater Individual
Accountability & Corporate Compliance
• The Justice Department’s interest in improving its
“relationships with good corporate citizens” and
incentivizing increased corporate compliance
• DAG Rosenstein:
• High corporate fines “do not necessarily directly deter individual
wrongdoers,” because “at the level of each individual decision-
maker, the deterrent effect of a potential corporate penalty is
muted and diffused,” hence continued emphasis on
enforcement against individual wrongdoers.
• “[M]any companies deserve great credit for taking the initiative
to develop truly robust corporate compliance programs.”
• “Compliance programs promote” the Justice Department’s
primary goal of deterring wrongdoing and encouraging prompt
disclosure of violations to enforcement authorities.
7. Moving Toward Greater Individual
Accountability & Corporate Compliance (cont’d)
•Past Deputy AG’s have made similar observations:
• Corporate enforcement should “incentivize corporations
to establish effective compliance programs.”
• Government should “make certain that responsible
corporate citizenship is encouraged and rewarded.”
8. Aggressive Enforcement
•In a single announcement in July 2017, the Justice Department
announced charges against 412 individuals in 41 districts involving
$1.3 billion in alleged false billing. Charges included medically
unnecessary treatments, treatments never provided, and kickbacks.
•More recently, the Justice Department announced charges against
601 individuals in 58 districts involving over $2 billion in alleged
fraudulent billing schemes, kickbacks, and opioid distribution.
•Overall, in fiscal year 2017, the Justice Department recovered $3.7
billion from False Claims Act cases, including $2.4 billion from the
healthcare industry.
•From October 2017 through March 2018, Office for the Inspector
General for the U.S. Department of Health & Human Services (HHS
OIG) reported expected investigative recoveries of $1.46 billion,
criminal actions against 424 individuals or entities, exclusion of 1,588
individuals and entities from participation in Federal healthcare
programs, and civil actions against 349 individuals and entities.
Increasing Focus
on Enforcement
Against
Responsible
Individual
Wrongdoers
9. Overview of Deferred Prosecution Agreements,
Non-Prosecution Agreements, and Corporate
Integrity Agreements
10. Definition of a Deferred Prosecution Agreement
• A DPA is a type of voluntary, pre-trial agreement used to
resolve investigations into corporate misconduct without
a guilty plea by the corporation.
• The agreement is between the company and the
government, and is designed to avoid the penalties of
conviction.
• The government agrees to defer – and ultimately forego
– prosecution of the matter pending the company’s
complying with the requirements of the DPA during a
specified term.
• A DPA is formally filed with a court along with charging
documents.
11. Definition of a Non-Prosecution Agreement
•Like the Deferred Prosecution Agreement, a Non-
Prosecution Agreement is a voluntary pre-trial
agreement used to resolve investigations into
corporate misconduct.
•An NPA is not formally filed with a court.
•For this reason, NPAs are viewed as more favorable
to the corporation than DPAs.
12. Key Provisions of DPAs & NPAs
•Key provisions of DPAs & NPAs typically include:
• Acceptance of responsibility.
• Statement of facts, which outlines the alleged misconduct.
• Prohibition against public statements contradicting the
acceptance of responsibility.
• Requirement to cooperate in government investigations.
• Requirement to self-report evidence or allegations of
certain misconduct.
• Appointment and terms for a corporate monitor.
13. Factors Government Considers
•In deciding whether to impose a DPA or NPA,
prosecutors consider several factors, including:
• The underlying misconduct.
• The root cause of that misconduct.
• The company’s prior history.
• Remediation efforts taken by the company.
• Cooperation with the investigation.
• The strength of the company’s compliance program.
14. Strong Compliance Programs Are Essential
• Companies with strong compliance programs should be
treated better than those with a weak compliance
commitment.
• In evaluating the corporate compliance program, the
government focuses on factors such as:
• Compliance autonomy.
• Compliance resources.
• Oversight.
• The strength of compliance policies and procedures.
• Compliance controls.
• Training.
• Audits and risk assessments.
• Compliance incentives.
• Confidential reporting and investigations.
• Disciplinary measures.
• Compliance testing.
15. Monitorships
• Monitorships are sometimes required as an aspect of an
NPA, DPA, or other consensual resolution.
• Imposition of a Monitor: “Benczkowski Memo”
• In October 2018, AAG Benczkowski issued new guidance
regarding the imposition and selection of corporate monitors in
Criminal Division matters (the “Benczkowski Memo”)
• Goals of the Memo:
• To further refine the factors that go into the determination of whether
a monitor is needed.
• To clarify and refine the monitor selection process.
• Procedural Implications:
• Supersedes the 2009 “Breuer Memo” on the same topic.
• Supplements the 2008 “Morford Memo,” which addressed the
selection of monitors in the contexts of DPAs and NPAs.
• Key Principles:
• The imposition of a corporate monitor is never meant to be punitive.
• Imposing a monitor should be the exception, not the rule.
• The Justice Department’s approach to monitorships should be
pragmatic.
16. Monitorships (cont’d)
• Guiding Principles for Determining When a Monitor is
Needed, including but not limited to:
• Whether the underlying misconduct involved the manipulation
of corporate books and records or the exploitation of an
inadequate compliance program or internal control systems.
• Whether the misconduct at issue was pervasive across the
business organization or approved or facilitated by senior
management.
• Whether the corporation has made significant investments in,
and improvements to, its corporate compliance program and
internal control systems.
• Whether remedial improvements to the compliance program
and internal controls have been tested to demonstrate that
they would prevent or detect similar misconduct in the future.
17. Monitorships (cont’d)
•New Standing Committee on the Selection of
Monitors
• Benczkowski Memo also marked the creation of a new
standing committee – the Standing Committee on the
Selection of Monitors
• Members include:
• Deputy Assistant Attorney General with supervisory responsibility
for the Fraud Section (or his/her designee)
• Chief of the Fraud Section or other relevant section (or his/her
designee)
• Deputy Designed Agency Ethics Official for the Criminal Division (or
pre-identified person as enumerated by the Memo)
18. Monitorships (cont’d)
•Selection Process
• Monitors may be compliance experts, former prosecutors,
or other individuals trusted by both sides to help the
company avoid repeat violations.
• The government and company will jointly select the
monitor:
• Company offers a slate of monitors.
• Government accepts one or asks for additional options before
accepting a nominee.
•Purpose
• Monitorships offer the opportunity to improve a
company’s compliance systems and ethical culture, reduce
the risk of recidivism, and improve relationships with
regulators and law enforcement officials
19. Monitor Duties
•The monitor has several responsibilities, including
overseeing, reviewing, and proposing modification
of a company’s compliance program
• In furtherance of those goals, monitors:
• Review policies.
• Test system controls.
• Assess compliance risks.
•Periodic reports
• The monitor provides periodic reports of its findings and
recommendations to the government and the company,
which make recommendations for improvements to
corporate compliance.
20. Monitor Team
•A monitor will generally select of team of individuals
at his/her firm to assist the monitor in carrying out
his/her duties.
•Monitors often employ forensic accountants as well.
• A forensic accounting team works with the monitor to
evaluate the effectiveness of internal accounting controls,
record-keeping, and financial reporting procedures as they
relate to compliance.
21. Monitor Recommendations
•Companies must typically adopt monitors’
recommendations or explain to the DOJ why they
have not.
•Strong incentive to adopt recommendations
•Imposes obligation on monitor to assess intended
and possible unintended consequences
•Ideally, the monitor discusses proposed
recommendations with the company and DOJ and
considers their views when finalizing
22. Certification
• The monitor’s investigations and assessments all lead to
what could be the most important aspect of a
monitorship—certification.
• The terms of certification vary from case to case.
• For example, some negotiated resolutions require the monitor to
certify effectiveness of the compliance program related to the specific
alleged misconduct that gave rise to the agreement, while others
require the monitor to certify the effectiveness of the company’s
program to prevent and detect fraud broadly.
• Example Certification Language: “[T]he Monitor shall certify in a final
report whether [the Company’s] compliance program, including its
policies and procedures, is reasonably designed and implemented to
prevent and detect violations of the [relevant statute].”
• Certification is a condition of non-prosecution.
• If the monitor cannot complete the certification, the monitorship
may be extended.
23. Monitorships Overview
• Monitorships are extensive, expensive, and time consuming.
• Companies under monitorships should cooperate with the
monitor as fully as possible, engage in open dialogue with the
monitor about strengths and weaknesses of compliance and
ethics culture, and embrace monitor recommendations for
improvement.
• A monitor’s ability to execute the certification will depend on
confidence that he or she understands the company, and that
it has genuinely addressed its issues. Successful
implementation of a monitor’s recommendations obviously
will play a role.
• Companies should work diligently to provide the monitor
with the confidence he or she needs to certify compliance.
24. Corporate Integrity Agreements
•When are they used?
• Civil Settlement Agreement
• Not every settlement results in CIA
•How are they used
• Enforcement tool
• Entity will not be excluded from participation in federal
healthcare program
• Typically 5 years
25. Corporate Integrity Agreements (cont’d)
CoreElements
(non-negotiable) Board and Management accountability
Compliance Officer status
Board and Management Certifications
Ineligible persons
Policies and Procedures
Independent Review Organization (IRO) engagement
Reporting provisions
26. Corporate Integrity Agreements (cont’d)
•Enhanced CIA Elements - “Version 2.0”
• Preamble (past compliance efforts)
• AmerisourceBergen CIA
• Monitoring and auditing specific to key risk areas (e.g. one
size no longer fits all entities)
• Specific Focused Education Requirements
• Community Health Systems/HMA Amended CIA
• Scope of IRO engagement
Key Takeaway
Evidence of Board and Management
accountability is paramount and a core
requirement under these recent CIAs
27. What Can We Learn From DPAs and CIAs
Regarding Compliance Programs?
28. Parties to CIAs Are Growing
• Hospitals and health systems
• Physician practices
• Long term care facilities (e.g., SNFs)
• Pharmaceutical companies
• Medical device manufacturers
Key Takeaway
Entities should review recent CIAs applicable to their sector
to be informed regarding the government's compliance
program expectations. A compliance work plan should be
designed to address these areas of exposure.
• DME suppliers
• Ambulance companies
• Laboratories
• Rehab and therapy
providers
29. Compliance Work Plan Impact Examples
• Pharmaceutical and Medical Device Related CIAs
• Included obligations regarding travel and expense
reimbursements for training and product demonstrations (AKS)
• Provider takeaway – are you aware of your health system’s
analysis of the CMS Open Payment Registry and the
existence/completeness of the Conflict of Interest disclosure
process (e.g., speaker fees, travel and entertainment)?
• Compliance Work Plan – Include Open Payment Registry and
Conflict of Interest Process audits; Research and Principal
Investigators
• Ambulance Provider Related CIAs
• What, if any, restocking policies exist within your facilities?
Have these policies and procedures been audited?
31. Definition of “Covered Persons” Expanding (cont'd)
•Essentially, the organization is responsible for
actions for anyone “under their control.”
Key Takeaway
Boards and management should assess the
coverage of their compliance program to
identify whether it is comprehensive enough to
cover the span of control outlined in recent CIAs
Global operations Subsidiaries or affiliates Compliance corporate
structures and joint
ventures
Outsourced
functions/departments
Complex supply chains
32. Board Accountability and Mandatory Certifications
Source: Individual Accountability/Mandatory Certifications/Expansions of “Covered Persons” – Signature Health CIA
“The Board of Directors has made a reasonable
inquiry into the operations of Signature’s Compliance
Program, including the performance of the
Compliance Officer and the Compliance Committee.
Based on its inquiry and review, the Board has
concluded that, to the best of its knowledge,
Signature has implemented and effective Compliance
Program to meet Federal health care program
requirements and the obligations of the CIA.”
33. Board Accountability/Mandatory Certifications
(cont'd)
•Annual reports to describe Board activity to
demonstrate active oversight of compliance
• Support for compliance officer reporting to Board
(minutes, notes, dates)
• Reports reviewed and actions taken
• List of policies and procedures
• Results of risk assessments performed
• Work plans developed
• Resources analyzed to address high risk areas
• Audits performed
• Corrective action taken
• Continuous risk assessment process
34. Board Accountability/Mandatory Certifications
(cont'd)
•Certifications clearly tell us the OIG’s expectations
for Board Accountability
• The Board should formally address via meetings:
• Performance of the Compliance Officer
• Performance of the Compliance Committee
• Effectiveness of the Compliance Program
Key Takeaway
The Board’s calendar should include these topics so that these
responsibilities can be accomplished during the year. These
responsibilities should also be included within the Board’s self
assessment process.
35. Management Certifications
and Expansion of “Certifying Employees”
Source: North Broward Hospital District
“I have been trained on and understand the compliance
requirements and responsibilities as they relate to [insert name
of department], an area under my supervision. My job
responsibilities include ensuring compliance with regard to the
[insert name of department] with all applicable Federal health
care program requirements, obligations of the Corporate
Integrity Agreement, and NBHD policies, and I have taken steps
to promote such compliance. To the best of my knowledge,
except as otherwise described herein, the [insert name of
department] of NBHD is in compliance with all Federal health
care program requirements and the obligations of the
Corporate Integrity Agreement. I understand that this
certification is being provided to and relied upon by the United
States.”
36. • Certifying Employees
• Who and how many can vary depending upon the nature of
the CIA
• Ranges from C-Suite to Line Management and in between!
• Controller
• Human Resources
• VP Philanthropy
• Division Vice President
• Chief Strategy Officer
• Physician Recruiter
• Education critical regarding roles and responsibilities
for compliance
Management Certifications
and Expansion of “Certifying Employees” (cont'd)
Key Takeaway
Assess the "certifying employees" in your organization to determine
whether compliance education is specific enough to address
individual accountability with case studies for maximum impact.
General Compliance 101 training is no longer sufficient.
37. Stature of Compliance Officer and Span of Control
Stature of Compliance Officer
Be independent and
protected from
executive level conflict
of interest
Be positioned as a
member of senior
management
Have appropriate
reporting relationships
with the CEO and the
board
CFO or General Counsel as
compliance officer can result in
conflicts of interest and generally
frowned upon by the OIG
without appropriate safeguards
in place.
38. Stature of Compliance Officer and Span of Control
(cont'd)
•Span of control to include additional high-risk areas
• Information technology
and cybersecurity
• Physician contracting
and recruiting
• Real estate
• Marketing
• Procurement and
supply chain
• Quality
• Joint ventures
• Outsourced Services
Key Takeaway
The compliance program stretches beyond
billing and coding. The Compliance Officer
should have authority to collaborate with
other high risk areas and departments and
be endorsed by management and the Board.
39. Incentivizing Compliance Through Compensation
•Compliance “modifiers”
• Adjustments to incentive compensation
(up or down)
• Individual, departmental and entity specific
•Performance appraisal systems
•Inclusion of compliance metrics in
balanced scorecards
• Culture surveys
• Audit results
(internal and external)
• Specific compliance matters
40. Incentivizing Compliance Through Compensation
(cont'd)
•GlaxoSmithKline (GSK) CIA – Executive Financial
Recoupment Program
• Potential for forfeiture and recoupment of an amount
equivalent to up to three years of annual performance pay
(annual bonus, plus long term incentives) for any GSK
executive who is discovered to have been involved in any
significant misconduct.
• Applies to all members of GSK’s corporate executive team
and to any vice presidents and senior vice presidents who
are based in the U.S. who are current GSK employees or
former GSK employees at the time of a Recoupment
Determination.
Key Takeaway
Assess how your employees are incentivized
and whether these incentives align with the
compliance culture of the organization.
41. Code of Conduct 2.0
Key Takeaway
Assess the last time your Code of
Conduct was revised. Does it
require commitment to a culture of
compliance and does your training
program provide real-life case
studies of ethical decision making?
Ethical
decision-
making
Raising and
resolving
ethical issues
Third-party
contract
provisions
Ongoing
training and
case studies
42. Evolution of Risk Assessments
•Completeness of risk universe
• Joint ventures, outsourced services, third-party
relationships
•Collaboration with “Internal Assurance Providers”
• Compliance, legal, internal audit, finance, risk
management, quality
•Collaboration with “External Assurance Providers”
• External audit, outside counsel
Key Takeaway
A compliance risk assessment should include risks that result
in audit coverage as well as those risks areas that cannot be
covered due to resource constraints for the Board to either
accept the risk or provide additional resources to address
44. New Positions, Functions, and Systems
•Arrangements officer
•Grants management system
•Focused arrangements system
• Central tracking system
• Written, signed and approved agreements
• Activities verified and supported
• Appropriate remuneration
• Fair Market Value
• Commercial reasonableness
Key Takeaway
Assess whether the entity's current
contract management system is capable
of tracking arrangements as required by
recent CIAs. Review expected criteria
during vendor selection process if
selecting a new contract management
system.
45. Independent Experts
•Independent Review
Organization
•Compliance “expert”
•Monitor
•Governance member with
compliance expertise
Key Takeaway
Enlist the assistance of a
compliance expert periodically to
conduct an independent
effectiveness assessment of your
compliance program.
47. Focused Education in High Risk Areas by Experts
•Anti-Kickback, Stark, and FCA
•Billing, Reimbursement, Clinical Decision Making, Case
Management, Arrangements (2 hours CHSI/HMA CIA)
•Employees and third parties
•Requirement in CIA regarding supervision of work
•Risk assessment should inform those to receive training
Providers
(employed and medical staff)
Marketing
Case Managers Physician Recruitment
Research Medical Education Grants
Supply Chain/Procurement Real Estate
48. Emphasis on Auditing and Monitoring of
Control Environment in High Risk Areas
•Systems review, arrangements review, eligibility
review, and claims review
Relationships
with referral
sources
Claims to
federal health
care programs
Quality of care
Marketing and
sales
Real estate Grant funding
Inpatient
medical
necessity
Drug
restocking
practices
Research
practices
Patient
eligibility
(e.g. hospice)
49. Key Takeaways
Key Takeaways
Board and Management
Accountability
Assess Compliance Incentives
Review of Recent CIAs Review Code of Conduct
Assess Compliance Program
Coverage
Breadth of Compliance Risk
Assessments
Assess Training Programs Assess Current Contract
Management System
Compliance Officer Span of
Control
Compliance Program
Independent Effectiveness
Assessment
51. Shannon Sumner, CPA, CHC
Consulting Principal
Compliance Officer
ssumner@pyapc.com
David Ogden
Partner
Chair, Government and Regulatory
Litigation Practice Group
david.ogden@wilmerhale.com
Thank you!