How to Start a Healthcare Compliance Program: One Day In-Person Seminar

By: CJ Wolf, M.D, CHC, CCEP, CIA, Educator/Compliance Executive
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Course Description:

Section 6401 of the Affordable Care Act provides that a “provider of medical or other items or services or supplier within a particular industry sector or category” shall establish a compliance program as a condition of enrollment in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). And even before the Affordable Care Act was passed, most healthcare organizations implemented compliance programs to help prevent fraud, waste and abuse of federal health care programs. Needless to say, if you provide services to Medicare or Medicaid patients and you either don’t have a compliance program or you need to strengthen your healthcare compliance program, this seminar is for you.

We will perform an in-depth review and application of the 7 elements of an effective compliance program as outlined in the U.S. Sentencing Guidelines as well as explained the U.S. Health and Human Services Office of Inspector General.

The current enforcement environment against hospitals, doctors and other provider types demonstrates financial penalties, fines, settlements and even jail time are on the rise. A compliance program is one way to prevent non-compliance and can also be to your organization’s benefit if something does go wrong and you are investigated by enforcement agencies.

On June 14, 2018 the Acting Associate Attorney General Jesse Panuccio stated, “As we deter fraud by holding individuals accountable, we also want to be sure that we continue to reward companies that invest in strong compliance measures. The challenge of corporate compliance is especially acute in large and diverse organizations. I empathize: every day at DOJ we face the challenges of an organization with 115,000 employees. Things go wrong in every organization. When something does go wrong, however, the greatest consideration should be given to companies that do not just adopt compliance programs on paper, but incorporate them into the corporate culture.”

Attending this seminar will help you learn what you need to learn in order to incorporate compliance into your organization’s culture.

Learning Objectives:

  • Comprehend the current regulatory enforcement environment in the health care industry
  • Review recent settlement cases due to a lack of compliance
  • Analyze and apply the 7 elements of an effective compliance program as defined by the U.S. Sentencing Guidelines
  • Understand the Role of the U.S. Health and Human Services Office of Inspector General in regards to Compliance Programs
  • Review principles of and effective compliance program
  • Summarize skills and roles of a Chief Compliance Officer

Areas Covered:

  • Published guidance documents from the U.S. Health and Human Services Office of Inspector General
  • Enforcement trends and government authority under the U.S. False Claims Act
  • Developing Policies and Procedures (Element 1)
  • Oversight of the compliance program (Element 2)
  • Compliance Training and Education (Element 3)
  • Reporting/Communication (Element 4)
  • Response/Disciplinary action (Element 5)
  • Auditing/Monitoring (Element 6)
  • Investigation, remediation (Element 7)

Who will Benefit:

The Affordable Care Act made it law for any provider participating in in Federal Healthcare Programs (such as Medicare, Medicaid, etc.) to have a Compliance Program so any of the following leaders in a healthcare provider types such as physician practice, hospital, skilled nursing facility, etc.

  • Director
  • Manager
  • Billing
  • Coding
  • Auditor
  • HIPAA Officers
  • Compliance Officers
  • Physician practice partner

Course Outline

Day One (8:00 AM – 4:30 PM)
  • 8:30 AM - 8:59 AM: Registration Meet & Greet.
  • 9:00 AM - 10:00 AM: Lecture 1
    • Seminar objectives review, expectations and scope.
    • Healthcare Enforcement Climate and Expectations/Requirements for Having a Compliance Program
    • Settlement Examples from Lack of Compliance
  • 10:00 AM - 11:00 AM: Lecture 2
    • The 7 Elements of An Effective Compliance Program
    • Element 1: Written Standards overview
    • Element 1: Policies/Procedures/Code of Conduct
    • Element 2: Responsible Party overview
    • Element 2: Chief Compliance Officer; Compliance Committee, Board of Directors
  • 11:00 AM - 12:00 Noon: Lecture 3
    • Element 3: Training and Education overview
    • Element 3: Tools and best practices for training
  • 12:05 PM - 1:00 PM: Lunch
  • 1:00 PM - 2:00 PM: Lecture 4
    • Element 4: Reporting/Communication overview
    • Element 4: Hotline, non-retaliation
    • Element 5: Response/Disciplinary action overview
  • 2:00 PM - 3:00 PM: Lecture 5
    • Element 5: Assessing for self-disclosure
    • Element 6: Auditing/Monitoring Overview
    • Element 6: Auditing examples: coding and billing, HIPAA, financial relationships with providers
  • 3:00 PM - 4:00 PM: Lecture 6
    • Element 7: Investigation, remediation
    • Element 7: Corrective Action/Sanctioned individuals
    • Overview of effectiveness reviews
  • 4:00 PM - 4:30 PM: Lecture 7
    • Review 7 Elements
    • Questions and Answers
    • Dismiss and Departure

Meet Your Instructor

CJ Wolf
CJ Wolf
M.D, CHC, CCEP, CIA, Educator/Compliance Executive

C.J. Wolf, MD, M.Ed. has been involved in healthcare for over 20 years beginning with his years in medical school. Shortly after graduating Dr. Wolf made a career change to healthcare administration, reimbursement and compliance. He has worked in various coding, reimbursement or Chief Compliance Officer roles for Intermountain Healthcare, the University of Texas MD Anderson Cancer Center, the University of Texas System and Merit Medical Systems. He currently is Sr. Compliance Executive at Healthicity.

Dr. Wolf has a passion for teaching and education. He has developed and taught curricula for adult employees seeking national coding certifications, trade workshops and seminars, and has served as adjunct faculty for Salt Lake Community College and currently is Faculty at Brigham Young University-Idaho and adjunct faculty at the University of Illinois at Chicago College of Medicine.

In addition to his medical degree from the University of Illinois at Chicago College of Medicine, Dr. Wolf holds a master of education (M.Ed.) from the University of Texas at Brownsville. He completed his B.S., magna cum laude, from Brigham Young University, Provo, UT.

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