Board Members’ Roles in HHSC Compliance Program

  1. Bloomberg BNA—Health Care Program Compliance Guide Monthly Focus
    • New Federal Statutes make BOD oversight more important
      • 60 day repayment window for credit balances
      • False Claims Act changes make it easier for whistleblowers
      • "Intent Standard” for anti-kickback law amended to not require direct knowledge-- “known or should have known” is new language
    • More aggressive anti-fraud cases--Less sympathy from prosecutors
    • Permissive exclusion Authority--
      • Directors excluded from Medicare if they”knew or should have known”
      • Even higher standard for BOD members—without any direct or indirect knowledge
      • BOD should trust management’s reports and input but question as they see fit and when things come up.
    • BOD should support management’s efforts to make compliance program “state of the art”
  2. HCCA—Compliance Officer’s Role in Board Oversight of Compliance Program
    • CO should report directly to the CEO and BOD
    • CO should be high in the management structure to reflect organization’s commitment to compliance
    • Education of BOD members should be provided regularly
    • There should be an active BOD or subcommittee scrutiny of issues, minutes, reports.
  3. Roach—Board of Directors’ Role in Compliance and Ethics
    • Federal “Organizational Sentencing Guidelines” revised and strengthened
      • BOD plays pivotal role in compliance
      • Should be knowledgeable about the content and organization of the compliance program
      • BOD should exercise reasonable oversight with respect to implementation and effectiveness of the compliance program.
    • BOD should request information about risk assessment process
    • Read the newspaper and ask questions about items they read/hear
    • Align incentives for expenditures, compensation, review with compliance goals
    • Encourage transparency in deliberations and compliance updates
    • Initiate relevant, regular, and substantive compliance reports to the BOD
  4. Governance Institute—Government Targets Healthcare Officers Directly
    • Individual liability is a looming and realistic possibility for hospital executives and leadership
    • BOD members held responsible regardless of direct involvement
  5. Governance Institute—Guide to BOD Oversight Duties
    • Compliance as part of fiduciary duty is “hot, hot, hot topic”
    • Expectations of BOD members increasing
    • Caremark decision has changed landscape for BOD members—more responsibility
    • BOD members must make “reasonable inquiry” when confronted with extraordinary facts or circumstances.
    • Recommended compliance structure of multi-hospital systems is what HHSC currently has. Regional Boards should also be active in compliance for their regions.
    • Recognize the dramatic regulatory focus on quality and patient care that is occurring
    • BOD members must be prepared to have “titanium spine”—be tough, consistent, follow through, and follow-up.
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