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When You Need and Don’t Need Legal Representation for OMIG

When You Need and Don’t Need Legal Representation for OMIG. (Former) Compliance Officer’s Perspective Laurie G. Radler, CHFP. Disclaimer. These are my own opinions, not the opinions of my employer In no means do I mean to say that our attorneys don’t provide us with great value

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When You Need and Don’t Need Legal Representation for OMIG

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  1. When You Need and Don’t Need Legal Representation for OMIG (Former) Compliance Officer’s Perspective Laurie G. Radler, CHFP

  2. Disclaimer • These are my own opinions, not the opinions of my employer • In no means do I mean to say that our attorneys don’t provide us with great value • My comments pertain to seasoned compliance officers, not “newbies”

  3. The Potter Stewart Perspective “I shall not today attempt to further define the kinds of material I understand to be embraced within (any OMIG audit); and perhaps I could never succeed in intelligibly doing so…But I know it when I see it…

  4. What’s the Reality? • Hospitals are very resource constrained • Hospitals are addressing a plethora of audits all the time (RAC, OMIG, CMS, NGS to name a few) • For many, compliance budgets have been cut back while the needs have actually grown • Self-audits are expected as a part of any “effective” compliance audit • This all translates to a need to be very judicious about the decision to go to outside “experts” (attorneys and/or consultants)

  5. What are the “Decision Points”? • CEO/Board directive • Results could be “material” to hospital financials (before fines and penalties) • When the audit findings will suggest that a voluntary self-disclosure will need to be made • For any Stark, physician contracting or anti-kickback allegations • Institution is the only target for this audit

  6. What are the “Decision Points”? (continued) • When e-discovery is involved • When criminality is suspected • Possibly when there is a high level of reputational risk involved • When initial self-audit (run and controlled by Compliance with subject matter experts) shows poor or questionable results, and requires further review.

  7. Compliance Officer’s Role (with or without counsel) • Attend all calls and meetings with your counsel • Extend audit deadline if necessary • Determine auditor’s knowledge of subject matter • CCO is the face of and the advocate for the organization

  8. Key Points to Remember • Adverse audit can lead to an OIG referral • Verbal responses during the audit are inadequate… request everything in writing. Be careful! • Take every opportunity to promptly present your organization’s perspective in responding to the audit even if you are not requested to do so.  • No audit should be considered routine. All must be taken seriously especially if audit letter alleges that you knew or should have known the regulatory requirements.

  9. Key Points to Remember • Always ask for more time if needed • Fully understand the knowledge of the contractors conducting audits. Take the opportunity if needed to defend yourself as you educate them • Remember the 60 day overpayment window! Sometimes just paying the money back and learning from the audit is best  • MOST IMPORTANTLY -  treat the OMIG with respect, not fear!! 

  10. The Potter Stewart Perspective “I shall not today attempt to further define the kinds of material I understand to be embraced within (any OMIG audit); and perhaps I could never succeed in intelligibly doing so…But I know it when I see it…

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