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Johns Hopkins Health System Corporate Compliance Orientation

Ethics, Integrity and Values

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Entities Under JHHS Corporate Compliance Oversight

• The Johns Hopkins Health System Corporation, Inc.• The Johns Hopkins Hospital, Inc.• Johns Hopkins Bayview Medical Center, Inc.• The Office of Johns Hopkins Physicians• Howard County General Hospital, Inc.• Johns Hopkins Medical Management Corporation• Johns Hopkins HealthCare, LLC • The Johns Hopkins Home Care Group, Inc.• The Johns Hopkins Home Health Services, Inc.• Johns Hopkins Pediatrics at Home, Inc.• Johns Hopkins Pharmaquip, Inc.• Suburban Hospital, Inc. and Suburban Hospital Healthcare System, Inc.• Sibley Memorial Hospital• All Children's Hospital, Inc. & All Children's Health System, Inc.  • Potomac Home Health Care

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JHHS Corporate Compliance:Who, What, Why, How, When, & Where

• Who oversees Compliance?• What is Corporate Compliance?• Why have a program?• How does it affect me?• When do I need to think about

Compliance?• Where do I turn if I have questions?

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Who Oversees Compliance?

The Department of Corporate Compliance. This Department was established to educate and train employees, preserve continued ethical and legal conduct and protect organizational and employee reputations.

Contact:-Laura Mezan, RN, JD, Chief Compliance Officer-Compliance Department, 410-614-6693 (local) or Hotline at 1-877-WE COMPLY (1-877-932-6675)-If intranet is available, visit our website at:http://www.insidehopkinsmedicine.org/JHHScompliance

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What is Corporate Compliance?

Compliance means we adhere to the rules and regulations required by Federal, State & Local laws.

• JHHS is committed to following all applicable laws and regulations and in particular, those laws and regulations that address health care fraud, waste, and abuse and the proper billing of Medicare, Medicaid, and other government funded health care programs. This includes the Federal False Claims Act and State law or related enforcement policies.

• JHHS recognizes its employees rights under these laws and is committed to abiding by them. We rely heavily on our employees, to help us comply with all of the legal and regulatory requirements applicable to us by identifying potential problems, reporting them and asking questions.

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What is Corporate Compliance?Cont’d

The Compliance team provides:• Education and training.• Auditing of high risk billing at each of

the entities. • Investigations of documentation and

billing irregularities.

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What is the Compliance Program?

• A program comprised of various policies and procedures to detect and prevent fraud, waste, and abuse, and to protect those who report suspected instances of fraud, waste, and abuse. They are:– JHHS Corporate Compliance Plan– JHHS Non Retaliation Policy– JHHS Organizational Ethics Statement– Conflict of Interest Policy– Other Applicable Policies and Procedures

Specific to Your Entity

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Why have a Program?

• To ensure that we:–protect our organization, employees, and customers;–preserve the level of integrity that JHHS is known for;–promote the continued effort to do the right thing;–maintain effective internal controls that promote adherence to legal and ethical standards;–promote detection, prevention, and resolution of illegal or unethical conduct.

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The Regulatory Environment Is Complex

Examples of Federal and State EnforcementFraud and Abuse Laws:

– Federal False Claims Act (and Qui Tam/ Whistleblower)

– State False Claims Acts (e.g., Maryland, Florida)– Stark I and II Self-referral laws – Federal Anti-Kickback Statute– State specific Self-referral and/or kickback laws – Health Insurance Portability and Accountability Act

(HIPAA)

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Federal False Claims Act (FCA)

• Basis for healthcare FCA prosecutions:- actual knowledge;- acts in deliberate ignorance;

- acts in reckless disregard to the truth;- knew or should have known.

• Civil penalties increased up to $11,000 per false claim and up to 3 times the amount of each claim as damages. - Penalties include acts that the provider knew or should have known were not accurate.

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Recent Health Care Settlements (For-profit Institutions)

Significant fines, penalties, and restitutionpaid in the health care industry for fraud, waste and abuse:

– Columbia/HCA $1.7 billion– Tenet Healthcare $900 million– Smith Kline Beecham $325 million– Caremark, Inc. $250 million– Lab Corp of America $182 million

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Recent Health Care Settlements (Not For Profit Institutions)

Imposed Regardless of Non-Profit or Teaching Institution Status:

• St. Barnabas Hospital $265 million• Stanford Medical Center $ 40 million

Local Settlements and Voluntary Overpayments:• St Joseph Hospital (Stents) $22 million• JHBMC (Coding) $2.75 million • JHHS (Medicare One Day Stays)

– JHH $1.6 million

– JHBMC $373 thousand

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Compliance with Billing & Coding Rules

• Bill only for items and services that have been rendered and fully documented.

• Bill only for the items and services that are “medically necessary” and were ordered by a physician or other appropriately licensed individual.

• Accurately represent the type or level of service provided.

Failure to follow billing and coding rules may put yourself, patients, co-workers, institutions at risk!

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Special Compliance Issues

• Interaction with others.• Conflict of interest.• Workplace conduct and responsibility.

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Interactions with Others

Gifts: With the exception of biomedical, pharmaceutical, and medical device vendors, nominal “gifts” may be accepted if the item offered is edible or usable in the workplace. Any other gifts should be discussed with the Compliance or Legal Department.

Supplier, Vendor of Consultant: JHHS and its staff may not accept gifts or contributions to influence with whom we do our daily business.

Physician and Provider Agreements: Contracts and other formal relationships should always be reviewed by our Legal Counsel.

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JHHS Policy on Gifts from Biomedical, Pharmaceutical, & Medical Device Vendors

• To comply with legislation, as of July 1, 2009, JHHS policy prohibits the acceptance of gift items from Biomedical, Pharmaceutical, and Medical Device vendors.

• Items such as ink pens, clipboards, note pads, calculators, etc. may no longer be accepted from these vendors by JHHS staff.

• Also, effective July 1, 2011, medication samples will be banned.

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Conflict of Interest

An Officer, Trustee or other Disqualified Person connected to JHHS Corporation is deemed to have a “conflict of interest” if the person has a financial interest, directly or indirectly, through business, investment or family.

Examples include:

• An ownership or investment interest in any entity with which the Corporation has a transaction or arrangement; or

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Conflict of Interest ExamplesCont’d

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• Any compensation arrangement with the Corporation or with any entity or individual with which the Corporation has a transaction or arrangement; or

• A potential ownership or investment interest in, or compensation arrangement with, any entity or individual with which the Corporation is negotiating a transaction or arrangement; or

• Compensation which includes direct and indirect remuneration as well as gifts or favors that are substantial in nature.

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• Obey applicable laws, rules and policies.• Behave honestly, use good judgment with high

ethical standards.• Strive for mutual respect and trust.• Avoid personal conflicts of interest.• Report actual or suspected violations to

management or Compliance staff.

Failure to follow the Code may put yourself, patients, co-workers, institutions and/or the System at risk!

Workplace Conduct & Responsibility

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Who do I ask if I have questions?

There are several options you have for answering questions about Compliance:

1. Talk to your supervisor.2. Review written materials.3. Contact the Compliance Department at

(410) 614-6693.4. Utilize the Compliance Hotline.

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Remember the Compliance Hotline!

Hotline Number:

1-877-WE COMPLY (1-877-932-6675)• 24/7 availability

• Non retaliation

• Anonymous, confidential

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DO THE RIGHT THING!