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PubMed1997

Federal government expands compliance initiatives.

In 1995, the Federal government initiated Operation Restore Trust to increase enforcement of fraud and abuse regulations in Medicare and Medicaid programs. With the success of the original initiative, the government is expanding the project to additional states and program areas. The initial scrutiny of home health agencies, nursing homes, hospice care, and durable medical equipment is being expanded to managed care plans and acute care hospitals with an eye toward DRG creep. To manage this increased enforcement activity, healthcare organizations should institute comprehensive corporate compliance programs. Such programs should provide a framework that delineates responsibilities and provides a systematic means to resolve issues in a timely manner.

Diagnosis-Related Groups↗
PubMed1997

Building an effective corporate compliance plan.

Corporate compliance plans are essential for healthcare organizations to cope with, and perhaps even stave off, investigations arising from allegations of illegal business practices. Initial development and implementation of a corporate compliance plan can be facilitated through four steps: determining the content of the code of conduct, determining how the code will be distributed, assigning responsibility for implementing the plan, and appointing a compliance task force to guide the implementation process. Special attention should be paid to education requirements of the United States Sentencing Guidelines to see that all employees understand and can apply provisions of the plan.

Employee Discipline↗
PubMed1997

What is a board's liability for not adopting a compliance program?

A key element of the 1991 United States Sentencing Commission's guidelines, used in sentencing corporations and business convicted of Federal crimes, is the provision of leniency for organizations that adopt effective corporate compliance programs. Given the increased scrutiny of healthcare organizations by Federal Investigators, the incentive to adopt corporate compliance programs has never been greater. Directors or trustees of healthcare organizations should be especially interested in adopting such programs, since recent case law suggests that they may be held personally liable for damages or losses resulting from a finding of fraud and abuse at their facilities.

Financial Audit↗
PubMed1997

Directors' duty to obtain a fair price in the conversion of nonprofit hospitals.

Boards of Directors of tax-exempt hospitals are increasingly struggling with whether to convert their facilities to for-profit status. Other than the traditional duties of loyalty and fair dealings imposed upon directors, there is currently little guidance to assure that boards obtain a fair price for the hospital in such conversions. The author provides recommendations to assure proper valuation.

Charities↗
PubMed1997

Internal compliance investigations can reduce government sanctions.

An effective corporate compliance program is facilitated by three essential elements: a well-qualified compliance officer; a policy of immediate investigation of every report of potential fraud and abuse; and clearly defined roles for both corporate and outside counsel in conducting the investigations. A government agency is less likely to exercise the full extent of its powers when these elements are in place and three is evidence of a sincere compliance effort.

Consultants↗
PubMed1997

Factors affecting the valuation of physician practices.

Valuation of physician practices provides physicians with a benchmark of their business success and helps purchasers negotiate a purchase price. The Center for Healthcare Industry Performance Studies (CHIPS) recently conducted a survey of physician practice acquisitions. The survey collected data on salaries and benefits paid to physicians after practice acquisition, historical profitability of the acquired practice, and specific values assigned to both tangible and intangible assets in the practice. Some of the survey's critical conclusions include: hospitals tend to acquire unprofitable practices, value is based on historical revenues rather than historical profits, the importance of valuation methodology and payer mix is underestimated, tangible assets represent a large part of the purchase price, and hospitals tend to pay higher physician compensation than do other purchasers.

Data Collection↗
PubMedDate not supplied

Exploring asset-based financing for physician practices.

Asset-based financing is an often overlooked option for financing acquistions. Two criteria for determining its applicability are the viability of the acquired entity and the liquid value of the borrowing base. Asset-based financing requires a lower initial investment than other forms of financing. However, overall costs may be higher than for traditional loans.

Capital Financing↗