Newspaper article The Florida Times Union

Prevention Better Than Cure Compliance Programs Help Hospitals Avoid Trouble with Feds

Newspaper article The Florida Times Union

Prevention Better Than Cure Compliance Programs Help Hospitals Avoid Trouble with Feds

Article excerpt

Teresa DuPree knows the ins and outs of hospital finance, honed

over nearly two decades as a health care executive at what is

now Baptist Medical Center-Beaches.

But since October, the 46-yearold Jacksonville woman has found

herself working overtime to master a tough new assignment:

Compliance officer.

Her job is to make sure Baptist/St. Vincent's Health System

employees dot their i's and cross their t's when it comes to

billing the federal government, the health system's single

largest customer.

"You want to do things honestly, ethically, responsibly," she

said. "Your reputation will be at stake."

DuPree is not alone. Officials at every hospital in

Jacksonville have tapped a senior executive to oversee their own

compliance efforts.

This task is harder than it sounds.

The rules covering hospital payments for Medicare, just one of

several big health care programs funded by the federal

government, take up more than 3,000 pages, DuPree said.

Furthermore, the government contracts with an insurance

intermediary, which processes bills and uses its own

interpretations of the rules in deciding what gets covered,

DuPree and other executives said.

"There are a lot of gray areas in billing that are now being

refined so that they are not so gray," said David Meltzer, the

ethics and compliance officer at Memorial Hospital in

Jacksonville.

Baptist/St. Vincent's plans to launch education programs for all

9,000 employees this summer, revise written guidelines and even

hook up a hot line for tips on any misconduct or problems

involving hospital billing, DuPree said.

Calls to area hospitals reveal that similar steps are being

taken everywhere.

Getting it right -- or at least showing the federal government

that a hospital is making serious effort to ensure that all

bills are justified -- can make big difference.

Everyone in the health industry knows the withering effect of a

government investigation on Columbia/HCA Healthcare Corp.

The probe torpedoed Columbia's stock price, triggered the ouster

of its aggressive executives and forced new management to

radically change the company's strategy. …

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