Anthony J. Burba, Partner, Barnes & Thornburg, Henry C. Leventis, United States Attorney, Middle District of Tennessee, and Ted Lotchin, Chief Compliance Officer, UNC Health, discuss new and developing risks and opportunities amid the changing health care compliance landscape. They cover the DOJ’s main areas of focus, key compliance trends and priorities, challenges related to self-disclosure, and the increased utilization of technology in health care. Anthony, Henry, and Ted spoke about this topic at AHLA’s 2024 Advising Providers: Legal Strategies for AMCs, Physicians, and Hospitals, in New Orleans, LA.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Anthony J. Burba, Partner, Barnes & Thornburg, Henry C. Leventis, United States Attorney, Middle District of Tennessee, and Ted Lotchin, Chief Compliance Officer, UNC Health, discuss new and developing risks and opportunities amid the changing health care compliance landscape. They cover the DOJ’s main areas of focus, key compliance trends and priorities, challenges related to self-disclosure, and the increased utilization of technology in health care. Anthony, Henry, and Ted spoke about this topic at AHLA’s 2024 Advising Providers: Legal Strategies for AMCs, Physicians, and Hospitals, in New Orleans, LA.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
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Speaker 2:This episode of A HLA speaking of health law is brought to you by A HLA members and donors like you. For more information, visit American health law.org.
Speaker 3:Hello and welcome to this A HLA podcast. My name is Anthony Verba , and I am a partner at Barnes and Thornburg in the Chicago office. I practice , uh, in the healthcare area , uh, former federal prosecutor with the healthcare fraud strike force out of main justice at the fraud section. Uh, and we're here today to talk about the topic of managing 2020 four's , uh, top compliance risks and opportunities. Um , the panel today is myself, Ted Chen and Henry LAIs , who I'll add , introduce themselves in just a moment. This is a conversation that started with a panel at the HLAs Advising Providers Conference earlier this year in New Orleans, and , uh, we thought we would continue that conversation today. So , uh, Henry, do you wanna introduce yourself?
Speaker 4:Sure. Hello, my name's Henry Levies . I'm the United States Attorney for the Middle District of Tennessee. In that role, I serve as the chief federal law enforcement officer and regulator for the nation's healthcare capital. My district's home to over 900 healthcare companies, including 17 publicly traded healthcare companies and the nation's largest hospital systems. Nashville based healthcare companies manage acute care hospitals, behavioral health hospitals, inpatient rehab hospitals, and skilled nursing facilities around the country. Just to name a few of the main areas. And accordingly, our office is one of the most active United States attorney's offices in the country when it comes to civil and criminal healthcare fraud enforcement. Uh , we are consistently engaging stakeholders from the healthcare industry, from the defense bar, from a RELAT bar, and within DOJ and H-H-S-O-I-G. Um , so it's great to be part of the conversation today. Before I turn it over to Ted, let me state my standard disclaimer, which , uh, I'm speaking on behalf of myself today behalf I'm not speaking on behalf of the United States Government, the Department of Justice for the US Attorney's Office. With that, I'll turn it over to Ted.
Speaker 5:Hey, thank , thank you, Henry. It's a , it's a pleasure to be here with y'all again , um, and really appreciate the opportunity. Um , my name is Ted Chen . I'm the , uh, chief Compliance Officer for UNC Health, which is headquartered in Chapel Hill, North Carolina. Um, we are an integrated academic and community health system. Um, we provide ho we have, we , we ma we operate hospitals , um, stretching from the mountains of North Carolina, close to Asheville all the way to , to the coast, a total of , uh, of 18 different hospital facilities. Uh , UNC Health also has , uh, four separate statewide , uh, physician practices , um, including our faculty practice plan and UNC Physicians Network , um, our , uh, network of community-based providers. Um, and then we also have several , um, statewide population health , uh, initiatives, including UNC Health Alliance and UNC Senior Health Alliance. So , um, just joined UNC Health , uh, in December this year. Before that , I was the , uh, chief Compliance and Privacy officer for another large , um, community health system in Wake County, North Carolina. And then prior to that, I was in a private practice with a couple of different law firms , uh, in Washington, DC for about 12 or 13 years. So I'm really excited about the opportunity to , uh, to, to be back on this panel with you gentlemen.
Speaker 3:Great. And it's great to be here with both of you. Um , your , your introductions make me feel lacking, but , uh, I'm, I'm glad to have such a distinguished panel. Um , and, you know, just for those listening, I think what originally prompted our panel at the Advising Providers Conference and , uh, is likely to drive our decision today is sort of is some of the changing landscape in the compliance space , uh, with the current administration , uh, as Henry, I'm sure can speak to in a , in a bit , uh, effective compliance has become , uh, mandatory and essential part of any well-functioning company and in healthcare more than most industries, given how heavily , uh, regulated that space is and how much focus is being placed on fraud, waste and abuse, and the federal healthcare programs, as many people likely know , uh, the DOJ has released a spate of , uh, guidance in the last year related to everything from , uh, benefits for criminal and civil self disclosures, as well as , um, a new criminal whistleblower program , uh, all of which are really driving towards trying to make companies , uh, take compliance seriously, build, manage, and , uh, execute on effective compliance programs. And in , in a similar fashion, in November of last year, 2023, the OIG released some pretty comprehensive updated compliance guidance that walks through each of the seven elements and gives specific examples of the types of resources they wanna see in , uh, companies taking compliance seriously. And so there's a real need now, more than ever for compliance programs to understand their risk profile , uh, and adequately construct a compliance infrastructure around both that risk profile and their own resources. Uh , one of the more , uh, interesting components of the OIG guidance, I think was the , um, the , the guidance for small providers, making clear that the OIG expects even small healthcare companies to have effective compliance programs, even if they don't have all the bells and whistles of what perhaps UNC health or others would have. So , um, with that kind of ground , uh, groundwork laid , I thought we would , uh, turn to Henry , uh, to just get a sense of what those risks are. Uh, what are some of the key areas of focus for his office and for the DOJ more generally, and what are some of the types of cases he's seeing , um, you know, this year and into the next 12 months or so.
Speaker 4:Sure. Thanks, Tony. Um, I, I say often our priorities in the, in the healthcare , uh, fraud, waste and abuse enforcement arena remain driven by two main factors. Uh , one, the amount of healthcare dollars in question, federal healthcare dollars, Medicaid dollars, tricare, healthcare dollars , um, and two, the potential for patient risk. Uh , and so an example I often point to are two cases we did last year that are kind of on the far end of the spectrum, if you will, with respect to, to dollars involved. One case involved the teaching hospital in our district , um, where they were billing for physician services , um, that were in fact being provided by non-physician residents that were unsupervised. Um, and ultimately given the nature of the hospital and the patient population that it served , uh, we resolved the matter for a hundred thousand dollars, which is relatively small amount in the False Claims Act space. But the reason we focused in that area and dedicated resources to that area, because there was a distinct risk for patient harm anytime you have , uh, patients being treated by folks who are not physicians, that are not supervised by physicians. On the other end of the spectrum, we resolved a case with a Medicare Advantage organization for , um, $37 million. The MAO had been inflating risk scores for beneficiaries, essentially to increase the reimbursements they received from Medicare Part C, and , um, it implicated a substantial amount of federal healthcare dollars. And so those are the kind of big picture factors we're looking at, no matter what , uh, the specific , uh, fact pattern is in a given , um, allegation, whether it's a, a tip or complaint given to us by a hotline, or whether it's something brought to us by, by a relator . Um, within that space, our office, because we're, again, the nation's healthcare capital, especially when it comes to , um, provider based healthcare companies, healthcare companies that actually treat patients as opposed to the life sciences industry or , uh, medical device industry , um, we've seen a lot of , uh, continued claims of worthless services , of over utilization of , um, flat out false billing. Um, and they tend to track on the areas of Medicare that reimburse at a high rate. Uh, we've also seen with the increase in utilization of telemedicine , um, frauds that has historically had been , uh, within a single jurisdiction are now , uh, multi-jurisdictional national fraud. So, for example, last year we prosecuted a Illinois physician for writing , uh, medically unnecessary scripts for , um, genetic testing for patients all over the country that were driven to him by marketers. Um, and then he would engage those patients via telemedicine and then directed those scripts to a lab in our district who in turn paid him kickbacks. So historically that that wouldn't have been a fraud that could have been perpetrated on that scale. Uh, but the, the increase in use of telemedicine has kind of made , um, small problems bigger, I guess, is a way of putting it. Um, so those are just a couple of the areas that we're seeing , uh, problems creep up. But, but the underlying fraud schemes continue to be over utilization , false billing, a KS violations and stark violations.
Speaker 3:Uh, excellent. And Ted, you know, I know we started this , um, panel in February talking about sort of upcoming trends in compliance for 2024. I'm interested to hear sort of how , uh, how , how that's going , uh, halfway through the year, sort of how your focus on risk may have shifted, if at all, and, and what some of your priorities as a compliance officer for such a large health system are , uh, for the remainder of this year and the beginning of next year.
Speaker 5:Yeah, no, tha thanks Tony . It's a great question. And, and Henry, I I really appreciate your comments on sort of the, the , the two factors that, you know, that are gonna be most likely to, you know, to get the, the federal sort of enforcement , um, you know , the attention of federal enforcement agencies. 'cause that really tracks closely with how we try and sort of stratify risk or stratify risk within our organization, and then communicate and educate , um, stakeholders within the organization. I've always, you know, believed very strongly that, you know, if you have, if you have the , I mean, it's , it's not great if you have, you know, significant financial exposure on its own. It's not great if you have potential for significant patient harm standing alone . But if you identify a risk that has the potential for, you know, to, to create both, you really threaten the , the federal fund , you know , the federal Medicare, Medicaid funds , and then also cause harm to the , the pa to the patients. That's really the, those are the areas where we feel like we, we also feel like we need to focus our, our energies and efforts the most . Um , but , you know , in terms of how things are going sort of halfway through the year , you know , about the OIG program is important . And we a lot of time this year, you know, trying to go through and line up and reevaluate all the different components of our compliance program , um, with the, you know, the updated guidance from the OIG. And, you know , I think it's just , I mean, there's some, there's some comments towards the end of that document that , um, I think are really interesting for larger organizations to consider, you know , based both around the how to, you know, how to think about the governance structure for your compliance program, but also kind of the internal org structure and staffing model that you use, especially for, you know , organizations like UNC Health that are, you know, geo geographically distributed, that have a combination of academic and, you know , community health systems. Um, so definitely spending a lot of time trying to be thoughtful and going through that document, taking a good hard critical look at our own organization and oversight structure to see how we can continue to improve going forward. Um, you know, I , I do think it's interesting. We were, we were sort of, you know, talking on our, our prep call about how everything, you know, ev everything comes down to e everything is focused on, on AI and the risk created by ai right Now. I know that there , you know, over the past few years, there's been a lot of discussion about these new and developing risk areas for hospitals in particular, you know, wider relief funding, ai, telemedicine, like all kind of technology driven . Um, but you know , Henry, to the point you just made, like I was going back through some of the , um, some of the, the , the year end like fraud and abuse kinda reviews that, that you different law firms have put out for hospitals. It's really, it all , it's really all basic blocking and tackling, right? It's, it's stark law, it's anti-kickback statute. And so what that makes me think about from a compliance perspective is , is it really, it's really a focus on third party risk management broadly, right? So do you have the appropriate , um, structures and protocols in place for , you know, financial arrangements, monitoring to monitor your, you know , to track and monitor your payments to community physicians ? You have your, you know , the appropriate , um, guardrails in place from a , from a conflict of interest perspective, making sure that you're , you know, that your , that the physicians in your , um, in your provider groups don't have relationships with drug or device companies that are, that are either the number one driving purchasing decisions at a hospital, which isn't great from a financial perspective. But then perhaps more importantly, are they driving decisions that could theoretically put patients at risk for using unapproved devices, devices that have been approved for some purposes, but not others. Um, and then just, you know , all of the, the, the , um, privacy and information security concerns that come along with, you know, or that come along with monitoring , um, your business associates and making sure that the data that , that your data that you're sharing with external partners , um, is being used appropriately the way it's intended to under the , uh, under the service agreement with that vendor . Um, those are the areas that we're kind of focused on this year in terms of like specific areas of coding and billing risk. Um, you know, we, we , we are also , um, kind of focused on, you know , given the kind of academic mission and academic core of the health system, we are , we are also always focused on some of the, the Medicare reimbursement rules that are specific to academic medical center . So, you know, Henry, to your point, the rules for supervising the teaching physicians , supervising residents , um, some of , you know , some of the rules around , um, o overlapping surgery and when do you need to have backup surgeons available? Um, I , I know that's also been a , been a , a big area of focus over the last, you know, five to 10 years. And so we , we wanna make sure that we have , um, we have our policies and procedures really in line with what the , uh, the , the federal government would be expecting. So , um, so Tony, to your point, lots of activity. The , uh, you know, the , the second half of the year has definitely not slowed down , uh, in comparison to the first half of the year. But , um, you know, I think lot , lots of great opportunity to, to , to really be thoughtful about how to structure our compliance program , uh, going forward.
Speaker 3:Um, I think that's all super helpful. Uh , you know, I think, as I said at the beginning of the podcast, we , uh, you know, self-disclosure has been a theme for probably over a decade now, but it's really ramped up in importance both for the OIG and DOJ , uh, as well as other , uh, federal agencies. And so, you know, I certainly, as outside counsel , often some of the challenges we face with , uh, those self-disclosure is , uh, is, you know, working with the client to accurately identify what the potential problematic conduct is to quantify that into a number of that we can report. Um , and also, frankly, with the new criminal guidance to convince the executives that they should self-report when the guidance requires the company to , um, you know, to cooperate in investigations against the people making the decision to self-disclose in the first place. Uh , but Ted , I , I wonder from your perspective, just , uh, you know, obviously in a hypothetical sense, what are some of the challenges , um, that, that you think organizations face when their , uh, compliance program is trying to evaluate whether or not self-disclosure makes sense?
Speaker 5:Yeah, I mean, it , it's, it's , it's a great question. I mean, you know, and I think you hit on one of the really important points in your , in , in , in your , in your lead up there, it , you need to start laying the groundwork for that way before you're actually in the situation of having to, to try and make decisions. So, you know, again, it's making sure that you, that, that, that senior leadership , um, and the board sort of understand the rules of the road when it comes to self disclosures. Um, and then, you know, so, and just trying to, again, make sure that you , that you're , that you've established that, that you know, the , the tone at the top and then sort of use that as a , a north star when you're, when, when you're working through some of these more difficult conversations. Um, but yeah, I mean, the , the , the data analysis is , is always challenging. I think, depending on what, you know, which specific area we're talking about. Um, you know , you can have, I mean , you know, you could , you can imagine a , a , you know, a healthcare system, you know, you know, a , a larger healthcare system, you're, you're potentially operating off , off multiple different , um, you know, clinical and , and administrative software platforms, so, you know, for , for different purposes. So you could be trying to pull data from multiple different , um, you know , applications within your sort of back office, you know, hr, AP coding, billing, et cetera. And then going through and trying to marry all that information up so that you have, you know, the clearest possible picture of what the , you know, the actual or potential misconduct , um, might be. I mean, I , I do think there's, there's definitely a balancing act between, you know , um, the need for transparency, but also the need, you know , to have time to do a thorough , um, a thorough investigation and review of whatever the concern might be. You know, I mean, one thing I think, you know , any , any compliance officer would tell you is that 95% of the information that comes, that comes through, you know, that first hotline report is probably not, not completely accurate. So it , it's worth, it really is worth it , um, you know, for ev from , from everyone's perspective to take the time, you know, to do with their investigation, make sure you're comfortable with the numbers that you're looking at , um, make sure that there , that you've built some consensus around, you know , what the actual misconduct , um, you know, what , what the actual misconduct , uh, looks like. And then I think once you do that, that, you know , that helps drive a lot of the conversations and, and , um, really helps clarify the , the pros and cons of disclosure for the , for the leadership and for the executive team.
Speaker 4:Tony, can I jump in here? Um, yeah, please. I think the past 18 months , um, has been a really interesting one because I think, as you noted, the department and H-H-S-O-I-G have issued guidance , um, not only on kind of what they wanna see with respect to a healthcare related compliance program, but also how corporate compliance programs will fit into decisions around , um, charging and resolution of a , a criminal corporate enforcement matter. Um, I haven't seen as much, there's been a lot of discussion about both those topics and that I haven't seen as much discussion about the tie in between having a robust compliance program and availing a company availing itself of the voluntary self-disclosure program. But I think it goes without saying that unless you have a robust compliance program, it's less likely that you're going to identify an issue in a timely fashion before a whistleblower goes to the government and be able to have the internal conversation that Ted was just talking about , uh, so that you can, if you choose to avail yourself of the benefits of the VSD program. But as you guys know , um, every , uh, litigating component of DOJ that that does, corporate criminal enforcement was required to , uh, author and publish a voluntary self-disclosure program last year , uh, uh, in response to the Monaco memo. And so those are out there, and when I talk to industry stakeholders, I'm preaching the benefits of the voluntary self-disclosure program as a way to kind of enlist industry as partners and , and addressing fraud waste and abuse in the healthcare system. Uh , but they can't do that if they don't find out about the problem and they don't find out about it first. So it's very tied in the compliance piece and the compliance guidance and the VSD , uh, policies that have been pushed out are very much related. I imagine Tony or Ted would agree with me on that.
Speaker 5:I would a hundred percent agree with that. I mean, and I, I I , I do think that, I mean, to me it feels like, like we are, we're the , we've been having the conversations within the health law bar and the health law industry about self-disclosure and the benefits of the compliance program for long enough that I , I , I think that, that , I really do believe that a lot of those messages are starting to , to take hold with , at sort of like the, you know , the management and leadership leadership level. I mean, I can't tell you how many conversations I've had, you know, over the past 10, 15 years with, you know, clinical leaders, operational leaders who are, you know, are very, like, they're very tuned in to , you know , to , to , you know , to your point, Henry, that you , you , we would always want the opportunity to be able to identify, you know, potential misconduct or coding errors or what have you internally and try and make , and try and rectify the situation on our own without having to go through, you know, a , like a , like a , the whistle a whistleblower process. I mean , I think that, you know , again, we were mentioned , we talked earlier about the two kind of big red flags. But, you know, from, from my perspective, it's also, it's also kinda the worst case scenario for a , for a provider organization, right? If you have someone in , in, in the organization who sees what they believe is misconduct or billing errors or what have you, they keep elevating concerns and just don't feel like anyone's listening to them. You know, we, I mean, honestly, like we, you know, it makes my job a whole lot easier if we do have that, you know, if we have built a culture where people are comfortable raising their hand and voicing concerns, and then, you know, at the , at the end of the day after investigation, you may still get to a point where you're gonna have to agree to disagree, right? I mean , reasonable people can look at the same set of facts and reach different conclusions, and that's, you know, that's just, that's just par for the course. But building the system, building the compliance program, so you have, you have a program in place to investigate all of these concerns as they come up. Um, I , you know , I , I do, I I really do like , feel like people are beginning to see the, the , the true benefit of having that robust process internally without having to , without you knows severe , not going through, you know, disgruntled employee sort of a whistleblower scenario.
Speaker 3:Henry, I think Ted's takeaway is that the DOJ should know that UNC has a highly functioning compliance program. Uh, everything's good there and , uh, nothing to worry about. Uh ,
Speaker 4:So I'm not only, not only am I not speaking on behalf of the d OJ today, <laugh> , I'm not , I'm not listening on behalf of the DOJ today either. Um , but <laugh> noted personally,
Speaker 5:This is gonna , this , this can get a lot more
Speaker 3:Interesting then you've put me in the awkward position and viri of having to be the one to speak on behalf of the do OJ from this point forward. But , um, Henry, so just practically speaking, you know, what, what is the , uh, voluntary self disclosure look like on your end? What are the things that a provider or healthcare company or life sciences company can do to make their life easier in that process? What , what , what are you looking for? What do you wanna see? You know, what's the, what's the best way to do it in a way that is helpful to DOJ and, you know, obviously , uh, helpful to the company themselves?
Speaker 4:Well, so the , the , the requirements are set out in the , in the policies. Um, uh, the criminal division of the Department of Justice has its own policy. Um, antitrust division has a policy. The US Attorney's Office community has a policy there . There's a lot of overlap there. There's some differences. Um, but the underlying , um, rationale is , uh, we want to , um, address fraud, waste and abuse in the healthcare system. So we're speaking specifically with respect to healthcare at the moment. Um, and we're better , uh, situated to do so through providing incentives , uh, to companies, right? And so in that context , uh, it has to be , um, voluntary, right? That goes without saying, but, but voluntary meaning there isn't a preexisting obligation to report to the government. The company's already not already under a corporate integrity agreement or a monitorship , uh, or some other contractual agreement to report to the government. So, has to be voluntary in that sense, has to be timely. Uh, in other words, it's not information we already know about, or there's not some imminent threat that the government's gonna find out. Um, you know, within the next 24 hours, timely is kind of a fact-based determination , um, and the onus is really on the company and their outside counsel to make the case that the disclosure was timely. Um, but we recognize, and, and I think Ted alluded to this a moment ago, there's tension between , um, finding out about a potential issue internally , uh, and making the determination to report immediately versus getting a handle on everything and deciding whether you think there really is a problem that warrants self-disclosure. And so the way the policy's written is that , um, it to encourage people just to put a marker in the sand, have your outside counsel reach out, say, we're aware of this issue. We think it may be a problem. We're obviously doing our own internal investigation. We're gonna report to you at regular intervals as we learn more. Uh, but that, that allows us to , uh, keep track of when the initial report was made. And if a whistleblower comes in the very next week reporting roughly the same problem , um, the company's still able to take advantage of the voluntary self-disclosure policy benefits because they put that marker in the sand. So that is another piece of it. Um, obviously we would expect that the reporting be fulsome , right? It's, it's everything, you know, at the time you report, and then as you learn more, report more mm-hmm , <affirmative> , um, and it would have to be accompanied by cooperation and remediation. So cooperation, you know, depends who you ask can be defined a lot of different ways. And certainly the , uh, justice manual speaks to what cooperation looks like in different contexts. Uh, but here in the healthcare company reporting a problem through the voluntary self-disclosure program context, it really looks like working with our office, working with H-H-S-O-I-G to give us a sense that we have a handle on the breadth and the depth of the problem. Um, and , and so that can be a , you know, a lot of conversations with the company, with key employees and executives. Um, so if , if there's a hesitancy to cooperate, then the VSD program might not be your best route, right? Um, and , and that's an internal conversation and conversation with outside counsel that we probably won't be a part of. Uh , but it, that is key to fully taking advantage of the program. And then I think it goes without saying, we'd also expect remediation, right? You , you start to fix the problem in real time . Um, you don't report a problem <laugh> , and , and then when , when you're updating us on the progress, it's still a problem six months later or whatever. Um, so those are, those are the key pieces of it. Uh, and then I think the benefit, I don't know if you asked about the benefits, but we try to make the benefits , um, clear and objectively positive. And usually that means , uh, depending on whether we're talking about a civil action or a criminal matter, you know, lower fines, possibly, no, you know, a declination or a , a nonprofit agreement on the criminal side , um, you know, not , uh, proclaim penalties, no proclaim penalties on the civil side, those types of things that the chief compliance officer, the chief legal officer in an organization can go to the board and say, look, we actually did well by this, and we were , it's really important to us that, that that conversation take place internally because we recognize that healthcare, the healthcare industry and the healthcare community talk, and if they're having bad experiences availing themselves with these, these policies, then we'll lose a very important piece of our overall enforcement strategy, and we don't wanna do that. So, so that's a very high level description of it time .
Speaker 3:So I think we're starting to head towards the end of our, our time on the podcast, but , uh, just outta curiosity, you know, what else do you guys see coming down the pike this year? You know, not just out of compliance, but sort of generally what are other things that you guys are looking at?
Speaker 4:Yeah, so there's so many things happening in the healthcare space and how it, you know, where it interfaces with governor enforcement around fraud, waste, and abuse. Certainly, as I mentioned earlier, we're tracking on , um, the role of telemedicine , um, in the provision of healthcare. We're talk , we're tracking on the role of artificial intelligence, not just in the provision of healthcare, but also potentially in the compliance space and how it's going to impact compliance. Um, we're also tracking on the role of AI and whether there's an appropriate role for AI in, in the investigative space, right? As we review Medicare claims data. Um, is there a role to do that utilizing AI in a more efficient, effective manner? Um, let me caveat that by saying, reviewing Medicare claims data is a way to be thoughtful about allocating limited investigative resources. It's not a way to determine fraud. And so, even if we're, we do begin to utilize AI in that space, ultimately that's never gonna be a substitute for then investigating and determining whether that something bad happened, right? But it , you know, there, that conversation is happening , uh, and that is something I'm certainly paying attention to. And then there is a conversation that I'm sure you're all aware of around the role of private equity in healthcare and , uh, whether the private equity model and the healthcare model are compatible, and it's a good thing. And , um, I think, you know, you can ask 10 different people and get 10 different opinions on that, but it's a conversation where , uh, paying attention to and at times , uh, participating in,
Speaker 5:Yeah, no , I was gonna, I was gonna say, I was gonna hit on a couple of those exact same points. Uh , definitely the role of technology, both for, you know, how can we, what solutions can we deploy, you know , to make our compliance program more effective, right ? Henry , to , to your point, you know, for , you know, for like, like monitoring, EEEM coding , for example, right? I mean, you know, we have something like 8,000 providers across the healthcare system, right? You would need an army of, you know, of, of, of auditors to, you know, to, to keep up with that kind of volume. But there are solutions out there that, you know, you can use for more of like a dashboarding approach or just different tools to identify , you know , your higher risk , um, areas for, for , for audits, for audits and monitoring. So definitely looking closely what kind of , if , if there are any technical, technological or technology solutions out there that we can deploy, you know, the other area where I think it's , um, I think it's gonna be really interesting to see how things develop is, you know, there's so much focus, and I think rightfully so on, you know, helping provide physicians and providers get back to just finding the joy in their, in their work, right ? The joy in, in providing direct patient care. But there are so many of the , the regulatory burden in healthcare can be so , um, you know , so heavy at times, you know, that , you know, physicians are spending a lot of what , you know, what we call, you know , pajama time, after hours, you know, documenting, coding, doing all the , responding to emails. And so, you know , and that necessarily creates a tension, right? With all of these incredible tech tools we have developing, you know, ai, you know, AI chatbots for, you know , for managing, helping physicians manage their, you know, their, their , their , their in basket and epic , um, you know, new tools like , uh, like Dragon and other sort of ambient, you know , tools for, you know, help build that sort of, you know, listen, for lack of a better word, and record the provider patient interaction all the way up to, and including, you know, documenting and potentially, you know , coding and selecting diagnosis codes . I mean, that's, you know, and if you look at the studies, some of these areas, like patients tend to say that they prefer those kinds of automated interaction because then their physicians are freed up to, you know, talk to them face to face , right? Without having to be tethered to a keyboard all the time. But then, you know, I look at that from a compliance perspective, and I'm like , it , you know, it gives me immediate pause like , well, okay, so that's great potential, but I , we feel like there's a lot more vetting and you sort of proof of concept that needs to go through, especially from, with some of the accuracy of coding decisions or anything like that. So I just, you know, I don't , I think we're just at a point where, you know , the providers and physicians are being asked to do so much every single day, both direct patient care and then administrative, and we have all these technological solutions to help alleviate some of that burden. It's gonna be interesting to see, you know, how and whether we're able to balance those two concerns.
Speaker 3:Uh, well, I I think that's probably , uh, a , a good place to wrap things up, right? I, I think it's a , a very , um, important point that you make Ted , um, truly like, so, so many times, the, the risk and the , uh, enforcement, the regulatory , uh, burden that comes with operating a healthcare entity , uh, does take away from that patient relationship and the focus on the core , uh, function of those companies. And , uh, I think it's important that, you know, everyone involved certainly keep that , uh, as their north star in handling these cases, whether it's the government dealing with , uh, you know , large healthcare providers in particular, or the, the compliance officer or outside counsel, that this is really about making sure that the patients are getting what they need, getting what they pay for , um, and getting quality service and , and items. Um, and with that, I, I guess , uh, Ted or Henry, any sort of closing thoughts you wanna offer?
Speaker 4:I , I think Ted is spot on. I think , um, the increased utilization of technology in the provision of healthcare is gonna have drastic implications for , um, these types of enforcement and compliance conversations and, and where that goes, and the answer is to be determined. Uh, but, but it'll, it'll be fascinating to see and, and it will require a lot of thoughtful , um, thoughtful approaches on both sides, right on , on , uh, with respect to the regulators and enforcers, and also the people providing healthcare every day . Um , so yeah, it's great to be with you guys today.
Speaker 5:Yeah, no, I was gonna , I was just gonna say, I , I , I think I completely agree with that, and that's one of the reasons that I really appreciate the opportunity to have conversations like this, because it really is gonna take an , an all of industry kind of effort to, I think, work through some of these, some of these really tricky problems. So thank you to thank you to you both for the , uh, for the time and the conversation. It's always great to catch up with y'all .
Speaker 3:Yeah, thank you both, and thank you for all those listening , uh, for your, your time and attention. Obviously, I'm sure any one of the panelists would be happy to continue this conversation , uh, in , in another format. But , uh, for now, thanks for listening to our podcast about 2020 four's key compliance risk areas, and , uh, I think we'll call it a day .
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