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William Beaumont Hospital Corporate Integrity Agreement

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William Beaumont Hospital Corporate Integrity Agreement CORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND WILLIAM BEAUMONT HOSPITAL I. PREAMBLE 1 William Beaumont Hospital (WBH) , a subsidiaryof Beaumont Health, hereby enters into this Corporate IntegrityAgreement (CIA) with theOffice of Inspector General (OIG) of the United States Department of Health and Human Services (HHS) to promote compliance withthe statutes, regulations, and written directives of Medicare, Medicaid, and all other Federal health care programs (as definedin 42 U.S.C. § 1320a-7b(f)) (Federal health careprogram requirements). Beaumont Health is a not forprofit corporationwhich operates eight hospitals in SoutheasternMichigan. Contemporaneously withthis CIA, WBH is entering into a Settlement Agreement with theUnited States. II. TERM AND SCOPE OF THE CIA A. The period of the compliance obligations assumed by WBH under thisCIA shall be fiveyears fromthe effective date of this CIA. The "Effective Date" shall be the date on which thefinal signatory of this CIA executes thisCIA. Each one-year period, beginning with the one-year period followingthe EffectiveDate, shall be referredto as a "Reporting Period." B. Sections VII, X, and XI shall expire no later than 120 days afterOIG's receipt of: (1) WBH's finalannual report; or (2) any additional materials submitted by WBH pursuant to OIG's request, whichever is later. C. The scope of this CIA shall be governedby the followingdefinitions: 1 WBH means: the William Beaumont Hospitals in Royal Oak, Troy, and Grosse Pointe, Michigan; Macomb TownshipASC LLC; Beaumont West BloomfieldASC LLC; and Beaumont Kidney Specialty Services LLC. 1 William Beaumont Hospital - Corporate Integrity Agreement 1. “Arrangements” shall mean: a. every arrangement or transaction that involves, directly or indirectly, the offer, payment, solicitation, or receipt of anything of value; and is between WBH and any actual or potential source of health care business or referrals to WBH or any actual or potential recipient of health care business or referrals from WBH; or b. every financial relationship (as defined in 42 C.F.R. § 411.354(a)) that is between WBH and a physician (or a physician’s immediate family member (as defined at 42 C.F.R. § 411.351)) who makes a referral (as defined at 42 U.S.C. § 1395nn(h)(5)) to WBH for designated health services (as defined at 42 U.S.C. § 1395nn(h)(6)). 2. The term “source of health care business or referrals” shall mean any individual or entity that refers, recommends, arranges for, orders, leases, or purchases any good, facility, item, or service for which payment may be made in whole or in part by a Federal health care program. 3. The term “recipient of health care business or referrals” shall mean any individual or entity (1) to whom WBH refers an individual for the furnishing or arranging for the furnishing of any item or service, or (2) from whom WBH purchases, leases or orders or arranges for or recommends the purchasing, leasing, or ordering of any good, facility, item, or service for which payment may be made in whole or in part by a Federal health care program. 4. “Focus Arrangements” means every Arrangement that: a. is between WBH and any actual source or recipient of health care business or referrals to WBH and involves, directly or indirectly, the offer, payment, or provision of anything of value; or 2 William Beaumont Hospital – Corporate Integrity Agreement b. is between WBH and any physician (or a physician’s immediate family member) (as defined at 42 C.F.R. § 411.351)) who makes a referral (as defined at 42 U.S.C. § 1395nn(h)(5)) to WBH for designated health services (as defined at 42 U.S.C. §1395nn(h))(6)). Notwithstanding the foregoing provisions of Section II.C.4, any Arrangement that satisfies the requirements of 42 C.F.R. § 411.356 (ownership or investment interests), 42 C.F.R. § 411.357(g) (remuneration unrelated to the provision of designated health services); 42 C.F.R. § 411.357(i) (payments by a physician for items and services); 42 C.F.R. § 411.357(k) (non-monetary compensation); 42 C.F.R. § 411.357(m) (medical staff incidental benefits), 42 C.F.R. § 411.357(o) (compliance training), 42 C.F.R. § 411.357(q) (referral services), 42 C.F.R. § 411.357(s) (professional courtesy), or 42 C.F.R. § 357(u) (community-wide health information systems), shall not be considered a Focus Arrangement for purposes of this CIA, provided that WBH maintains sufficient documentation to demonstrate compliance with the applicable exceptions to 42 U.S.C. § 1395nn (Stark Law). Such documentation shall be made available to OIG upon request. 5. “Covered Persons” includes: a. all owners, who are natural persons, officers, directors, and employees of WBH; and b. all contractors, subcontractors, agents, and other persons who furnish patient care items or services or who perform billing or coding functions on behalf of WBH excluding vendors whose sole connection with WBH is selling or otherwise providing medical supplies or equipment to WBH; and c. all physicians and other non-physician practitioners who are members of WBH’s active medical staff, including but not limited to physicians and non-physician practitioners employed or contracted through Beaumont Medical Group – Primary Care Services, Beaumont Medical Group – Specialty Services, or Beaumont Medical Group – Hospital Based Services; and 3 William Beaumont Hospital – Corporate Integrity Agreement d. Beaumont Health shared services personnel in the following departments who support WBH: Financial Services, Transcription and Coding, and Human Resources, Operations, Information Technology, Marketing, Nursing Administration, Quality, Corporate Compliance, Office of General Counsel, Chief Medical Officer, Credentialing, and Physician Recruiting. 6. “Arrangements Covered Persons” includes each Covered Person who is involved with the development, approval, management, or review of Beaumont’s Arrangements. III. CORPORATE INTEGRITY OBLIGATIONS WBH shall establish and maintain a Compliance Program that includes the following elements: A. Compliance Officer and Committee, Board of Directors, and Management Compliance Obligations 1. Compliance Officer. Within 90 days after the Effective Date, WBH shall appoint a Compliance Officer and shall maintain a Compliance Officer for the term of the CIA. The Compliance Officer shall be an employee and a member of senior management of Beaumont Health, shall report directly to the Chief Executive Officer of Beaumont Health, and shall not be or be subordinate to the General Counsel or Chief Financial Officer or have any responsibilities that involve acting in any capacity as legal counsel or supervising legal counsel functions for WBH or Beaumont Health. The Compliance Officer shall be responsible for, without limitation: a. developing and implementing policies, procedures, and practices designed to ensure compliance with the requirements set forth in this CIA and with Federal health care program requirements; b. making periodic (at least quarterly) reports regarding compliance matters directly to the Board of Directors of Beaumont Health and WBH, or their designated committees, 4 William Beaumont Hospital – Corporate Integrity Agreement and shall be authorized to report on such matters to the Board of Directors of Beaumont Health and WBH at any time. Written documentation of the Compliance Officer’s reports to the Board of Directors of Beaumont Health and WBH shall be made available to OIG upon request; and c. monitoring the day-to-day compliance activities engaged in by WBH as well as any reporting obligations created under this CIA. Any noncompliance job responsibilities of the Compliance Officer shall be limited and must not interfere with the Compliance Officer’s ability to perform the duties outlined in this CIA. WBH shall report to OIG, in writing, any changes in the identity of the Compliance Officer, or any actions or changes that would affect the Compliance Officer’s ability to perform the duties necessary to meet the obligations in this CIA, within five days after such a change. 2. Compliance Committee. Within 90 days after the Effective Date, WBH shall appoint a Compliance Committee. The Compliance Committee shall, at a minimum, include the Compliance Officer and other members of senior management necessary to meet the requirements of this CIA (e.g., senior executives of relevant departments, such as billing, clinical, human resources, audit, and operations). The Compliance Officer shall chair the Compliance Committee and the Committee shall support the Compliance Officer in fulfilling his/her responsibilities (e.g., shall assist in the analysis of WBH’s risk areas and shall oversee monitoring of internal and external audits and investigations). The Compliance Committee shall meet at least quarterly. The minutes of the Compliance Committee meetings shall be made available to OIG upon request. WBH shall report to OIG, in writing, any changes in the composition of the Compliance Committee, or any actions or changes that would affect the Compliance Committee’s ability to perform the duties necessary to meet the obligations in this CIA, within 15 days after such a change. 3. Board of Directors Compliance Obligations. The Board of Directors (or a committee of the Board) of Beaumont Health (Board) shall be responsible for the 5 William Beaumont Hospital – Corporate Integrity Agreement review and oversight of matters related to compliance with Federal health care program requirements and the obligations of this CIA. The Board must include independent (i.e., non-executive) members. The Board shall, at a minimum, be responsible for the following: a. meeting at least quarterly to review and oversee WBH’s compliance program, including but not limited to the performance of the Compliance Officer and Compliance Committee; b. submitting to the OIG a description of the documents and other materials it reviewed, as well as any additional steps taken, such as the engagement of an independent advisor or other third party resources, in its oversight of the compliance program and in support of making the resolution below during each Reporting Period; and c.
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