As public light shines on Medicare payment data to medical providers, planning becomes key

Medicare payment data

Posted by Kimberly Zeoli , Partner, Governance, Regulatory & Risk Services Practice, Deloitte & Touche LLP on April 16, 2015.

Recent news articles talk about how Medicare payment data won’t stay pent up in the databases of providers and federal agencies. For example, it was recently reported that Medicare will publish physician-payment data yearly. This information is finding its way into the spotlight as news organizations and other groups aggressively seek to understand more about how Medicare dollars flow to healthcare providers.

The heightened curiosity surrounding Medicare payment data should prompt healthcare organizations to ask important questions about what they are billing and why they are billing it. On one hand, organizations with many physicians on staff should understand that high volumes or potential anomalies in payment data aren’t necessarily a sign of impropriety. On the other hand, these organizations should become serious about understanding the implications of detailed Medicare payment data and other relevant information available in the public realm. While there are many considerations that organizations will need to evaluate, below highlights four key points for organizations to know now.


King v. Burwell: the Supreme Court as a catalyst

US Supreme Court building

Posted by Anne Phelps, Principal, US Health Care Regulatory Leader on February 27, 2015.

On March 4, 2015, the Supreme Court will hear arguments in King v. Burwell, a case that challenges an important coverage provision of the Affordable Care Act (ACA). The ACA makes federal tax credits available to certain individuals to help them offset their premiums when they purchase coverage on an insurance Exchange established by a state. If the state does not elect to establish an Exchange, the ACA charges the HHS Secretary with establishing and operating one within the state. The IRS has made the federal tax credits available to certain individuals who purchase health insurance on both state-run and federally-facilitated Exchanges through regulatory rules.

The major issue that the Supreme Court will determine is whether the IRS has the authority to make federal tax credits available to individuals who purchase coverage through the federally-facilitated Exchanges. To date, 34 states have elected not to run insurance Exchanges of their own and have defaulted to the federal government. If the Supreme Court invalidates the IRS rule, millions of Americans who are receiving tax credits through the federally-facilitated Exchanges would lose these subsidies.


Cross-Industry Compliance Leadership Summit finds we have a lot in common


Posted by Tom Rollauer on February 19, 2015.

Regulation can apply to each of our industries in such specific ways—from a liquidity coverage ratio in banking to an ICD-10 code in medicine—that we may sometimes feel the very process of regulatory compliance is unique to our industries too. It isn’t, of course. Regulatory compliance is an experience we share across many ways of doing business.

On October 29, 2014 Deloitte’s Center for Regulatory Strategies invited more than 30 corporate compliance chiefs, regulators and others to use that common experience as a bridge. The Cross-Industry Compliance Leadership Summit was a day-long dive into well-earned wisdom and leading practices across not only financial services and healthcare but also energy, education, life sciences, retail, and other sectors.


An ethical culture helps uphold the rules—but it doesn’t begin with them


Posted by Keith Darcy on February 19, 2015.

Culture is one of those words we use a lot, but have trouble getting our hands around. At our recent Cross-Industry Compliance Leadership Summit at Deloitte University, we gave it a try. Compliance leaders from the financial services, healthcare, life sciences, consumer, energy, and other industries joined me and several of my Deloitte colleagues to discuss the challenges in culture-building that extend across disparate industries—and the common strategies as well.

The heart of the discussion focused on the notion that a culture of compliance is made up of human interactions. The right attitude can be worth more than the number of rules you promulgate. Fostering trust is a good way to earn it back. Organizations that build trusting relationships with stakeholders experience reciprocity from them.


To assess compliance, look beyond the rules

Culture Posted by Paul Campbell on February 19, 2015.

I recently moderated at an interactive discussion on evaluating compliance programs at Deloitte’s Cross-Industry Compliance Leadership Summit, where compliance executives from a variety of industries compared notes on the methodologies and metrics they use to measure their efforts.

“If my compliance program prevents, that’s great,” one attendee stated. “If it fails to prevent but detects, that’s okay too. Where it ultimately fails is if there’s management inaction.”


Building relationships with regulatory agencies


Posted by Peter Reynolds on February 19, 2015.

When a number of C-level compliance officers joined me recently for a discussion about their relationships with regulatory agencies, it was more than a meeting, it was an education. That’s because we had two regulators with us, and the give and take between them and among the other Compliance officers—the candor, and constructive input—could serve as a model for regulatory interactions all year round.

The occasion was Deloitte’s Cross-Industry Compliance Leadership Summit. Chief Compliance Officers from energy, healthcare, finance, retail, and other sectors all took part, as did Jim Sheehan from the New York State Attorney General’s office and Carlo di Florio, Chief Risk Officer of the Financial Industry Regulatory Authority (FINRA).


NFA reps say examinations vary, and cooperation is part of the answer

NFA reps say examinations vary, and cooperation is part of the answerPosted by Mike Prokop, Director, Deloitte & Touche LLP

On October 2, 2014, two representatives of the National Futures Association (NFA) — an independent self-regulatory organization for the futures industry — co-led a discussion on that body’s examination approach as part of Deloitte’s Dodd-Frank Compliance Leadership Academy.

Dale Spoljaric, managing director of NFA’s Compliance section, and Michael Brosius, director in NFA’s OTC Derivatives section, pointed out that the NFA has substantial authority. In addition to communicating information about violations to the CFTC, it can also bar an NFA member from doing business with other member firms, discipline members that violate its rules, and facilitate arbitrations between its members. In conducting examinations, the NFA can look at any activity covered by CFTC regulations.


On SDR reconciliation, energy companies find reasons to exceed requirements

On SDR reconciliation, energy companies find reasons to exceed requirementsPosted by Mike Prokop, Director, Deloitte & Touche LLP

At a panel discussion I recently facilitated on swap data repository (SDR) reconciliation, fewer than half the energy industry attendees said they have a solution in place for that function. Still, at least one participant said reconciling data in the SDR is a good idea because it enhances end-users’ understanding of the information being reported and serves as an internal risk mitigation measure. Our October 3, 2014 discussion was part of Deloitte’s Dodd-Frank Compliance Leadership Academy.


Energy companies eye compliance monitoring; panel advises close ties with business

Energy companies eye compliance monitoring; panel advises close ties with businessPosted by Paul Campbell, Principal, Deloitte & Touche LLP and Ron Chovanec, Specialist Leader

Trade surveillance is a rising concern in the energy industry, and regulators have an increasing expectation that companies in the industry will have trade monitoring solutions in place. At Deloitte’s Dodd-Frank Compliance Leadership Academy on October 2, 2014 we joined a group of industry representatives in a panel discussing where trends are headed.

Establishing a trade monitoring and surveillance program isn’t just to avoid regulatory scrutiny. Internally, it can also make the gathering, review, and presentation of trade data a lot easier. But there are challenges involved. When you gather more data, regulators may ask for more data. Compliance teams will need to partner with people on the operational side to review what they learn. Management buy-in, budget, and other resources can stand between the blueprint and the reality. And while a monitoring system may be simple in concept, applying it across multiple divisions can be less simple, especially in a global organization.


In compliance data, quality rivals quantity

Energy companies eye compliance monitoring; panel advises close ties with businessPosted by Paul Campbell, Principal, Deloitte & Touche LLP and Howard Friedman, Director, Deloitte & Touche LLP

“Our best metric is still a gut feel.” That’s how one panelist summed up his company’s approach to making sure its compliance program provides the most useful feedback.

That comment was part of a panel discussion on compliance data benchmarks we facilitated on October 2, 2014 as part of Deloitte’s Dodd-Frank Compliance Leadership Academy. The participants were eager to get in front of compliance trends so they could apply the indicators today they’ll need to report on tomorrow. And while many of those indicators arise directly from the compliance function, we found it’s just as important to keep abreast of operations-related data, such as the management of physical assets.

But first, back to that “gut feel.” One theme that ran through our discussion was the need to take a broad view of what constitutes useful compliance data.



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