One on one

Levin­son talks Stark law, big data

Modern Healthcare - - THE WEEK IN HEALTHCARE - Joe Carl­son

Ed­i­tor’s note: Daniel Levin­son, HHS’ in­spec­tor gen­eral, sat down with Mod­ern Health­care re­porter Joe Carl­son for an ex­clu­sive in­ter­view last week af­ter Levin­son ad­dressed thou­sands of com­pli­ance of­fi­cers at the Health Care Com­pli­ance As­so­ci­a­tion’s an­nual Com­pli­ance In­sti­tute in Las Ve­gas. The ques­tions and an­swers have been edited for clar­ity and space.

Mod­ern Health­care: One of the things I hear a lot from providers is that the Stark law is sim­ply too complicated.

Levin­son: Un­for­tu­nately, I’m not in charge of de­cid­ing what the law should be when it comes to health­care com­pli­ance. We have an ar­ray of statutes of which Stark is a very im­por­tant part. And our job in the IG’S of­fice is to en­force all the laws that we are em­pow­ered to en­force.

Mod­ern Health­care: So you’re en­forc­ing the law as it is, you’re not mak­ing the law.

Levin­son: That’s the job of the in­spec­tor gen­eral’s of­fice when it comes to not only the Stark law, the False Claims Act, all the five laws I men­tioned (the anti-kick­back statute, the civil mon­e­tary penal­ties law and the ex­clu­sions statute). We take our obli­ga­tion, our re­spon­si­bil­ity that is given to us by law­mak­ers, very se­ri­ously, and we en­force those laws ag­gres­sively but fairly.

Mod­ern Health­care: Is the Stark law too puni­tive? Does it pe­nal­ize things that are sort of mi­nor, in a ma­jor way?

Levin­son: You know, I un­der­stand the rea­sons for the Stark law, and we en­force that law as it is, in a way that we try to do jus­tice to what was in­tended by it.

Mod­ern Health­care: Any thoughts on the CMS’ ef­forts to use big data, as you said be­fore, and dig­i­tal tools, data-min­ing?

Levin­son: Those ef­forts are still be­ing rolled out, if I un­der­stand the pos­ture of where those things are right now. We need to look at whether the hoped-for re­sults are hap­pen­ing. I think we’re in the process of eval­u­at­ing the CMS’ ef­forts.

Mod­ern Health­care: Hard to say One PI (a project in­te­grat­ing claims data across Med­i­caid and all parts of Medi­care) hasn’t had some time to come into be­ing.

Levin­son: Yeah, well, things in­vari­ably take longer than we would like to see them hap­pen. We re­ally don’t tend to com­ment on where things are when it comes to tech­no­log­i­cal de­vel­op­ments. And I don’t think that we’ve ac­tu­ally is­sued any re­ports on that.

Spokes­woman Roberta Baskin: No, it’s not some­thing you want to talk about be­cause of your role in terms of over­sight of it down the road. But there’s been a lot that has been done in terms of data-min­ing and data-anal­y­sis in the OIG en­force­ment ef­forts.

Levin­son: To a cer­tain de­gree, I think the suc­cesses we’ve had on be­ing able to get real-time data on some of the Strike Force cases we’ve been deal­ing with is be­cause the CMS has been able to sup­ply it. This data isn’t ours. This data, in terms of gov­ern­ment own­er­ship, is by and large the CMS’. To a cer­tain de­gree, you can say that what CMS is do­ing is al­low­ing us to do in many cases the kind of job in pro­tect­ing the pro­grams that in the past we weren’t in a po­si­tion to do.

Deputy In­spec­tor Gen­eral Larry Gold­berg: And one is­sue, of course, is it does not now in­clude Med­i­caid data, largely since that would come from each par­tic­u­lar state. So the goal is for it to be­come more com­pre­hen­sive.

Mod­ern Health­care: I was in­ter­ested in your idea, the thing you men­tioned be­fore about dep­u­tiz­ing com­pli­ance of­fi­cers. Could you talk a lit­tle bit more about that, about how you think a com­pli­ance of­fi­cer should be viewed or you hope they could be viewed in an or­ga­ni­za­tion?

Levin­son: Yeah, the pur­pose was to un­der­score the value that we place on cor­po­rate com­pli­ance of­fi­cers and the im­por­tance that they should be viewed as hav­ing within their or­ga­ni­za­tion. The kind of chat­ter that ex­ists around con­fer­ences like that is cor­po­rate com­pli­ance of­fi­cers do not get the kind of hear­ing, at least in some venues, that they should have in or­der for their mes­sage to be ef­fec­tive. It’s un­for­tu­nate not only for them and for their provider, but for our pro­grams.

When I hear about the kinds of stress lev­els in­duced (on) com­pli­ance of­fi­cers who feel like they aren’t be­ing lis­tened to, I think that is a cause for con­cern. And I think it is an im­por­tant mes­sage to send to com­pli­ance of­fi­cers in the com­mu­nity that I view their role as very, very im­por­tant. And their role should be viewed as very im­por­tant within their or­ga­ni­za­tion.

Mod­ern Health­care: The CMS just re­leased their pro­posed reg­u­la­tions for the 60-day re­pay­ment rule. Is that some­thing where you are com­mu­ni­cat­ing with them? And do you have any thoughts on that rule and how it works? And if your of­fice would be in­volved with it as well?

Levin­son: I’m not talk­ing at the mo­ment to the CMS about it, but then again, I per­son­ally don’t of­ten have oc­ca­sion to be able to do that in the course of these things.

Mod­ern Health­care: You wouldn’t be able to of­fer an opin­ion on the 60-day re­pay­ment rule?

Levin­son: I wouldn’t now, no.

Mod­ern Health­care: Any­thing else you think is im­por­tant to bring out?

Levin­son: I think the fact that we have 2,700 peo­ple at­tend­ing this con­fer­ence is a pos­i­tive in­di­ca­tion that the world of com­pli­ance is get­ting big­ger. And from the in­for­mal con­ver­sa­tions I have had, is get­ting more so­phis­ti­cated. It is draw­ing more im­pres­sive tal­ent, as the stakes get larger and more peo­ple are un­der­stand­ing that where we are headed with co­or­di­nated care and this em­pha­sis on qual­ity means a larger and more strate­gic role that com­pli­ance of­fi­cials might play in the fu­tures of their or­ga­ni­za­tions.

Levin­son

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