PROCEDURES.
WITHIN 120 DAYS AFTER THE EFFECTIVE
DATE, TENET SHALL IMPLEMENT WRITTEN POLICIES AND PROCEDURES REGARDING TENET'S
OPERATIONS AND ITS COMPLIANCE WITH FEDERAL HEALTH CARE PROGRAM REQUIREMENTS.
AT
A MINIMUM, THE POLICIES AND PROCEDURES SHALL ADDRESS THE FOLLOWING SUBJECT
AREAS:
A.
BILLING AND REIMBURSEMENT.
THESE POLICIES AND PROCEDURES SHALL
BE DESIGNED TO ENSURE THAT TENET COMPLIES WITH THE FEDERAL HEALTH CARE PROGRAMS
REQUIREMENTS ON BILLING AND REIMBURSEMENT, AND SHALL INCLUDE THE FOLLOWING:
(I)
ENSURING THE PROPER AND ACCURATE PREPARATION AND SUBMISSION OF
CLAIMS TO FEDERAL HEALTH CARE PROGRAMS;
(II)
ENSURING THE PROPER AND ACCURATE DOCUMENTATION OF MEDICAL
RECORDS;
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(III)
ENSURING THE PROPER AND ACCURATE SUBMISSION OF COST REPORTS
SUBMITTED TO THE FEDERAL HEALTH CARE PROGRAMS;
(IV)
CONDUCTING PERIODIC BILLING AND CODING REVIEWS AND AUDITS AT TENET
HOSPITALS;
(V)
ENSURING THAT EACH TENET HOSPITAL HAS AN ESTABLISHED CHARGE
STRUCTURE WHICH IS APPLIED UNIFORMLY TO EACH PATIENT AS SERVICES ARE FURNISHED
TO THE PATIENT AND WHICH IS REASONABLY AND CONSISTENTLY RELATED TO THE COST OF
PROVIDING SERVICES (CONSISTENT WITH THE PROVIDER REIMBURSEMENT MANUAL);
(VI)
MONITORING ALL CHANGES TO THE CHARGEMASTERS AT TENET HOSPITALS TO
ENSURE REVIEW AND APPROVAL BY APPROPRIATE TENET PERSONNEL; AND
(VII)
REPORTING AND REPAYMENT OF ALL IDENTIFIED OVERPAYMENTS TO FEDERAL
HEALTH CARE PROGRAMS AND OTHER PAYORS.
B.
COMPLIANCE WITH THE ANTI-KICKBACK STATUTE AND STARK LAW.
THESE
POLICIES AND PROCEDURES SHALL BE DESIGNED TO ENSURE THAT EACH EXISTING AND NEW
OR RENEWED ARRANGEMENT DOES NOT VIOLATE THE ANTI-KICKBACK STATUTE, 42 U.S.C. §
1320A-7B(B), AND/OR THE PHYSICIAN SELF-REFERRAL LAW ("STARK LAW"), 42 U.S.C. §
1395NN, OR THE REGULATIONS, DIRECTIVES, AND GUIDANCE RELATED TO THESE STATUTES,
AND SHALL INCLUDE THE FOLLOWING:
(I)
CREATING AND MAINTAINING A DATABASE OF ALL EXISTING AND NEW OR
RENEWED FOCUS ARRANGEMENTS THAT SHALL CONTAIN THE INFORMATION SPECIFIED IN
ATTACHMENT 1 (FOCUS ARRANGEMENTS DATABASE);
(II)
TRACKING REMUNERATION TO AND FROM ALL PARTIES TO EACH FOCUS
ARRANGEMENT;
(III)
TRACKING SERVICE AND ACTIVITY LOGS TO ENSURE THAT PARTIES TO THE
FOCUS ARRANGEMENT ARE PERFORMING THE SERVICES REQUIRED UNDER THE APPLICABLE
FOCUS ARRANGEMENT(S);
(IV)
MONITORING THE USE OF LEASED SPACE, MEDICAL SUPPLIES, MEDICAL
DEVICES, EQUIPMENT, OR OTHER PATIENT CARE ITEMS TO ENSURE THAT SUCH USE IS
CONSISTENT WITH THE TERMS OF THE APPLICABLE FOCUS ARRANGEMENT(S);
(V)
ESTABLISHING AND IMPLEMENTING A WRITTEN REVIEW AND APPROVAL
PROCESS FOR ALL ARRANGEMENTS, INCLUDING BUT NOT LIMITED TO A LEGAL REVIEW OF
FOCUS ARRANGEMENTS BY COUNSEL WITH EXPERTISE IN THE ANTI-KICKBACK STATUTE AND
STARK LAW AND APPROPRIATE DOCUMENTATION OF ALL INTERNAL CONTROLS, THE PURPOSE OF
WHICH IS TO
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ENSURE THAT ALL NEW AND EXISTING OR RENEWED ARRANGEMENTS DO NOT VIOLATE THE
ANTI-KICKBACK STATUTE OR STARK LAW;
(VI)
REQUIRING THE CHIEF COMPLIANCE OFFICER, OR APPROPRIATE DESIGNEE,
TO REVIEW THE FOCUS ARRANGEMENTS DATABASE, INTERNAL REVIEW AND APPROVAL PROCESS,
AND OTHER ARRANGEMENTS PROCEDURES ON AT LEAST A QUARTERLY BASIS AND TO PROVIDE A
REPORT ON THE RESULTS OF SUCH REVIEW TO THE BOARD COMMITTEE;
(VII)
IMPLEMENTING EFFECTIVE RESPONSES WHEN SUSPECTED VIOLATIONS OF THE
ANTI-KICKBACK STATUTE AND STARK LAW ARE DISCOVERED, INCLUDING DISCLOSING
REPORTABLE EVENTS AND