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<silence>

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This episode of A HLA speaking of

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health law is brought to you by A HLA members

0:11

and donors like you. For more information,

0:13

visit American health law.org.

0:21

Hello , uh, and thank you for joining

0:23

, uh, this , uh, episode of the

0:25

HLA podcast. My name is Andy

0:27

Ruskin. I'm a partner in the Washington

0:30

DC office of the Law firm of k and l Gates. Uh,

0:33

I specialize in Medicare, Medicaid , uh,

0:35

reimbursement and compliance three 40 B

0:37

, and a whole host of adjacent

0:40

, uh, areas . With

0:42

me today is , uh, my , uh,

0:44

colleague and friend, Mary Edmondson. And

0:47

Mary, why don't you tell everybody , uh, uh,

0:49

a little bit about your background,

0:52

Andy ? Um, I'm Mary Edmondson. I'm the Chief

0:54

Compliance Officer at Inova Healthcare

0:57

System. And , um, I,

0:59

I should say I'm a reformed lawyer because

1:02

I used to be an active participant in A-A-H-L-A

1:05

, and I still follow everything you all do. It's

1:08

a great organization, but now I consider myself

1:10

a compliance professional, so thanks

1:12

for having me.

1:14

Thank you, Mary. And yes, it's nice that

1:16

you wear , uh, both of those hats because some

1:19

of these issues can be very thorny. The

1:21

issue that we're talking about today specifically

1:23

, uh, is the aftermath of

1:25

the Supreme Court's super value decision

1:28

from last year. The super value

1:30

decision , uh, looked at whether or not

1:33

a , uh, a target for

1:35

, uh, FA False Claims Act investigation

1:38

would be able to have the case

1:40

dismissed if there was a

1:42

reasonable objective explanation

1:45

that could be offered for , uh, the

1:48

decisions made as to how to file certain claims

1:50

with the federal government , uh,

1:52

where in fact there may not necessarily

1:54

be evidence ahead of time , uh,

1:57

that , uh, that tho those

1:59

, uh, very same reasons were the reasons that

2:02

the entity used as to

2:04

how to decide whether to submit the claims

2:07

in exactly the way they were submitted. Uh,

2:09

obviously , uh, the False Claims Act

2:11

is incredibly important for healthcare

2:14

providers , uh, because , uh,

2:16

there are many cases , uh, that

2:18

, uh, start off as potential

2:21

billing errors that , uh, because of

2:23

any sort of , uh, circumstantial

2:26

evidence, there may be , uh, some

2:28

grounds for believing that there was

2:30

at least , uh, uh, some form

2:32

of recklessness about , uh,

2:35

submitting , uh, wrong ergo

2:37

false claims , uh, that , uh, triggers

2:40

something more than overpayment liability and

2:42

turned something into a False Claims Act case. Uh,

2:45

the, the question , uh, that everyone

2:48

was hoping for a different answer for

2:50

, uh, from the Supreme Court was

2:52

whether, if it turns out that

2:55

there was reasonable justification,

2:57

even if there was no documentation of

2:59

that , uh, at the time of the

3:02

claim submission , uh, that

3:04

that justification could after the

3:06

fact , uh, uh, provide

3:08

some form of, of , uh,

3:11

uh, immunity so to speak, from false

3:13

Claims Act liability, even if it

3:15

had not been , uh, thought of at

3:18

the time. But now, what we're understanding

3:20

from the Supreme Court is, is no,

3:22

it's really critical that

3:25

the , uh, that the claimant , uh,

3:27

have good reason for

3:30

its conduct at the time , uh, that

3:32

it's submitted the claim , uh, or

3:35

otherwise , uh, it faces False

3:37

Claims Act liability. Uh, so

3:40

that raises a whole host of, of

3:42

, um, uh, challenging questions

3:44

for, for providers as they

3:46

try to figure out how to avoid being

3:49

in situation where their only support

3:52

after an investigation has been

3:54

initiated is something that is post hoc.

3:57

Uh , and so , uh, since , uh, uh,

4:00

Mary is a Chief compliance

4:02

officer, she deals with these questions every

4:05

day. Uh, my own honest opinion

4:07

is, is that she deals with them better than most. Uh,

4:09

and so we thought it would be

4:11

useful to have a podcast about this

4:14

particular topic , uh, specifically,

4:17

how do you set up the predicate ahead

4:20

of time to make sure that those

4:22

difficult questions that could end up

4:24

in front of DOJ one day , uh,

4:27

are all vetted ahead of time, even if it

4:29

turns out you're wrong , uh, because

4:31

the government sees it a different way. What

4:34

more can you do as an organization to,

4:37

to just prepare yourself , uh,

4:39

so that , uh, if you ever do get

4:42

investigated, you can say, Hey, we, we've

4:44

processed this exactly the right way. So,

4:46

Mary, I'm gonna ask you a a bunch of questions

4:48

, uh, to get at that point. The

4:51

first of which is, is how would you ensure

4:54

that stakeholders in the organization

4:56

feel comfortable raising questions

4:58

with compliance instead of just dismissing

5:02

challenging questions is , is not so important?

5:05

Yeah. Thank you, Andy , for that question. I

5:08

, I think one thing our organization

5:10

has spent a lot of time working on is

5:14

building a culture where it's okay

5:16

to ask questions and raise your hand

5:18

and, and speak up. Um,

5:21

so my organization has worked very

5:23

hard on psychological safety, and,

5:26

you know, that is a , that's a catchphrase

5:28

that's circulated often, but we're really

5:31

drilling down what does that mean to

5:33

people? What does that mean to somebody on the front

5:35

line ? What does that mean to an executive? Um,

5:38

and that's hand in hand with our core value

5:40

of integrity. Um, of

5:43

course, as a compliance department, we want

5:45

everyone to be aware of our non-retaliation

5:47

policy. Um, we openly

5:50

take , uh, you know, have an open door policy

5:53

for direct questions coming into compliance.

5:56

And if somebody is still nervous about

5:59

speaking out about something, we have a hotline

6:01

and we publicize that hot hotline

6:04

so that there's an anonymous venue

6:06

for somebody to call or make an

6:09

after hours inquiry by email

6:11

if that, if that's something that

6:13

, um, they'd rather do. Um,

6:16

and then of course, we wanna follow up on all

6:18

those questions. Um, somebody's calling the

6:21

hotline or checking in with us on something

6:23

to be sure it's okay. We

6:25

feel so strongly about circling back.

6:28

We've gotta close the loop so that , um,

6:31

our team members, our colleagues don't

6:33

feel like it's just a black hole , uh,

6:35

that their question goes into and nobody gets

6:37

back to them. So that's something we

6:39

really try to focus on. But you know, what's

6:41

really tricky is when

6:44

you get a question or you get , um,

6:47

somebody making an offhand comment in one

6:49

of these avenues that's not so direct

6:51

, um, it's not coming

6:53

in through an email or a , or a question. It

6:55

may be a hallway conversation where

6:58

somebody says, Hey, I heard that

7:01

so and so in this department is doing such

7:03

and such . Well , um, that's

7:06

a little bit trickier because then you've got to

7:08

, um, number one for me, remember

7:11

the comment , <laugh>, of course, I'm

7:13

joking, but I take all, all those kind of

7:15

comments seriously. You have to go back to your

7:17

desk and say, you know what? I just heard, we

7:20

need to look into this. And, and then

7:22

we build , um, a way for

7:24

those non-traditional ways to be logged on

7:27

our , um, investigation log so

7:29

that we can track it really , um,

7:32

look to see if there's any there, there, and

7:34

, um, and then move along to

7:37

see what, what may open up.

7:40

That sounds great. So, so first you have

7:42

to build a , a culture of trust , uh, that

7:45

people will, will not just be able to,

7:47

to , uh, to voice their concerns,

7:49

but that they'll be listened to. But

7:52

what can you do , uh, to , to make

7:54

sure that , um, that the, this

7:56

, all of your stakeholders , uh,

7:59

feel like it's their duty? Uh, so it's

8:01

one thing to make everyone comfortable, but

8:03

how do you emphasize that it's their duty to

8:05

, uh, to actually , uh, provide that information

8:08

proactively to compliance?

8:10

Well, and that's, I'm glad you asked

8:12

that, because that's really a cornerstone of

8:14

our , um, core value of integrity.

8:17

And that message is built in

8:19

our code of conduct. It's something that we

8:22

practice on a daily basis that compliance,

8:25

the obligation of compliance doesn't

8:27

just belong to that group of individuals

8:29

in that department. Compliance belongs

8:32

to all of us. Um, and, and

8:34

as team members, we all believe

8:36

that and own that. Um , we're

8:38

only as, as good as our entire

8:41

organization. And , um, we

8:44

want to hold up our, our, you

8:46

know, mantle of integrity, not by taking

8:48

shortcuts, but by believing

8:51

in all those things we do on a daily basis.

8:55

That sounds great. So, so that's how

8:57

we get the questions in, right? You can't

8:59

do anything if you don't actually get the questions. So

9:01

what's the first step, Mary ? You get the question,

9:04

how do you decide, someone says, I

9:06

don't think this is right. Um,

9:09

but that's a person, person's view, and,

9:11

you know, and not everyone is in , in

9:14

ESQ or jd, and so we need to

9:16

get some way to actually evaluate

9:18

it. So what, what do you, what's the

9:21

first step you do to evaluate whether there's

9:23

a, there, there, as you said,

9:25

Right? So we, you've gotta dig

9:27

into the facts. And that's

9:29

something that I feel like we've all also

9:32

in the compliance department have taken on an

9:34

additional hat of being an investigator <laugh>

9:36

. So , um, or mouse

9:38

detective as my, my friends like to call

9:40

me. So, you know, we put on our detective

9:42

hats and start to dig into

9:45

the facts. Um, you know,

9:47

ask the, the who, what, where, when, why questions

9:50

nail down what department we

9:53

rely on , um, the

9:56

skillset , um, in our department, including

9:58

the coders who help us look into

10:00

medical records, if that's , um,

10:03

a logical piece of fact finding that

10:05

we need to do. Um, we also

10:07

have , um, other core , uh, core

10:10

compliance professionals that can help us interview

10:12

witnesses if that's what we need to do. So

10:15

depending on the type of , um,

10:19

scenario that's been thrown at you, you

10:21

you wanna look around to see what makes sense,

10:24

what kind of fact , um, finding

10:26

can we do here? It's not unusual

10:29

for us to reach out to our internal

10:31

audit partners if it's a real

10:33

question of financial controls. That's

10:36

, um, a situation where we

10:38

might look to them to help us dig

10:40

into the facts of a situation.

10:44

Okay . So you, you look at the facts. Do you ever

10:46

come across circumstances where

10:49

these facts are hinky, but you're not

10:51

really quite sure? Did anything really wrong?

10:53

Go on. What what do you do under circumstances

10:56

like that?

10:57

Well, that's, that's where we want

10:59

to look to see what is the, what is our

11:01

responsibility? What's the policy, what's

11:04

the regulation, what's the law that's

11:06

applicable here? And , um, you

11:09

know, if that's not always clear, and sometimes

11:11

it can be ambiguous. Um,

11:14

there , there , every now and then we have to call our,

11:16

our lawyer friends. Um, so Andy

11:18

might be getting a call from me occasionally , uh,

11:21

when these kinds of things come up, particularly where

11:24

there's not an on point manual

11:26

provision or we don't have a CMS letter

11:28

on point that helps us understand what

11:30

do they mean by this? Um , or

11:33

this seems kind of vague, what are we supposed to

11:35

do in this situation? I'm not

11:37

finding any clear guidance here. Uh,

11:39

what are we supposed to do?

11:42

So this is interesting. You mentioned both

11:45

policies as well as manual. And so

11:47

what you're, you're saying is that sometimes, even

11:50

if it's not necessarily against the law, compliance

11:52

is of course also responsible

11:55

for, for , uh, actually

11:57

, uh, making sure that the policies

11:59

of the organization are, are , are adhered to. So

12:02

in other words, it could be that the outcome

12:04

of a compliance review is,

12:06

is a warning to a particular employee

12:09

as opposed to necessarily a , a,

12:12

a repayment and that both of these fall within

12:14

the compliance department's purview.

12:16

It sure can. Andy, and, and

12:18

thanks for raising that point. Um,

12:21

I would say one of our most, you

12:23

know, active policies is our

12:25

policy on the 60 day payment rule, though

12:28

<laugh> . So , um, it's,

12:30

it , uh, comes in handy because it provides

12:33

us as a compliance department,

12:35

a bright line rule on what are

12:37

we supposed to do next? If we find X,

12:40

then we do y and that really helps

12:42

us , um, with scoping

12:45

and, you know, making sure there's not

12:47

scope creep that we're really staying within

12:49

the confines of our question , um,

12:52

and drilling down on those important

12:54

details.

12:56

Yeah, and , and I, I, I would echo

12:58

that having a good , uh, six city , uh,

13:01

repayment , uh, rule , uh, policy

13:03

is really helpful because the , the

13:06

guidance from CMS, while detail does

13:08

not answer every question and not

13:10

every answer from CMS that they give is

13:12

practical. And so organizations

13:14

, uh, should try to figure out for themselves

13:17

what are they willing to live with, and having

13:19

some level of detail to be able

13:21

to distinguish between the real issues versus

13:24

the, yeah, there's just some noise there.

13:26

It's not really a repeat issue. Could be

13:28

very , uh, very helpful. So , um,

13:31

so you mentioned that, that , uh, compliance

13:33

couldn't possibly do this all on their own.

13:36

Uh , and we certainly expect that

13:38

everyone within the organization understands that

13:41

in , in some, in some fashion, they're all wearing two

13:44

hats. Everyone is a deputy in

13:46

the compliance , uh, department

13:49

in some, in some form or another. Um,

13:51

but are there certain , uh, other departments

13:53

you rely on specifically

13:56

, um, as you are trying to, to

13:58

figure out whether or not , uh, an

14:00

issue is, is truly an

14:02

issue, or if it's just something where , uh,

14:05

there might have been a misunderstanding , uh,

14:08

by an individual or two within the organization?

14:12

Absolutely. Um, there , it would be

14:14

impossible to do this job on our fire

14:17

cells and in a silo. We have a

14:19

very close relationship and a working

14:21

group that meets regularly with

14:24

our revenue integrity colleagues, as

14:26

well as our coding operations colleagues,

14:28

so that we are all on the same page when

14:31

there are questions that arise on just

14:33

day-to-day operations. Um, how can

14:35

we align and make sure that we're doing

14:38

the right thing as we, as

14:40

we move along? Um, and

14:42

of course, there, there are times when , um,

14:44

there may be a real discreet part

14:46

of the regulations that I don't come across every

14:49

day , um, where I

14:51

rely on , uh, the clinicians that

14:53

work here in the organization to

14:55

help us understand what, you know, what

14:58

is our operational practice, how does,

15:00

how does this work practically? Uh

15:02

, and sometimes that's just as important , um,

15:05

not more important than, than the law,

15:07

but we need to understand those things in

15:09

order to have an appreciation

15:11

for potential corrective measures

15:14

and, and , um, what are our

15:16

peer organizations doing? Um,

15:19

and when you're working with, let's

15:22

say we're drilling down on a particular investigation,

15:25

and , um, it looks like we're

15:27

thinking through potential corrective

15:29

measures, and we want to , um,

15:32

work hand in hand with our operational

15:34

teams to be sure that whatever we

15:36

are recommending makes sense practically,

15:39

you know, it's gotta be able to, to have

15:41

a functional workflow in order for

15:44

it to be effective. And

15:46

, um, we don't wanna recommend things that

15:48

are just going to sit in an inbox

15:50

and not , um, be practical

15:53

and workable. Um, so that's,

15:56

that's really important to involve all

15:58

those folks. And, you know, sometimes

16:00

somebody who may raise this, I mentioned a hallway

16:02

conversation, Hey, I

16:04

heard this is going on over there,

16:07

and you guys may wanna look into it eventually,

16:10

we wanna get back to that person too. You

16:13

know, we wanna be sure and say, Hey, I'm

16:15

so glad you said something to me

16:18

because we looked into it and here's

16:20

what we found. And I want you to be aware that

16:22

, um, we

16:24

do things more formally too. We have

16:26

compliance billing alerts we share

16:28

with our colleagues , um, and

16:31

we of course try to get on meeting agendas

16:33

for our service line leaders to speak

16:35

about recent investigations and

16:38

outcomes , um, when that happens, so

16:40

that everybody's aligned and on

16:42

the same page and hearing this message from

16:45

compliance department.

16:48

Yeah. So what , what one of several things

16:50

that I heard there. One is that , um,

16:52

it's important that you have allies, and

16:54

that even though everyone theoretically

16:57

has their own mandate as to what

16:59

they're supposed to do on their, in their

17:01

day to day , that , um, that there's

17:03

always going to be some overlap. And it's important that

17:06

people don't , uh, uh,

17:08

put fences around their turf that essentially

17:11

everyone needs , uh, to , to work together. Um,

17:14

uh, and that secondly , um, compliance

17:17

is not , uh, compliance's goal

17:19

is not to be , uh, uh,

17:22

the , uh, the traffic cop. They're not supposed

17:24

to be there just to say, Hey, you

17:26

can't do that and tell someone stop

17:28

or No, your goal is just to come up with

17:30

a practical solution that will allow

17:33

something to actually move forward , uh,

17:35

in a, in a sensible fashion. Um,

17:38

and that to do so, you have to see

17:40

it from their perspective before , uh,

17:42

before you're able to tell them, well, this could

17:44

work for you and it would be compliant. So

17:47

, um, so it is , it is

17:49

really important that it be a give and take as opposed

17:51

to , uh, compliance , uh, sitting

17:53

up from , uh, from up high and

17:55

, uh, and , and make passing judgment. So

17:58

, um, um, so that's

18:00

, uh, I , that those are all very , um, uh,

18:02

helpful , um, uh, helpful ways

18:04

for, for people to be thinking about , uh,

18:07

that particular role. And they also

18:09

will all go towards helping to

18:11

avoid being in a situation where

18:14

you're in a super value . If you are

18:16

, uh, if if communications

18:18

from compliance are one way and they're

18:20

all driven, pushing out, then

18:22

it's hard for compliance to get that information , uh,

18:25

uh, in , uh, taken , uh,

18:27

from the other business , uh,

18:29

units. And as a result, then

18:32

, uh, you will, you

18:34

will be surprised when , uh, when you

18:36

, you're settling investigated for , uh,

18:38

for reasons that you never knew about because no one shared

18:40

it with you. So , um, okay.

18:43

So Mary , uh, you and I are

18:45

both aware that there was this recent Christiana

18:48

case , uh, where , uh, there

18:50

were accusations that , uh,

18:52

Christiana allowed , um, uh,

18:54

its apps , uh, to be

18:57

, uh, used by , uh, clinicians

18:59

who were then billing for , uh,

19:02

the services of the apps as if

19:04

it was incident two, even though the

19:06

apps were employed by the provider

19:08

and could not actually be , uh,

19:11

billed as incident two under under

19:13

Medicare rules. Um, it looks

19:15

from, from public reporting that

19:18

, um, that the compliance

19:20

office may very well have

19:23

raised a couple of issues, but those issues

19:25

had not necessarily been thoroughly vetted

19:27

by compliance until , uh,

19:30

DOJ uh , came in on the backend.

19:32

We know that split shared billing is

19:35

an incredibly complicated area, and for all we

19:37

know, Christiana may very well have had a

19:40

number of, of defenses that they

19:42

had tried to put out there based

19:44

upon some of these split shared billing rules

19:47

or what have you. Um , but

19:49

it ended up being a very sizable settlement,

19:52

all the same. Um, do

19:54

you , uh, see any lessons learned , uh,

19:57

with respect to Christiana

19:59

, uh, you know, taking into account

20:01

some of the super value , uh, decision

20:04

factors that you think other

20:06

organizations should say, Hey,

20:08

I really should do X, so , so I'm not in

20:10

a , in a similar situation where I have , uh, an

20:12

eight figure or retainment , uh, to the government,

20:17

Right? Well, I certainly wanna

20:19

avoid that at all, <laugh>

20:21

. Um, the Christiana

20:23

case , uh, was certainly

20:25

troubling. And the , you know, I've

20:28

dug into some of those media releases

20:30

as well, and it

20:32

was the chief compliance officer who was the

20:34

whistleblower there, which is fascinating.

20:36

And some of the reports make

20:39

it look like that some of the work had been

20:41

done, but that it was, there was

20:44

inability to roll it out. So what do you

20:46

do if you come up with recommendations,

20:49

you see the problem, you have a

20:51

recommended solution, and

20:54

your counterparts or the leaders

20:56

in your organization , um,

20:59

are troubled by this and not willing to

21:01

, to move? Well, you

21:03

know, I knock on wood,

21:05

that never happens to

21:07

me or any of my , uh, the potential

21:10

listeners out there, because that is

21:13

very scary indeed. Um, I

21:16

think that several things

21:18

come to mind when thinking about that one.

21:22

Um, if you feel like , uh,

21:24

you've escalated to the extent

21:26

that you can, you've, you've gone

21:28

up through all the ranks, you've , um,

21:31

discussed what due diligence you've

21:33

done, what fact finding you've

21:35

done, you've proposed the solution, the

21:38

, the law, maybe ambiguous

21:42

may be clear. What if they're not acting,

21:44

then , um, that's where you really

21:46

want a good relationship with your board.

21:49

Um, I'm, I'm really thankful that I've

21:51

got that , um, dotted line

21:53

to the, the chair or somebody on

21:55

the board and meet with them regularly.

21:58

I think you might even wanna talk to , um,

22:01

your committee chair, your board chair about

22:03

potentially meeting every

22:05

now and then so that it doesn't see

22:07

, seem so unusual if you go into

22:10

executive session with them. Um , make

22:12

it look like this is a regular thing and it

22:14

should be happening, that you have those kind of closed

22:17

door discussions so that you can

22:20

escalate to that board member when you're

22:22

not getting the kind of traction that you want.

22:26

Um, uh,

22:28

that, that I think, has gotta

22:30

be critical, critical to go into

22:33

that executive session and ask for that reinforcement

22:36

and the support. Um, fortunately

22:39

for me , um, here, I,

22:42

anytime I've said , um, you

22:45

know, we have to hold claims right

22:48

now , uh, for these federal payers

22:51

because of this, I have

22:53

never gotten pushback, and I think

22:55

I'm lucky. I hope that my

22:57

colleagues out there have that same

23:00

kind of cooperation where

23:02

you get to take a pause and

23:05

have that opportunity to do some

23:07

really important digging to make sure you're

23:09

getting it right. Um, because we don't

23:12

want a claim to drop if it's not right.

23:14

And , um, I, I feel

23:16

really lucky to work for an organization

23:18

that takes those requests so seriously

23:21

and doesn't hesitate.

23:24

So , so we've talked previously

23:26

about everyone is, is, is

23:29

to some extent a deputy of the compliance department.

23:31

What I'm hearing you say is, is that goes

23:33

all the way up to the, to CC

23:36

the c-suite, as well as to the board itself.

23:39

Uh, and that , um, whatever someone

23:42

in your role can do to , to

23:44

foster those, those , um, uh,

23:47

relationships that is going

23:49

to pay off in spades in terms

23:51

of avoiding a situation where compliance

23:55

is , um, is not just vetoed,

23:57

but vetoed without potentially

23:59

any alternative explanation, having

24:01

been thought through and documented

24:04

, um, and potentially li lying

24:06

out there as a, as a, you know, as

24:09

a grenade that's just waiting to go off.

24:11

Uh , so , uh, so , so

24:14

leadership

24:15

Question for you , Andy , if you don't , if this is a good

24:17

time,

24:19

Go for it .

24:19

Okay. So as

24:22

you know, we have the 60 day payment

24:24

rule policy that we work on , um,

24:27

that requires us to do a lot of

24:29

due diligence, and , um, sometimes

24:32

we start to get

24:35

close to that 180 days

24:37

or , um, you know, the, the , the

24:39

long period of time that you get for

24:41

the due diligence. We're getting

24:44

very close to that mark and may even surpass

24:46

that. Mark, what, what

24:48

should somebody in our position do to

24:52

demonstrate to the government , um, if

24:54

they come to investigate that you have been

24:56

taking reasonable steps , uh,

24:59

related to the 60 day repayment

25:01

rule?

25:02

Yeah , uh, excellent question, Mary. This

25:04

comes up all the time because , uh, even

25:06

if you dedicate a ton of resources

25:09

to fixing a problem, sometimes those problems

25:11

are really intractable and

25:14

will require quite a bit more time than

25:17

the six months the government gives you

25:19

to, to try to , uh, uh,

25:21

figure out all of your due diligence and

25:23

then take the additional 68 to make

25:25

the payment. So the, the , this

25:27

, the most important thing is, is that you

25:29

don't let something just fester

25:31

you. Uh, you should routinely

25:35

check in and make sure that activity

25:37

has occurred with respect

25:39

to a particular issue, so

25:41

that it's very clear that

25:43

, uh, that there's no stalling , um,

25:46

uh, because the, not to get too

25:48

hyper-technical here, but if

25:50

you don't, if you don't actually make

25:53

a repayment of an amount

25:55

that is due , uh, under the six

25:57

day repayment rule, then that becomes a

26:00

, what's called a quote unquote obligation

26:02

under the False Claims Act. And

26:04

, uh, and knowingly , uh,

26:07

an improperly concealing an

26:09

obligation is one of the triggers

26:11

for , uh, for the false, for false

26:14

Claims Act liability. So if you can

26:16

say, well, we are not , we

26:18

haven't done anything knowingly and improperly

26:21

because even though we're outside

26:24

of the, you know, the six , the

26:26

six months in , in 60 days , uh,

26:29

IE eight months, we still are

26:31

working this in a reasonable

26:33

fashion. Uh , then it's not

26:35

knowing an improper , uh,

26:38

concealment of, of , of a particular

26:40

or retention of a , of a particular obligation.

26:43

And so the goal is, is always to

26:46

demonstrate reasonableness , uh, and

26:49

steadfastness in terms of the approach that

26:51

you're taking , uh, to, to handling

26:53

an issue. My suggestion as well

26:55

is always to document every instance

26:58

in which , uh, the issue has been touched,

27:01

as well as the next step and, and , uh,

27:03

some sort of timeframe to make it

27:06

very clear that this isn't just supposed to

27:08

happen organically. That in

27:10

fact , uh, the organization is taking all

27:12

reasonable measures to bring an issue

27:14

to a close in whatever is

27:16

the most reasonably expeditious fashion

27:19

possible. Uh , so by

27:21

doing so, it would be very hard for the

27:23

government to say that even if it took a

27:26

year or two years, that it necessarily

27:29

was due to in , uh, inattention by

27:31

the, the entity , um, and

27:33

that ultimately this got taken care

27:35

of in the minimum reasonable

27:38

amount of time , uh, necessary

27:40

, uh, to, to be able to handle that

27:42

particular issue. So, yeah

27:45

,

27:45

Um , I could agree more. Andy and I,

27:48

I think it's also great if you can document

27:51

and keep those notes under privilege , um,

27:53

to protect yourself and

27:56

keep , keep track, you know, it's

27:58

not only a great , um, documentation

28:02

practice, but it helps you with your next

28:04

steps and to-dos, and it's constant , you

28:06

know, constantly there and being monitored. So,

28:09

great tips . Yeah .

28:11

Yeah. So it so much complexity

28:13

in , in a lot of, a lot of the stuff too

28:15

, um, especially in areas like

28:18

research , uh, which is just so, it's

28:20

a whole world unto itself. So , um,

28:23

well , uh, with that , uh, we will

28:25

close this out. Um, I just wanna say

28:28

thank you to all the listeners for giving us an

28:30

opportunity , uh, to present our

28:32

experiences on this particular

28:34

topic. And if everyone looked at

28:37

super value last year and said, shucks,

28:39

I really had hoped that , uh, that

28:41

I was going to be able to , uh,

28:43

limit my responsibilities for, for

28:45

doing due diligence on the front end. Uh,

28:48

hopefully Mary and I have convinced you it's really not so

28:50

terrible. It really does , uh,

28:52

come down to , uh, creating a

28:54

culture where compliance is, is

28:57

respected , um, and is an , uh,

28:59

a good business partner. Um,

29:02

and , uh, when that happens, then

29:04

it all happens organically, even

29:06

if there's still, still a still a lot of hard

29:08

work that that occurs. Uh, so

29:10

, uh, Mary, thank you so much for sharing

29:13

your wisdom today. Uh, and

29:15

with that, we will , uh, we will conclude.

29:25

Thank you for listening. If you enjoy

29:27

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29:41

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