Business Integrity Program: Ensuring UW Health is complying with federal and state regulations

The main function of the Business Integrity Program is to create a comprehensive strategy to ensure UW Health is consistently complying with the federal and state regulations relating to our missions. Business Integrity has six offices that assist with this function:

• Corporate Compliance

• Reimbursement Compliance

• Internal Audit

• Privacy

• Pharmacy Compliance

• Research Billing Compliance

Corporate Compliance

The primary function of the Corporate Compliance Department is to ensure UW Health complies with federal and state regulatory requirements, provides compliance oversight to UW Health for matters that span the organization and promote corporate responsibility.

The Corporate Compliance Department is responsible for central policy development, including the Code of Conduct and the UW Health Compliance Plan. This department also monitors the Conflicts of Interest process for UW Health staff and coordinates interactions with outside industries.

Reimbursement Compliance

The mission of the Reimbursement Compliance Office is to ensure UW Health medical staff and employees comply with the regulatory requirements, including, but not limited to, documentation, coding and billing, HIPAA, fraud and abuse laws, the Stark Law and the Anti-Kickback Statute. This mission is accomplished through educational sessions, clarification of specific regulatory issues and the completion of internal reviews/audits.

Internal Audit

The UW Health Internal Audit Office is an independent and objective resource of UW Health. It provides assurance and consulting services designed to assist UW Health in achieving its mission by evaluating and offering recommendations to improve the effectiveness of financial accounting and reporting, information technology, internal control and operational- and compliance-related activities.

Privacy

The mission of the Privacy Office is to ensure UW Health medical staff and employees comply with the regulatory requirements of the Health Insurance Portability Accountability Act (HIPAA), state privacy regulations and UW Health's privacy policies and procedures. The Privacy Office's primary duty is to protect the confidentiality and privacy of patients' protected health information (PHI) within UW Health. This mission is accomplished through educational sessions, clarification of specific regulatory issues and the completion of internal reviews and audits.

Pharmacy Compliance

Pharmacy Compliance ensures UW Health employees from all disciplines adhere to expectations regarding controlled substance handling defined by, but not limited to, the Drug Enforcement Administration, The Joint Commission, Centers for Medicare and Medicaid Services, UW Health policies and procedures and other advised best practices. The team also acts as a consultant to ensure this handling is adequate and effective to prevent or detect diversion, and provides a safe place for reporting potential theft or diversion of medications.

Research Billing

The mission of the Research Compliance Office is to promote and support ethical research practices at UW Health by partnering with the research community so that we are compliant with federal, state and local laws and regulations, as well as University of Wisconsin–Madison policies. This mission is accomplished through educational sessions, clarification of specific regulatory issues, establishing study billing parameters and the completion of internal reviews/audits.