By Erin Smith
The Eastpointe Board of Directors received training from Theresa Edmundson regarding compliance monitoring of providers and Eastpointe staff. She told the board it is important to have a strong compliance program in place.
“When you handle the amount of money Eastpointe handles, you have to have compliance monitoring in place,” said Edmondson.
Chief Executive Officer Sarah Stroud asked Edmondson to explain the difference in external compliance program integrity and provider monitoring. Edmondson said external compliance program integrity monitors for things such as potential fraud, waste and abuse committed by providers.
Provider monitoring reviews the various types of services offered by providers and ensures the clients are receiving the services advertised by the providers.
Edmondson said Eastpointe has a written compliance plan which specifies how the company does business with clients, providers, etc. Some of the things covered by the compliance plan include fraud, waste and abuse; conflicts of interest; internal compliance investigations; and HIPPA issues, to name a few things.
Edmondson said Eastpointe’s Conflict of Interest monitoring is stronger than that of most MCOs.
“The reason is we serve a rural area. A lot of our employees know the providers because they have either worked for them or they may have family members who work there,” said Edmondson.
She explained to the board when it is learned an Eastpointe employee may have a conflict of interest, a conflict of interest plan is developed for that employee addressing the conflict and how it is to be handled. Edmondson said the conflict of interest plan can include such things as the Eastpointe employee having no contact with that particular provider.
She also said there are various subcommittees that also report back to the Compliance Committee. The subcommittees include a HIPPA subcommittee; a Regulatory Compliance Committee which deals with matters involving federal and state legislation and ensuring Eastpointe is complaint; and a Risk Assessment Subcommittee.
Edmondson explained to the board the Compliance Committee will meet and review data submitted by various departments and subcommittees within Eastpointe such as billing, provider services, etc. The committee reviews all of the data it receives and if something appears to be out of compliance or if a claim submitted for payment by a provider appears to be fraudulent, it is then given to the SBI. Edmondson told the board the Compliance Committee does not make any determination of whether fraud or abuse may have ocurred. The State Bureau of Investigation makes the final determination if actual fraud or abuse has ocurred and pursues the matter from there.
Edmondson told the board the Risk Assessment Subcommittee is the newest group. It was created in March 2016 and the final risk assessment plan was submitted to the Quality Improvement for implementation and monitoring this summer.
Edmondson said the Risk Assessment Subcommittee asked each department to identify the types of things deemed a high risk and what things were deemed a low risk. Edmondson explained to the board the departments were asked to submit scenarios, which if they ocurred, would be detrimental to their services and to score them based on that. She said those items were then taken and compiled into a Risk Assessment Plan.
In other business, the board received a report from CEO Sarah Stroud. She told the board since the meeting in August, she has made a presentation to the Scotland County Board of Commissioners regarding Eastpointe’s services.
Stroud also said she joined some other Eastpointe Board members for a ribbon cutting for Monarch’s newly remodeled facility in Robeson County.
Stroud also gave the Human Resources report. She said there have been no new hires at Eastpointe since the last meeting. Stroud told the board has been one internal transfer, and eight people have left Eastpointe. She said Eastpointe is currently advertising for eight positions.
Mrs. Judge asked Stroud about those that left Eastpointe’s employ.
“I noticed that most, if not all of the positions, are in one area. Is there any particular reason for that?” asked Mrs. Judge.
“I really don’t know,” said Stroud. She further explained there were some openings at a neighboring MCO in Rocky Mount.
Mrs. Judge asked about how those that have left will be replaced and Stroud replied that most of the vacancies are in the Rocky Mount area and Eastpointe will not be replacing all of those positions. Stroud said the company will only be replacing the most vital positions in the Nash County (Rocky Mount) area.
The board approved the Human Resources report.
Catherine Dalton, Chief of Business Operations, gave the financial reports. She called the board’s attention to the balance sheet and explained that as of August 31, 2017, Eastpointe had a fund balance of $127,452,540 and liabilities in the amount of $25,555,574 for a total balance of $153,814,000 which includes both the fund balance and liabilities.
On the profitability report, Dalton told the board as of August 31, 2017, Eastpointe had $51,123,693 in revenues and $43,744,695 in expenses for a profit of $1,529,950.
Dalton said the liquidity analysis report shows as of August 31, 2017, Eastpointe has $45,654,702 in undesignated, unreserved funds.
The board voted to approve the finance reports.
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