A Conversation With ... Charity Elmer

What’s the primary role of a general counsel attorney for a company?
Being general counsel is basically making sure your organization is compliant in all things legal, making sure you review contracts and making sure you are there to give advice to your client. General counsel generally don’t do operations. We do legal advice. We give operations folks advice on how to navigate through the legal issues impacting the operations world. I tend to think we are a jack-of-all-trades, master of none. I have a lot of information about a bunch of things, but my in-depth knowledge, like you would have in private practice, isn’t as vast. When you go in-house, you basically have to know a little about everything and a lot about nothing. The beauty of being general counsel is you have one client. You can know everything about your client and give the best service possible.

How does that differ from a company simply hiring an attorney to represent them?
If I’m hiring outside counsel, they only get to know that little slice of what I’ve given them. They are limited by the information I’ve given them, by the project I give them. The advice they give me is really dependent on the project I ask them to do. Working as outside counsel can still be really rewarding, but it’s more piecemeal than being in-house.

What do your duties entail at CoxHealth?
I’m responsible for all things legal at CoxHealth and all of our affiliates, which includes Branson and Monett. Not only the legal issues, but my department handles purchasing insurance for the system, workers’ compensation for CoxHealth employees, risk management, and I’m responsible also for corporate integrity. I don’t do all of that. I hire really great people. We have four lawyers, other than myself, and 11 total in the legal department.

Corporate integrity isn’t in this department, but they have between 20 and 30 people. Some people call it corporate compliance. It’s a department that makes sure on a day-to-day basis the things we do are compliant with all the rules and regulations that are out there. Compliance does a lot of auditing, in terms of billing.

Last year, a federal audit of CoxHealth found the hospital was overpaid more than $300,000 by Medicare because of billing errors. How did you advise the department in this matter?
As counsel, any advice I give is privileged so I cannot comment on any specific matter. However, part of my job involves giving advice on billing matters. That advice may range from revising policies or procedures to making a refund. Billing audits are a routine part of the everyday operations of every health system. Sometimes these audits show refunds are necessary, but often they show we under- billed and are entitled to additional payments. Regardless, we strive constantly to ensure full compliance with all billing regulations. With respect to the refund you asked about, the refund was identified as part of a routine Medicare audit, and while $300,000 is a significant amount of money, to put it into perspective, this reflects a billing error rate of less than 0.1 percent.

What legal issues do you tackle most?
I would say, by nature of being corporate lawyers, contracts by far are our biggest line of business, so to speak. When I say contracts, it’s not only purchasing contracts, but physician contracts, regulatory agreements, every type. The next biggest thing that keeps us busy are just random calls from people who have issues with the system. One day it might be a human resources matter, it might be a billing matter, it might be a behavior matter. For me in particular, it might be risk management issues.

What are some of the larger projects you have handled for CoxHealth?
Most recently, we just completed a very large corporate restructure which involved purchasing the Ferrell-Duncan Clinic Inc., which closed at the end of the year. That was a big transaction. We brought Ferrell-Duncan fully into the CoxHealth system. Ferrell-Duncan Clinic Inc., used to be owned by the physicians, and now it’s owned by a CoxHealth subsidiary. We also have completed numerous bond deals, most recently getting financing for our new tower.