A Break in Compliance Program Continuity is Dangerous

Tips and Suggestions

No health care organization can afford a break in compliance program continuity. A break occurring as result of a loss of a compliance officer can result in quick degeneration of the program. Missing any information concerning regulatory or legal violations from the hotline or internal review processes can lead to serious consequences, especially because both the OIG and DOJ have a 60 day rule for identification of a potential violation to disclosure. In the case of a potential false claims matter, failure to meet the deadline may result in the DOJ considering it to be a “reverse false claim” and actionable. The seeds of a regulatory or legal problem and resulting liabilities can grow fast if not addressed promptly. The reality is that few organizations can afford the risk of a loss in day-to-day compliance direction. Designating someone internally to do the work until a new compliance officer is recruited is also very risky. If during this interregnum a compliance issue arises and is not properly addressed in a timely manner, it could become a serious problem. This includes any potential violations of law or regulation detected, or overpayments identified. Both the DOJ and OIG have the clock ticking when these events require disclosure, and the failure to disclose can result in serious damage to an organization. In this day and age, with such a rapidly evolving regulatory and enforcement environment, health care organizations cannot afford to take the chance on having a gap in the compliance office. The question then becomes what can be done when an interruption in a sitting compliance officer that may take 3-5 months resolve arises.

Designate Someone Internally to Act as the Compliance Officer

• Having someone temporarily take on the role as a set of secondary duties to his or her current job is seldom a good option, as it commonly leads the individual to continue giving priority to the current job and doing as little as possible in compliance.
• Those acting as stand-in compliance officers cannot be expected to address emerging problems in a timely fashion.
• Without having the full authority of the office, it is difficult to make substantive decisions and, in fact, may be perilous to the designated person’s career to take an unpopular stance on issues.
• Acting individuals are likely to do what they consider minimal in risk for themselves.
• This decision may lead to a backing up of problems that the replacement compliance officer will have to address.

The only real alternative to having someone internally acting in the capacity of compliance officer is to seek temporary outside assistance from experts.

Engaging: Temporary Compliance Officers

Steve Forman, CPA, is an expert on the subject with over 35 years experience, having served as both as a compliance officer for one of the largest hospital systems in the country and as interim compliance officer for other organizations. He sees the best way to meet the challenge while searching for a replacement compliance officer is to engage compliance experts to ensure continuity of the compliance program until a permanent replacement is ready to take over. As an outsider, there is added value of bringing ‘fresh eyes’ to the program. Due to their experience in the role, compliance experts can quickly provide an objective assessment on the state of the compliance program, offer suggestions, and give guidance for improvements. They can identify issues and make decisions with high level of credibility, in a way that a salaried employee cannot.

Carrie Kusserow, MA, CHC, CHPC, CCEP, is another expert who has served as both compliance officer and interim compliance officer for major health care systems. She has found that generally, changes in compliance officers are due to various levels of dissatisfaction in the compliance program operation, such as weaknesses and a backlog of unaddressed issues. Outside experts would be free of involvement in prior decisions. They can more effectively hold the program together until a suitable replacement has been found. Those considering using experts should build the following tasks into the engagement: (1) provide advice on the state of the compliance program; (2) identify how well high-risk areas are being monitored; and (3) formulate a plan for program improvement. Executive leadership and the Board should tap into expertise to ensure their compliance program is on track.

Camella Boateng, MPH, CHC, CHPC, is another compliance expert who has served as an interim compliance officer for several different provider organizations. Boateng notes that using an interim compliance officer may appear to be costly in the short run, but it is like an insurance policy to guard against new liabilities from occurring. She notes that using a properly qualified outside expert has a lot of advantages, including the experience of serving in other organizations and dealing with many of the same issues. While it may be costly in the short run, it can offer extra value due to experience and efficiency of operation.

All three experts agreed that when selecting an outside expert to act as a temporary compliance officer, organizations should be careful to not gamble on someone lacking expertise. It is important to look for someone who has built, managed, and evaluated compliance programs. To gain the best value for using outside experts, in addition to managing the day to day work of the office, have them:

1. Assess high-risk areas that warrant attention;
2. Provide an independent assessment of the status of the compliance program;
3. Offer suggestions to build a firmer foundation for the compliance program;
4. Review the existing code of conduct, compliance policies, and other guidance;
5. Evaluate the quality and effectiveness of compliance training;
6. Develop a “roadmap” for the incoming compliance officer to follow;
7. Assist in identifying and evaluating candidates for the permanent position;
8. Assess resources needed to effectively operate the compliance program;
9. Identify or build metrics that evidence compliance program effectiveness;
10. Develop comprehensive briefings for management and board on the state of the program;
11. Provide a closeout report with a suggested action plan for the permanent replacement; and
12. Assist in finding a fulltime replacement.

Find Interim Compliance Officers to Fill Leadership Gaps

Strategic Management Services has Interim Compliance Officers with decades of experience assessing and improving compliance processes. If you are looking to fill a leadership position or need additional help for your program, contact us online, or call (703) 683-9600.