Nineteen Compliance Officer Tips For 2020

The ever-growing healthcare regulatory and enforcement environment increases the challenges for compliance officers. Results of the 2019 Strategic Management and SAI Global Compliance Benchmark Survey provided considerable information as to where compliance officers may wish to focus attention in the coming year. The following are tips to consider:

1. Verify that program managers are engaged in ongoing monitoring of compliance risks in their area of management;
2. Increase focus on selling the importance, value, and benefits of the compliance program to the Board, leadership, and the all employees, along with the personal consequences for not having an effective program;
3. Do not compromise principles in the face of resistance from leadership or program managers, because once you begin to “cave in” to their more unreasonable views/demands, it creates a pathway to ineffectiveness;
4. Reach out to and convince first line managers to carry the compliance message to their subordinates, by word and example. What they project to their staff is far more powerful than pronouncements from “on high;”
5. Be more visible and walk around to talk with people about their jobs, thoughts, concerns, etc. It is all part of selling the program;
6. Audit the Compliance Office staffing and reallocate priorities to ensure that time is spent on the most important compliance responsibilities;
7. Improve cooperation and coordination with Human Resources, Legal Counsel, and Internal Audit, as turf battles negatively impact the compliance program. Develop protocols that establish working relationships and methods of cooperative effort;
8. Dig deeper into cyber security issues and HIPAA privacy, the highest priority issues and concerns of compliance officers in the 2019 Compliance Benchmark Survey;
9. Review recent regulatory and legal changes at both the federal and state level, especially as it relates to federal and state False Claims Acts, Stark physician self-referral laws, and Anti-Kickback statutes and privacy requirements to determine any changes in work planning;
10. In light of the high priority that most government agencies place on the opioid crisis, take time to determine where and under what circumstances it might be an organizational risk;
11. Ensure independent review of any arrangements with potential referral sources, as this remains the number one enforcement priority of the Department of Justice and the Department of Health and Human Services Office of Inspector General (OIG). A legal document review of arrangements is only a small part of this type of review;
12. Consider closer review of claims accuracy, as compliance officers rated this as their number three priority in the 2019 Compliance Benchmark Survey;
13. Focus on a conflicts of interest program to ensure there are no sleeping compliance issues related to physician and practitioner conflicts;
14. Take time to review recent OIG Corporate Integrity Agreements, as they reflect the OIG’s current thinking and enforcement priorities;
15. Never stop selling the importance of compliance to executive leadership and the board, along with the potential personal liability for not meeting their obligations and responsibilities;
16. Ensure the work plan includes addressing regulatory compliance issues identified in risk assessments;
17. Continue developing and maintaining compliance outcome metrics to benchmark progress of the compliance program’s effectiveness (e.g. using a validated compliance culture or knowledge survey) that evidences improvements from one period to another;
18. Work on metrics to evidence compliance program effectiveness, as this was the number one rated priority of compliance officers in the 2019 Compliance Benchmark Survey; and
19. Obtain independent evidence of compliance program improvement by having independent experts evaluate its effectiveness and offer suggestions for improvements.

About the Author

Richard P. Kusserow established Strategic Management Services, LLC, after retiring from being the DHHS Inspector General, and has assisted over 2,000 health care organizations and entities in developing, implementing and assessing compliance programs.