Recent Compliance Updates & Tips
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Compliance Officers must manage staffing needs against a growing list of duties and responsibilities. Finding and hiring highly qualified staff may prove to be a difficult and expensive endeavor. Many Compliance Officers acquire needed expertise and assistance through outsourcing or by developing partnerships with expert firms for “on call” services. The right type of arrangement could boost efficiency and cut costs. Reasons Compliance Officers may consider outsourcing include: (a) there is a spike in the work load due to regulatory action or an internal event; (b) there is a gap in the office that requires temporary filling; or (c) there are new management challenges that require expert assistance. Regardless of the type of service, the agreement needs to be tailored to the office’s specific requirements and needs.
Outsourcing commonly occurs in selected parts of a compliance program, such as the compliance hotline, sanction screening, compliance training, employee compliance surveying, specialized investigations, claims reviews or HIPAA Privacy support. Sometimes outsourcing may extend to various positions that report to the Compliance Officer such as the HIPAA Privacy Officer or a compliance staff person in a remote facility. Camella Boateng, an expert who has frequently served in these capacities, observed that “most engagements involve work that fluctuates considerably over the course of a year, making it difficult to fill with full time permanent staff.” Further, she stated that “HIPAA Privacy Officers, for smaller organizations, definitely fall into the category of downtime between crisis and urgent work requirements.” Boateng said “in some cases, organizations need to outsource the entire management and operation of the program to fill a temporary staffing gap through the use of an Interim Compliance Officer (ICO).” Jim Cottos, who has served as an ICO for more than a dozen organizations, noted that “organizations seeking an ICO invariably have built up problems and issues that required immediate attention and those problems are often much more significant than what the organization originally thought when engaging me.” Cottos further stated that “one of the biggest benefits an organization receives from an ICO is quick and efficient resolution of issues and an overall assessment of the program that can serve as a road map for the future permanent compliance officer.”
Others may look to outsource the program on a permanent basis with a Designated Compliance Officer (DCO), but this kind of decision really should be limited to smaller organizations that find it difficult or too expensive to recruit full time staff. It should be noted that, sometimes, outsourced expert assistance may not require that all work be performed on site. Steve Forman, CPA, is a former OIG executive with over 15 years experience as a Compliance Officer including being the DCO for several organizations. He notes that “many smaller organizations that simply cannot afford a full time Compliance Officer could consider engaging a real expert on a limited part time basis and receive better results at less expense.” Forman stated that “this is the reason that the OIG went on record as recognizing the use of experts to provide part time DCO services on behalf of such organizations”.
“On Call” Services
Another strategy is to develop an ongoing relationship with a compliance expert firm that is willing to tailor an agreement to the needs of a Compliance Office, whether in terms of staffing, consulting, services, specified task work and/or all of the above. This approach is primarily task order driven for qualified experts to be “on call” for specific necessary services. Examples of periodic assistance might include: (a) reviewing selected high-risk areas such as physician arrangements; (b) supplementing staff temporarily when special needs arise or a gap occurs in staff; (c) occasional investigation of potential wrongdoing; (d) determining error rates for certain types of claims submissions; and/or (e) conducting independent evaluations of the compliance program effectiveness. Tom Herrmann, JD, has specialized in providing “on call” servicing for a number of years. His experience also includes over 30 years in the OIG legal counsel’s office, as well as 6 years as Medicare Appeals Board Appellate Judge. He believes that “having a compliance expert vendor partner available can provide the added benefit of an independent perspective on matters – unencumbered by personalities or past decisions.” Herrmann states that “the relationship should be maintained through mutual benefit and high quality services, not by locked in formal agreements.” Herrmann stated that “either party should be able to terminate the contract without a stated cause with a simple notice to the other party.” Herrmann believes that “this way places the burden on both parties to keep the relationship focused on achieving objectives.” This approach also addresses another potential problem where outside partners cause friction with full time staff.
Additional benefits of utilizing outside-contracted parties can include greater exposure to knowledge, experience, and skills. One of the greatest perks is the ability to bring in experienced and/or recognized experts to the organization. Outsourcing and ‘on call” servicing arrangement are options worth considering but it’s important that organizations evaluate the benefit and cost savings to determine whether alternative staffing is the most efficient solution. It is also advisable to seek out and evaluate prospective firms in advance of any urgent need, as it may take some time and effort to find the right firm with the breadth of expertise, experience, and reputation to fulfill all needs. That way, necessary individuals can be brought on board more quickly and efficiently.