Selling Compliance to All Stakeholders

Major Challenges for Compliance Officers

Compliance officers are not tasked solely with developing the seven standard elements of a compliance program. Another significant challenge involves changing and embracing the culture of the organization, which requires much effort. Whether you call it preaching or selling, it amounts to the same effort; without gaining widespread buy-in and support, no compliance program can become effective. Indeed, this was the very topic at a recent roundtable meeting of top healthcare compliance experts. These leaders focused their comments on the various stakeholders within an organization that must be sold on compliance.

1. 1. The Board. Carrie Kusserow, MA, CHC, CHPC, CCEP, has 15 years of experience as a compliance officer and consultant and she sees the board of directors (“board”) as the biggest ‘sell’.  Once the board is sold on compliance, executive leadership will follow suit. The board should create a committee to act as the focal point for its compliance oversight. Compliance officers should stress the benefits of a successful program and the personal consequences that board members may be subject to for an unsuccessful program. The board should receive professional and informative presentations on their role and expectations in carrying out their responsibilities, and the personal liability risks for ignoring their fiduciary responsibilities. Let board members know that when the Department of Health and Human Services (HHS) Office of Inspector General (OIG) finds weak board oversight of compliance, the organization’s Corporate Integrity Agreement (CIA) will include a mandate for board members to sign and submit resolutions that attest to the compliance program’s status. The OIG may also require the board to engage compliance experts to assist them in their duties. Remember that board compliance education must be ongoing and presented in “bite size” pieces. It cannot be taught in one long presentation. The compliance message must be constantly reinforced, alongside recurring presentations about how the program is functioning and what improvements can be made.
   2. Executive Leadership. Al Bassett, JD, has over 35 years of compliance experience and knows the importance of successfully selling compliance to the organization’s executive leadership. Without their active support and commitment, the compliance officer will never be sufficiently empowered to effectively carry their message to others. Executive leadership must understand that the compliance program is a positive addition to the operations and management of organizations and not a negative hindrance. A key to achieving success with leadership is through an effective executive compliance committee, made up of executives and program managers. This group must be educated and sold on carrying out their compliance duties and obligations. It is important for executive leadership, and the compliance program, to evidence their involvement and actions in the meeting minutes. The Department of Justice (DOJ) underscored the importance of evidencing support of the compliance program in its Yates Memorandum, which focuses on executive involvement in fraud cases. Similarly, the OIG follows the Responsible Corporate Officers Doctrine, to find executives responsible for fraud arising from the dereliction of their duties. Additionally, there are CIAs that now require the CEO, COO, CFO, and other corporate officers to attest to and certify compliance.

1. Operational Management. Steve Forman, CPA, has over 30 years of healthcare compliance experience and points out that all program managers must be sold on their affirmative duty for ongoing monitoring of compliance risk areas related to their operations. Program managers must know that failing to do this can result in adverse events and potential liability for them and the organization. Program manager’s monitoring responsibilities include: (a) identifying all high-risks in their operational area; (b) keeping abreast of applicable regulations and rules affecting them; (c) providing up-to-date written guidance (policies/procedures) on compliance with those rules; (d) training their staff on the written guidance; and (e) monitoring to ensure that written guidance is being followed. Additionally, independent and ongoing auditing is required to verify that operational managers are carrying out these responsibilities and validate that these efforts are achieving the desired outcome. Both the monitoring and auditing of results must be shared with executive leadership and the board.
2. First Line Supervisors and Managers. Catie Heindel, JD, CHC, CHPC, is a highly experienced compliance consultant. Ms. Heindel believes that for compliance officers to be effective, they must convince first-line managers to carry the compliance message to their subordinates, through their word and example. She believes that in many ways, what first-line managers say, and the attitude they project to their staff, is more powerful than pronouncements by the compliance officer and executive leadership. Ms. Heindel has found that talking to first-line supervisors and managers about the compliance program is one way to determine program effectiveness. When supervisors and managers do not evidence these traits, this identifies another selling opportunity for the compliance program. Furthermore, the OIG calls for supervisors to include compliance as an element in their performance plans. Accordingly, compliance officers must ensure that this has been done.
3. Related Compliance Functions. Tom Herrmann, JD, served in the Office of Counsel to the OIG Inspector General, as a Medicare Appeals Board Appellate Judge, and for many years as a healthcare compliance consultant. He believes that compliance officers must make every effort in selling cooperation and coordination, and not competition, with other functions that overlap with compliance. These functions include Legal Counsel, Human Resources, HIPAA Privacy and Security, and Internal Audit. In far too many organizations, these functions operate antagonistically with one another and engage in turf battles, all of which has a serious negative impact on the effectiveness of the compliance program. As such, much benefit can come from developing protocols (policy documents) that establish working relationships and methods of cooperative effort.
4. Workforce. Suzanne Castaldo, JD, CHC, has served as an attorney in a major law firm and as a healthcare compliance consultant. She notes that in order to win over the workforce in terms of compliance, the compliance officer must promote receptivity of information across management, Human Resources, the compliance office, and the compliance hotline. If employees do not believe that the organization is listening and acting on their feedback and compliance matters, the compliance program will never be effective. This means that compliance officers must actively and promptly investigate and resolve matters raised by the workforce, in a competent and professional manner.  However, this itself is not enough. The compliance officer must also be visible and available to hear the concerns that people have and, where appropriate, act upon them promptly and efficiently. Compliance officers should “show the flag” by walking around and talking to people about their jobs, thoughts, concerns, etc. All of this is part of “selling” the compliance program.
5. Outside Authorities. Jillian Concepcion has many years of experience in measuring and benchmarking compliance programs. Ms. Concepcion believes that it is important to maintain ongoing metrics to benchmark progress of the compliance program effectiveness. Often outside parties, whether they are investors or government agencies, must be sold on the effectiveness of the compliance program. One method for doing this, encouraged by the OIG, is to periodically survey the workforce about how well they have accepted the compliance program. There are two methods commonly used to do this: 1) Compliance Culture Surveys to monitor employee perceptions and attitudes towards compliance; and 2) Compliance Knowledge Surveys. In either case, the surveys must be professionally tested and administered, as well as anchored in a large database to permit benchmark comparisons to other healthcare entities. Taken periodically, these surveys can benchmark progress in the program and further empower the compliance office. When professionally developed and delivered, the compliance officer can use the results to sell outside parties on the effectiveness of the compliance program.
6. Never-ending Process. Camella Boateng, MPH, CHC, CHPC, a senior healthcare compliance consultant, noted that it is key for compliance officers to persevere in the face of skepticism. Compliance officers frequently encounter resistance in a business environment where leadership, employees, and medical staff consider compliance to be a distraction to their mission of delivering care. The compliance officer has to be seen as supporting the organization and leadership by avoiding regulatory and legal issues that can give rise to liabilities and loss of reputation. The challenge is to work, day in and day out, on selling that message and gaining support for the compliance program.

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