There has been considerable discussion and questions raised about approaches taken by health care organizations for the best way to meet the great challenges of maintaining an effective compliance program in the ever-changing regulatory and enforcement environment. There really are three approaches to the problem: (1) in-sourcing where the Compliance Office does it all; (2) out-sourcing the compliance program to designated or interim Compliance Officers; or (3) co-sourcing by using on-call experts to supplement the Compliance Office. This blog will serve to define and differentiate among them.
For in-sourcing, all the work is handled in-house, using consultants only occasionally for advisory services or evaluation of the compliance program. Some organizations find themselves in a position whereby they believe they must out-source the function to an expert firm. Most commonly, this occurs where gaps develop in compliance officers, a temporary solution for maintaining continuity is using an expert to be the interim Compliance Officer. Some small organizations cannot justify the cost and burdens of supporting the program in house and out-source it entirely to a designated Compliance Officer, who most often is a part-time engaged expert. The Office of the Inspector General (OIG) recognized the use of designated Compliance Officers that may serve in that capacity for several organizations (65 FR 59434, October 5, 2000).
More recently, co-sourcing has evolved as a third option and “middle ground” between in-sourcing and out-sourcing. This approach is also recognized by the OIG as a useful solution to where an organization is limited in its compliance expertise and resources. It involves using experts on an ongoing basis to supplement limited staff resources to carry out part of their workload. It offers the advantage of the Compliance Officer maintaining control and direction of the program. Co-sourcing can help bridge the gap in a manner that does not compromise the flexibility to easily return to a position where the Compliance Office can reassume full operation and end co-sourcing at anytime, when staffing issues are resolved. Some of the most common types of co-sourced functions include the following:
- Deputy or Assistant Compliance Officer;
- Compliance Liaison/Manager (outlying facilities);
- HIPAA Privacy and/or Security Officer;
- ongoing monitoring/auditing;
- Compliance Liaison (outlying facilities);
- enterprise risk management/analysis;
- Statistical Data Claims Analyst Expert;
- Compliance Trainer/programs;
- Hotline Management Operations Management;
- compliance investigations/training;
- arrangements reviewer; and
- sanction screening operations.
Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.
Copyright © 2015 Strategic Management Services, LLC. Published with permission.