Kusserow on Compliance: Engaging experts to supplement and assist compliance offices

Most compliance offices are swamped with work. Sometimes it is a periodic rush to meet some urgency, while at other times there is just too much to be done with too little to meet all challenges in the ever-changing regulatory and enforcement environment. There are three broad ways to handle the load: (1) insource, so that all compliance office work is handled in-house, using consultants only occasionally for advisory services or evaluation of the compliance program; (2) outsource the compliance program to designated or interim compliance officers as a temporary solution for maintaining continuity, using an expert to be the interim compliance officer; or (3) cosource by using on-call experts to supplement the compliance office with specific duties or assignments.

Suzanne Castaldo, J.D., an expert on the subject, notes that many smaller organizations cannot justify the cost and burdens of supporting the program in-house and outsource it entirely to a designated compliance officer, who most often is a part-time engaged expert. The HHS Office of the Inspector General (OIG) recognized the use of designated compliance officers who may serve in that capacity for several organizations. Taking this approach should entail engaging experts on a part-time basis. If a full-time person can be afforded, then using this approach doesn’t make sense. The benefits include bringing the experience of many organizations to the entity that could ill afford to develop in-house.

Kashish Chopra, J.D., MBA, CHC, has served as an interim compliance officer and makes the point that 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. Having an expert on a short-term engagement can take over the reins of the program while a permanent replacement is found.

Jillian Bower, a highly experienced consultant has been instrumental in providing supplemental support to compliance officers. She noted that cosourcing has evolved as a “middle ground” between insourcing and outsourcing and has also been recognized by the OIG as a useful solution when expertise and resources are limited. 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. Cosourcing 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 cosourcing at any time, when staffing issues are resolved. It is hiring piecemeal as needed. Common cosourcing may be using a consultant as a HIPAA privacy and/or security officer, conducting ongoing monitoring/auditing, performing enterprise risk management/analysis, engaging a statistical data claims analyst expert to determine error rates, hotline operations management, compliance investigations/training, reviewing arrangements with referral sources, and managing the sanction screening operations.

The fact is that there are options for consideration when a compliance program is being stretched beyond its capability to meet challenges or where a gap takes place among key compliance staff.

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.

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Copyright © 2017 Strategic Management Services, LLC. Published with permission.