Kusserow on Compliance: Filling a staffing gap in compliance

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.  Every healthcare organization will from time to time find they have a gap in their compliance program staffing, as result of someone retiring or moving on to another opportunity. Few organizations can afford the risk of a loss in day-to-day compliance direction; and when a break occurs, as result of a loss of a compliance officer or key compliance staff, for whatever reason, quick degeneration of the program may occur. Acting on a gap may take 3–5 months to resolve and designating someone internally to do the work until a new person can be recruited is very risky. Missing any information concerning regulatory or legal violation from the hotline or internal review processes can lead to serious consequences, especially since both the OIG and DOJ have a 60 day rule from identification of a potential violation to disclosure. In the case of a potential false claims matter, failure to meet the deadline may result in DOJ considering that to be a “reverse false claim” and actionable. Furthermore, the seeds of a regulatory or legal problem and resulting liabilities can grow fast if not addressed promptly. There are two choices when there is a interruption in compliance staffing; (a) designate someone internally to act until a replacement can be found, or (b) engaging an outside expert to act as interim compliance officer.

Suzanne Castaldo, JD, Vice President of Strategic Management Services, is responsible for providing compliance staffing assistance to clients. She notes that designating someone internally, as a secondary duty, until replacement is not a good option. They will tend to give priority to their regular job, they know; and doing as little as possible in compliance which they don’t know. They can’t be expected to address problems in a timely and professional manner, especially in the absence of the full authority of the office. She believes it is highly advisable to have someone experienced and knowledgeable in compliance to fill a gap as an interim compliance professional, during a time of transition. For some smaller organizations, it may make sense to just outsource the whole program to a part time Designated Compliance Officer, rather than hire a full time employee for the job. This approach is recognized by the OIG as an effective alternative for organizations with limited resources. An expert Designated Compliance Officer can develop, implement, manage, and provide compliance advisory services in a manner scalable to the organization’s needs. Furthermore, an outside expert can bring a much wider range of experience and expertise.

Castaldo noted that over the last 25 years, her firm has worked with over 3,000 health care organizations in evaluating, managing, and building compliance programs. This provides a unique level of knowledge and expertise that has been used by clients, ranging from large health care systems to skilled nursing facilities, physician practices, DME companies, clinical and imaging centers, third party billers, etc. All the consultants used in staffing compliance programs have served as compliance or HIPAA privacy officers.  She believes the combine experience of the firm provides a depth of resources that can be leveraged on behalf of clients in a great variety of settings.  For more information, she can be reached at (703) 683-9600, or go to online contact form.

 

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.