Kusserow on Compliance: Tips on finding the right hotline vendor

One of the critical elements of an effective compliance program outlined by OIG compliance guidance is the establishment and maintenance of communication channels with employees and management. Such communication permits employees to report sensitive matters outside the normal supervisory channels. Both the U.S. Sentencing Commission and DHHS Office of Inspector General (OIG) call for a hotline. Results from the Ninth Annual Healthcare Compliance Benchmark Survey conducted by SAI Global and Strategic Management Services found that 55 percent of organizations outsource their hotline. Daniel Peake of the Compliance Resource Center provides hotline services and explained there are many reasons why so many choose to outsource their hotline. Although there are benefits of maintaining the function in-house, it is far outweighed by the advantages of outsourcing it to a professional vendor service. He cited some of these reasons why so many decide to use a professional vendor service, including the following:

  • Cost of staffing with qualified people in-house is prohibitive
  • Systems must blocked and “backstopped” to prevent anonymous caller identification
  • Those answering the calls in house should not be highly visible to the work force
  • Calls should never be answered in an area where they can be overheard by others
  • Hotline vendors have the training and experience to handle complainants
  • Callers are nervous and speaking with an outside party generally is reassuring

TIPS FOR EVALUATING HOTLINE VENDORS

  1. Cost of operation. Vendor’s services should be a set fee under $2/employee/year.
  1. Contract. Avoid contracts not permitting cancellation by 30 day written notice. Client should be held by good service, not by contracts.
  1. Industry expertise. Seek vendors knowledgeable of health care issues.
  1. Hotline services. Must include both live operator and Web-based reporting. Either approach alone has its deficiencies and is not a best practice.
  1. Policies and procedures. Vendor should assist with developing operating protocols for following up an allegations and complaints received through the hotline.
  1. Timelines. Insist on a provision of a full written report within one business day of receipt of the call. For urgent matters, it should be immediate.
  2. Reports provided. Written reports must clear, concise, and of high quality.
  3. Report Delivery. The manner the report is delivered is important. There is security problems with reports provided either by facsimile or email. Insist on secure web-based reporting with notification of a report being provided via email.
  1. Insurance. Like any other vendor, the company should have at least one to three million dollars liability coverage.

 

For more information, Daniel Peake can be reached at (dpeake@compliancereource.com or (703)-236-9854)

 

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.

Connect with Richard Kusserow on Google+ or LinkedIn.

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Copyright © 2018 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: Advice for compliance officers taking on a new engagement

One of the great hurdles for someone moving into a new position is meeting the expectations of the organization.  Kash Chopra, JD has served as compliance officer on multiple occasions.  Among her duties at Strategic Management is providing clients with interim compliance officers to fill gaps between permanent appointments. She found that in far too many cases, new compliance officers inherit a host of problems, many of which can be of longstanding nature. and in a very short time the interim compliance officer will come to own these problems. She advises that at the time an organization notifies a person that they been accepted for the position as compliance officer, that person should request an independent compliance program evaluation in order to find out the status of the program and just exactly what they are inheriting. If possible, it is helpful to include having an independent evaluation performed to be part of negotiating terms of the engagement. Not taking this step may result in having the job get off to the wrong start and lead to piecemeal reporting of problems as they are encountered. This seldom plays well with management or the board. The better play is to let the outside reviewer identify the problems, and have the new compliance officer focus on the solutions. It will make clear to the executive leadership and the board that the flaws, weaknesses, and exposures identified belongs to the predecessor. Such a review should also provide a road map of what needs to be done to ensure the program is on the right track. By taking this approach, the new compliance officer will be seen as cleaning up the problems.

Kash Chopra can be contacted for more information on interim compliance staffing or independent compliance program evaluations at kchopra@strategicm.com or (703) 535-1413.

 

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.

Connect with Richard Kusserow on Google+ or LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2018 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: Achieving compliance support from the Board and CEO

Carrie Kusserow, has been working with and making presentations to Boards and CEOs for over 15 years. She highlights the need reinforce CEO and Board expectations for the compliance program—expectations then can cascade down through the entire organization. She finds that often Boards and CEOs played a major role in kicking off the compliance effort, but over time their interest and support wane. The real test is keeping the commitment, support, and spirit for the compliance program over time, which requires a concerted effort on their part of the compliance officer. Key to making this possible is for the compliance officer to hlep the CEO and Board understand their roles in the compliance program and what is needed from them to meet that obligation.

Al Bassett, J.D., has over 35 years in compliance including building and reinforcing dozens of compliance programs. He emphasizes the importance for the Board and CEO being directly involved in the hiring decision for the compliance officer. They need to select someone in terms of proven experience and competence, but ethical consideration should play a large role. Once appointed, there must be continued contact and monitoring of performance with the person reporting and accountable to the CEO on a day to day basis, as well as having direct access to the Board, as needed.

Steve Forman, CPA, has decades of experience as a compliance consultant as well has having served as compliance officer for a large system and as in an interim capacity for others. He makes the point that the compliance officer needs to provide the CEO and Board with evidence of what is needed to improve the program. This is the best way to keep communication channels open and ensure continued interest and support. A very important principle for the compliance program is open and ongoing communication with all the leadership, including gaining the attention and support of first and second line management.

Expert thoughts for compliance officers’ consideration:

  1. Develop a strategy to carry the compliance message from executive leadership to first and second line managers.
  2. Recruit compliance office staff possessing the character and competence to carry out the duties of the office and advance the compliance message to the entire workforce.
  3. Prepare meaningful briefings and education for the Board and executive leadership on what is required of them.
  4. Focus on creating education and training programs that reinforce the compliance message.
  5. Ensure that those reporting suspected problems are not made subject to any form of reprisal or retaliation that would undercut the entire compliance program ethos.
  6. The compliance culture of the organization is an important factor in establishing an effective compliance program and finding methods to document and measure it.
  7. Further away from headquarters, the greater the likelihood that something can get lost in translation, therefore pay special attention to business units or individuals that operate away from the shadow of the corporate leadership.
  8. Uniform enforcement of the rules is critical and any departure from this can seriously undermine confidence and support for the compliance program.

Carrie Kusserow is COO of Strategic Management and can be found at ckusserow@strategic.com, Al Bassett (abassett@strategicm.com) and Steve Forman (sforman@strategicm.com) are Senior VPs at Strategic Management.

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.

Connect with Richard Kusserow on Google+ or LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2018 Strategic Management Services, LLC. Published with permission.

Kusserow on compliance: OIG report on Medicare payments for clinical diagnostic lab tests

The OIG analyzed claims data for lab tests that CMS paid under Medicare’s Clinical Laboratory Fee Schedule, under Medicare Part B. Effective this year, CMS replaced payment rates with new rates for clinical diagnostic laboratory tests. This was the first reform in three decades to Medicare’s payment system for lab tests. Congress mandated that the OIG monitor Medicare payments for lab tests and the implementation and effect of the new payment system for those tests. The OIG concluded the new payment system for lab tests took for this year has resulted in significant changes to the Medicare payment rates for lab tests. The OIG used the data collected to date as a benchmark against which to measure the effects of changes to the payment system when new data from 2018 become available. The OIG report provided the fourth set of annual baseline analyses of the top 25 lab tests. The OIG identified the top 25 tests based on Medicare payments in 2017 and found:

  • In 2017, Medicare paid $7.1 billion for Part B lab tests, at about the same level for last 4-years.
  • The top 25 tests totaled $4.5 billion, 64 percent of the total and about the same rate for prior years.
  • A total of 50,000 labs received payment in 2017 and three labs received $1.1 billion, 15 percent of the total payments.
  • The top 25 tests were similarly concentrated among a few labs: 1 percent of labs received 55 percent of all Medicare payments for the top 25 lab tests in 2017.

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.

Connect with Richard Kusserow on Google+ or LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2018 Strategic Management Services, LLC. Published with permission.