Kusserow on Compliance: Extending limited compliance resources

Co-Sourcing and On-Call Experts

Health care organization seek the most efficient and effective means to meet the great challenges of maintaining an effective compliance program in the ever-changing regulatory and enforcement environment. As compliance officers seek ways to supplement their limited in-house resources, Co-Sourcing has been evolving as preferred method when internal resourcing is lacking and out-sourcing the program to expert firms to provide a Designated Compliance Officer. Co-Sourcing involves using vendor expert services to supplement limited staff resources to carry out part of their workload. One of the most common Co-Sourcing methods is to engage firm with compliance experts on a “on-call” engagement agreement. This would permit using the experts only when and as needed, while maintaining control and direction of the program. This approach is also recognized by the OIG as a useful solution where an organization is limited in its compliance expertise and resources.

 

Co-Sourcing Benefits

  • Gains immediate access to specialized resources and experts not available internally
  • Less expensive to hire experts for limited services, than to hire full new full-time staff
  • Addresses the problem of an unexpected loss of staff and resulting resource issues
  • Brings the benefit of experience with other organizations
  • Provides subject matter expertise
  • Fills any lack of in-house expertise in selected areas
  • Facilitates meeting the ebb and flow of managing all the compliance obligations
  • Keeps organizations current with ever-changing regulatory and enforcement challenges
  • Accesses needed services, on-demand
  • Can be tasked to complete special projects
  • Fills a knowledge gap in training, fraud risk assessment, or other compliance-related needs
  • Meets obligations across multiple facilities in different jurisdictions
  • Develops best practice solutions to problems identified
  • Provides benchmarks of current processes against compliance standards
  • Implements or improves compliance effectiveness metrics
  • Quickly address new regulatory and emerging risks
  • Promptly and efficiently meets new leadership demands
  • Implements best practice standards and processes
  • Provides any sudden need for investigative or forensic expertise
  • Evaluates ongoing monitoring of compliance high risk areas
  • Assists in development of compliance work plans
  • Enables compliance officers to stay focused on program management and strategic planning
  • Increases flexibility in using experts who understand related laws/regulatory requirements
  • Performs operational and compliance auditing

For more information on how Co-Sourcing arrangements can work, contact Kashish Parikh-Chopra, JD 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.

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Copyright © 2019 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: Hospital insurance trust fund will be exhausted by 2026

This year’s Medicare Board of Trustees Annual Report found that the  hospital insurance (HI) Trust Fund will be able to pay full benefits until 2026. The Medicare Program is the second-largest social insurance program in the U.S., with 59.9 million beneficiaries and total expenditures of $741 billion in 2018. By comparison, in terms of size, the Department of Defense entire budget during this period was $686 billion.

The Trustees projected that total Medicare costs (including both HI and SMI expenditures) will grow from approximately 3.7 percent of Gross Domestic Product in 2018 to 5.9 percent of GDP by 2038, and then increase gradually thereafter to about 6.5 percent of GDP by 2093. The SMI Trust Fund, which covers Medicare Part B and D, had $104 billion in assets at the end of 2018. Part B helps pay for physician, outpatient hospital, home health, and other services for the aged and disabled who voluntarily enroll. It is expected to be adequately financed in all years because premium income and general revenue income are reset annually to cover expected costs and ensure a reserve for Part B costs.

However, the aging population and rising health care costs are causing projected costs to grow steadily from 2.1 percent of GDP in 2018 to approximately 3.7 percent of GDP in 2038. Part D provides subsidized access to drug insurance coverage on a voluntary basis for all beneficiaries, as well as premium and cost-sharing subsidies for low-income enrollees.  The President’s Fiscal Year 2020 Budget, if enacted, would continue to strengthen the fiscal integrity of the Medicare program and extend its solvency.

CMS has already introduced several initiatives to strengthen and protect Medicare that includes increasing choice in Medicare Advantage and adding supplemental benefits to the program; and offering more care options for people with diabetes; providing new telehealth services; and lowering prescription drug costs for seniors. CMS is continuing to advance policies to increase price transparency and help beneficiaries compare costs across different providers.

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 © 2019 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: Questions board-level compliance committees should be asking

HHS OIG compliance guidance calls for a Board-level committee to oversee the Compliance Program (CP). The HHS Inspector General noted that the best boards are those that are active, questioning, and exercise (constructive) skepticism in their oversight, asking probing questions about the compliance program. Boards need to know what type of questions they should be asking, and compliance officers should assist them with this problem. However, compliance officers in turn should be prepared to provide full and complete answers to them. The OIG and American Health Lawyers Association developed specific suggested questions that Board’s should be asking in their jointly produced “Corporate Responsibility and Corporate Compliance: A Resource for Health Care Boards of Directors” and “Corporate Responsibility and Health Care Quality (2007): A Resource for Health Care Boards of Directors”. The following are drawn from these advisory documents:

  1. Does the compliance officer have sufficient authority to implement the CP?
  2. What is the level of resources necessary to properly implement and operate the CP?
  3. Has the compliance officer been given the sufficient resources to carry out the mission?
  4. Have compliance-related responsibilities been delegated across all levels of management?
  5. What evidence is there that all employees are held equally accountable for compliance?
  6. How has the code been incorporated into corporate policies across the organization?
  7. What evidence is there that the code is understood and accepted across organization?
  8. Has management taken affirmative steps to publicize importance of code to employees?
  9. Have compliance-related policies been developed that address compliance risk areas?
  10. Are there policies/procedures for CP operation and how they should be reviewed/updated?
  11. What kind of document management ensures compliance-related documents are up to date?
  12. What is the scope of compliance-related education and training?
  13. What evidence is there of the effectiveness of CP training?
  14. What measures enforce training mandates and provide remedial training?
  15. What evidence is available that employees understand compliance expectations?
  16. How are compliance risks identified?
  17. What is the evidence that identified compliance risks are being addressed?
  18. Is the board being kept up to date on regulatory and industry compliance risks?
  19. How is the compliance program structured to address such risks?
  20. How are “at risk” operations assessed from a compliance perspective?
  21. Is conformance with the CP periodically evaluated?
  22. Does the CP undergo periodical independent evaluation of its effectiveness?
  23. What is the process for the evaluation and responding to suspected compliance violations?
  24. What kind of training is provided to those who conduct investigation of reported violations?
  25. How do the CO, HRM, and legal counsel coordinate in resolving compliance issues?
  26. What are the policies to ensure preservation of relevant CP documents and information?
  27. What policies address protection of “whistleblowers” and those accused of misconduct?
  28. What are the results of ongoing compliance monitoring by all program managers?
  29. How is ongoing compliance auditing being performed and by whom?
  30. How often is sanction-screening conducted and with what results?
  31. Are results from sanction-screening included in a signed report by the responsible parties?
  32. Has the CP been evaluated for effectiveness by a qualified independent reviewer?
  33. What evidence regarding effectiveness of hotline operation and follow-up investigations?
  34. What are the metrics being used to evidence CP effectiveness?
  35. What are the results of an independent review and assessment of the CP?

 

More information regarding available tools and resources available to assist in answering these questions, contact Daniel Peake at (dpeake@complianceresource.com) (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.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2019 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: Compliance document management

Controlling and managing compliance-related policies and procedures are among the most challenging areas for compliance officers and are a subject of great confusion. Kash Chopra, MBA and JD, works in assisting Compliance Officers with compliance related problems and has found that most organizations go about development of compliance policies in a haphazard and ad hoc manner that exposes them to a great deal of potential liability. She has frequently encountered organizations that do not properly keep track of policies with the result of overlapping or duplicate policies on the same subject that could create significant liability. The failure to keep track of rescinded or revised policies is another common problem with potential liability consequences. For Compliance Officers addressing this issue, she notes that policy management refers to all stages of document life cycle and is critical to an effective compliance program. This includes:

  1. Controlling all compliance-related documents
  2. Standardizing document form/format
  3. Establishing a need for a new document
  4. Prompting when action is needed
  5. Managing work flow in creation of new/revised documents
  6. Tracking when documents should be reviewed for updating
  7. Maintaining an archive of retired documents and policies
  8. Storing and managing all compliance-department documents
  9. Ensuring document access controls and security
  10. Establishing hyperlinks to related regulators and authorities
  11. Facilitating distribution to employees, vendors, and consultants
  12. Documenting certifications and attestations

For more information on this subject, contact 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.