Kusserow on Compliance: The value of surveying compliance professionals

There is great value of knowing where you are in relation to others

When asked to participate in surveys, it is worthwhile to know its purpose and why it is worthwhile to participate in one. In short, surveys are a method of gathering information from individuals. They can serve a variety of purposes. The survey should be considered as another confidential communication channel that permits sharing information with others in the compliance arena. The objective of the Compliance Benchmark Survey designed for compliance professionals is to permit compliance professionals to participate as a network in understanding what challenges their colleagues in other healthcare organizations are facing and preparing for 2018. It is a data collection tool utilized to describe the current state of affairs facing compliance professionals in the real-world. As respondents share their thoughts and challenges anonymously with others, other compliance professionals benefit by knowing they are not alone in struggling to meet the challenges of compliance within their respective organizations.  The Survey taps into what compliance professionals are thinking and find useful information to assist in meeting challenges. Understanding what other compliance professionals are thinking and doing can assist in planning ahead to address the evolving challenges and expectations in an ever changing regulatory and enforcement environment. Results from the Survey can help proactively identify and respond to trends and issues confronting compliance professionals. This in turn may lead to a decision to shift priorities.

 

Benefits of Survey Participation

 

  1. It permits benchmarking your compliance efforts with other professionals at other healthcare organizations and gaining insights into developing a more effective compliance program.

 

  1. By participating in the Survey respondents will receive the analytical report of the results and a “free ticket” to a webinar hosted by a panel of compliance experts providing added feedback as to the significance of data collected and how it can be used in planning work for the upcoming year.

 

To join the network of compliance professionals in sharing their experience and concerns about meeting the challenges in 2018, click below:

 

Participate in the Survey

 


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

Kusserow on Compliance: Getting ready to evidence program effectiveness in 2018

In its compliance guidance, the HHS Office of Inspector General (OIG) calls for periodic evaluation of compliance program effectiveness. This can be done by a full field evaluation by experts, however, there are other methods that can help accomplish this end. One way to evidence effectiveness is measuring the compliance culture of the organization with a compliance culture survey. However, to obtain meaningful results requires using a professionally developed and independently administered instrument. Internally developed surveys have little value and are often considered suspect by those asked to participate in the process.

Dr. Cornelia Dorschmid, PhD, advises that a culture survey should be professionally developed, tested, and validated in order to obtain reliable and useful results with the best results being anchored in a larger database for comparison of results. She was instrumental in developing the Compliance Benchmark Survey©, along with a PhD behavioral scientist and a former HHS Inspector General that has been in use since 1993. It uses a Likert Scale model, wherein respondents are asked to rate the question on a scale of one to five. Mean scores are computed for each item. Some questions items are reverse-scored to control for response set (the tendency to respond in a given pattern), “halo effect”.  The survey also includes items known as validators that ensure that respondents are being candid in their responses and not trying to manipulate the survey.

Jillian Bower Concepcion, VP for the Compliance Resource Center explained that the Compliance Benchmark Survey© has been widely used by hundreds of health care organizations with more than a half million employees surveyed. Results of this survey will assist identifying compliance program strengths, as well as opportunities for improvement. Reports present employee perceptions with respect to five different dimensions and four compliance themes. The results by question, panel, and overall results can be compared and benchmarked against the universe of those who used the survey.  The overall score level (i.e., sum of individual item scores) of the company is evaluated against the Health Care Compliance Index (HCCI©). An organization using the same survey over time can also benchmark their progress and measure improvement in the organization’s culture. For more information on compliance surveys, see https://www.complianceresource.com/publication-topics/compliance-surveys/

Steve Forman, CPA, a nationally recognized healthcare compliance consultant whose experience includes serving as an executive in the OIG and the CCO for one of the nation’s largest healthcare system has used the Compliance Benchmark Survey© since it was first introduced.  He has found survey results assist in identifying areas where attention is needed that is very useful in the maintenance and enhancing an effective compliance-program. The results can tell you the “what”, but not the “why” and as such he uses the information in talking to employees and conducting “focus group” meetings that can provide additional insights as to the full meaning of the information derived from the survey.

Al Bassett, JD, is another nationally recognized expert on healthcare compliance, who has been building and evaluating compliance program for over 15 years. Prior to his work in compliance, he was a Deputy Inspector General and FBI executive. He noted that he has found the survey is very valuable in assessing compliance program effectiveness. Results provide compliance officers with a road map to improving the program effectiveness and the costs of using the survey in evaluating the compliance program is only about only 10 percent of a full field assessment by experts.

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

Kusserow on Compliance: OIG report on research compliance through OHRP

The OIG conducted a study of the Office of Human Research Protection (OHRP) at HHS in response to Congressional requests that raised questions about its independence. The request was for the OIG to review OHRP procedures and make recommendations to strengthen protections for human subjects and ensure OHRP’s independence. OHRP enforces compliance with HHS regulations for protecting human subjects. Its mission is to protect the rights of human subjects-individuals who volunteer to participate in research conducted or supported by the HHS. The OIG conducted a survey of research institutions that were the primary subjects of the compliance evaluations about their experiences with the OHRP. The OIG also reviewed documents from eight compliance evaluations that had been closed; and interviewed OHRP staff, other HHS officials, and individuals with expertise in protections for human subjects.

OIG findings regarding OHRP

The OIG found that OHRP:

  • evidenced carrying out its compliance activities independently from agencies funding the research and the institutions conducting the research;
  • made decisions on how to use resources, resulting in fewer compliance evaluations, while increasing its use of other mechanisms in response to allegations;
  • determined the scope of its evaluations and what methods to employ;
  • was able to access the information it needed to conduct its compliance evaluations;
  • maintained documentation on its determinations;
  • may be limited in its ability to act independently due to its role, placement within HHS, and the way its budget is set may limit; and
  • may have the appearance of limited oversight and independence due to the practice of not reporting publicly on all of its compliance activities.

OIG Recommendations to HHS

The OIG recommended that HHS:

  1. issue guidance that clarifies OHRP’s role;
  2. re-evaluate OHRP’s position within HHS;
  3. evaluate sufficiency of OHRP’s resources;
  4. consider ways to elevate the prominence of OHRP’s budget (e.g. having a separate line item in the President’s budget);
  5. foster a shared understanding for OHRP’s independence by considering seeking statutory authority for OHRP’s independence; and
  6. post on OHRP’s website: (a) a description of its approach to oversight and (b) data (in aggregate) regarding its compliance activities.

 

 

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

Kusserow on Compliance: Health care mergers and acquisitions due diligence

Hardly a day passes when the press does not report on a new merger or acquisition in the healthcare sector.  Some of these are monumental in scope, but most relate to individual hospitals, facilities, or entities.  The number of hospital and health system mergers and acquisitions continued their upward trend in the first quarter of 2017, with an eight percent increase from 25 to 27 transactions compared to the first quarter of 2016.  This trend is likely to continue and is stimulated by health care reform that will likely result in more consolidation and integration among hospitals and physician practices.  There are two common types of due diligence; financial and legal.  However, the highly regulated nature of the health care industry requires a third type; regulatory due diligence to avoid discovering and having to make disclosures of regulatory violations and overpayments of millions of dollars.

Financial and Legal Due Diligence

Due diligence reviews generally focuses on financial accountability and legal liabilities. An independent accounting firm focuses on reviewing and evaluating the balance sheets, income statements, audit reports, and cash flow statements and projections in measuring financial viability. There are many very competent public accounting firms that specialize in this type of work. For legal due diligence, the focus is on examining the entity’s structure; business permits and/or approvals; employment and labor law compliance; environmental law approvals, permits and compliance; contractual rights and obligations; intellectual property rights and obligations; real property law compliance; securities and financing regulatory compliance; tax exposure risks; consumer protection law and exposure risks; and/or licenses; previous and/or current litigation; media reports; and external consultants and/or advisors. There are an abundant number of law firms that provide high quality services in this type of work.  What is often missing is focusing on the potential health care regulatory and legal compliance issues.

Health Care Regulatory Due Diligence

In the health care sector, things are more complicated, wherein health care facilities are subject to a tremendous number of state and federal laws and regulations that govern how business must be conducted. As such, there are significant risks that a purchaser can inherit serious regulatory liabilities without checking to see how the entity is complying with these rules. With the right experts with experience in doing this kind of work, the time and costs for the due diligence review be only a small fraction of the costs of either a financial or legal review. The reason is simple: financial and legal due diligence involves detailed examination of a large volume of information. Regulatory compliance experts know exactly where to look for any weaknesses without having to do a “deep dive.” As such, it is difficult to imagine why a party looking to make an acquisition would not want a regulatory due diligence. High on the list for any reviews should be arrangements with referral sources—the highest enforcement priority of both the DOJ and OIG for many years—and review of the claims processing system and controls to ensure that there are not regulatory issues waiting to be discovered by CMS contractors or enforcement agencies.  In virtually all cases, problems will be identified that in very few cases would interfere with the decision to acquire, but is very likely to not only avoid a future liability but puts on the table additional tools to improve the negotiation terms and conditions.

 

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