Kusserow on Compliance: OIG report on 2017 Hotline activity

The HHS Office of Inspector Genera (OIG) is mandated to provide a semiannual report to Congress to summarize its activities. Included in this report was a section on the OIG Hotline (1-800-HHS-TIPS), available to individuals to report fraud, waste, or abuse in HHS programs.  The OIG considers the hotline a significant avenue of intelligence. What it also underscores is that many more “Whistleblowers” contact the OIG directly, than by filing qui tam actions with the DOJ. During the second half of 2017 alone, the OIG Hotline received 58,110 hotline contacts which were evaluated to determine whether an issue rises to the level of a complaint and whether it falls within OIG’s jurisdiction. Of that 13,781 were sufficient in details to warrant evaluation. The hotline phone was the source for 5,815 of these cases with another 3,966 obtained via the OIG website.  In addition 1,107 complaints were obtained via letter or fax. After evaluation, 10,888 were referred for action. The balance did not provide basis for further action or were found to not provide evidence of violations. The source of those tips that were referred for action varied.  Those received via the hotline phone were 5,127.  The internet was the source for 3,768 tips with the remaining 1,075 tips coming from letters and facsimiles.

The OIG forwarded approximately one-third of the complaints to its field offices for follow-up, slightly less than half to CMS, with the balance referred to other HHS operating divisions and other federal agencies. During this semiannual reporting period, the OIG Hotline reported expected recoveries of $9.9 million as a direct result of cases originating from hotline complaints.

Jillian Bower, has assisted scores of clients with their hotline operations through the Compliance Resource Center (CRC). She notes that having an effective hotline program is a must for any effective compliance program, however many organizations with hotlines that are not effective.  Those not promoting an effective hotline operation are making a grave error and risk driving complainants externally to the DOJ and OIG, litigating attorneys, media, etc. and that can only spell trouble. Receiving and resolving issues internally is the right approach and is good for the organization on many levels. Failing to do so can result in potential liabilities, headaches, and a lot of remedial work. By maintaining such a positive culture for employees to be able to report problems, concerns, and perceived wrongdoing will encourage internal reporting rather than having individuals thinking they must resort to “whistleblowing” to external parties.

10 Practical Tips

  1. Develop and implement written guidelines relating to the hotline operation that should information on the (a) hotline operations, (b) duty to report, (c) non-retaliation, (d) anonymity, (e) confidentiality, (f) investigations of complaints, among others.
  2. Have information about the use of the hotline made part of the Employee Handbook and Code of Conduct.
  3. Promote a culture that encourages employees to raise concerns and report perceived problems with managers being counseled that these are opportunities for improvement in the organization.
  4. Maintain a confidential recordkeeping system to enable a review of employment history for those employees who have raised concerns or reported problems.
  5. Have posters on the employee bulletin boards for the availability and use of the hotline.
  6. Ensure the hotline number and its availability is included in new employee orientation.
  7. Consider having a flyer go out to all employees on the availability of the hotline.
  8. If there is an Intranet for employee use, include information about the hotline.
  9. If there is an organization newsletter, use it to promote the hotline.
  10. Extra care needs to be taken to avoid doing anything that might be interpreted as retaliatory.

 

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

Kusserow on Compliance: Using experts to staff gaps in the compliance office

It is becoming increasingly common for changes in compliance programs to lead to “gaps” that can leave an organization without day to day management or support. This can result in serious problems and potential liability, especially at a time when mandatory compliance requirements are under development and there are increasing expectations for compliance by the Department of Justice (DOJ), HHS Office of Inspector General (OIG), and CMS. With the heightened enforcement environment, leaving such a gap can be risky. All this makes the problem of finding a suitable replacement of someone properly qualified in a timely manner a relatively high priority, but not an easy task. In many cases, the gap is not with the chief compliance officer, but compliance managers or other professionals in the office. In any case, the effort that goes into finding and hiring a properly experience and qualified person may be difficult and time consuming. The quick fix of designating someone internally to do the work, until a permanent replacement can be recruited, is unwise and may be downright dangerous. For smaller organizations, it is not likely there is anyone who is sufficiently qualified to carry out all the duties. It is also not good for someone to take on those duties temporarily and make decisions that may haunt them when they return to their old job. Also, making some decisions, when not properly trained or qualified, may create a potential problem for the organization. What is worse is selecting someone to take on the role of compliance officer as a temporary set of secondary duties to their current job. This will always lead the individual to continue giving priority to their regular job and do as little as possible in compliance. As such, it is not surprising that many turn to engaging temporary experts to fill the gap until suitable replacement can be found.

A properly qualified outside expert acting in a temporary capacity has a lot of advantages. They bring the experience of having served in other organizations and dealing with many of the same issues already addressed by prior jobs. Important also is that they have not be invested in any prior decisions, nor have they been aligned with any parties in the organization. Most importantly, they bring “fresh eyes” to the program. They can provide a lot of added benefits, such as:

  • Offering suggestions and giving guidance for improvements
  • Providing an independent assessment of the status of the compliance program
  • Making an assessment of high-risk areas that warrant attention
  • Giving ideas on building a firmer foundation for the compliance program
  • Reviewing adequacy of the existing code, compliance policies, and other guidance
  • Evaluating the quality and effectiveness of compliance training
  • Developing a “road map” for the incoming compliance officer to follow
  • Assisting in identifying and evaluating candidates for the permanent position
  • Assessing resources needed to effectively operate the compliance program
  • Identifying or building metrics that evidence compliance program effectiveness
  • Developing comprehensive briefings for management and board on the state of the program

 

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: 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: 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.