Kusserow on Compliance: The relationship between an Interim Compliance Officer and the CEO

Getting the right start is the best way to have a good return on investment

Catie Heindel, J.D., a highly experienced compliance consultant who has served as an Interim Compliance Officer, notes it is increasingly common for healthb care organizations to seek a temporary compliance officer to cover a gap. Though the rationale behind hiring an interim compliance officer is different for every organization, the ultimate goal is usually the same—to provide high quality and efficient compliance program leadership that will reduce exposure to unwanted risks and problems. Preparation and communication with staff to introduce the person selected to act in an interim capacity is very important to having a successful result from the engagement.

Ensuring a successful hiring decision really needs the personal involvement of the CEO. The OIG compliance guidance stresses that the compliance officer should report directly to the CEO. This sentiment also applies to Interim Compliance Officers; and the best return on investment for having someone move in and successfully temporarily fill a compliance officer gap is for the CEO to establish a direct reporting relationship. It is also helpful for everyone involved if the CEO personally provides a detailed background briefing on the organization that includes:

  • management structure;
  • mission/vision;
  • why the person was engaged;
  • expectations for the engagement; and
  • their role in the organization.

Upon arrival, the CEO should ensure there is a proper “on-boarding” process that includes personally introducing the interim compliance professional to the executive leadership, key program managers, legal counsel, HRM, and Board members. This interaction, from the outset, sets the right tone and will help to ensure that the interim is in lockstep with the CEO.  Furthermore, this empowerment exercise will permit the interim to move more quickly in gathering the reins of the compliance program and guard against having anything fall “beneath the cracks”.  It will also help the interim compliance professional to “hit the ground” running immediately and begin productive work.

For more information regarding engaging and preparing Interim Compliance Officers, Catie Heindel can be contacted at www.cheindel@strategicm.com, or via phone at (847) 707-9830.

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 © 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: 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.

Kusserow on Compliance: Time running out for nursing and long term care providers’ development of mandated compliance programs

Tips to meet the challenge in a timely and cost effectively manner

The OIG issued voluntary Compliance Program Guidance for Nursing Facilities in March 2000, followed by Supplemental Compliance Program guidance in September 2008. However, the Patient Protection and Affordable Care Act (ACA) made compliance a mandate and it is a game changer for this sector. The new mandates note as a condition of enrollment in Medicare and Medicaid “a facility shall . . . have in operation a compliance and ethics program. . . .”   HHS was directed to issue regulations “for an effective compliance and ethics program for operating organizations” and CMS has issued those regulations with a deadline for organizations and facilities to meet these requirements by November 28, 2019. At that time, state survey agencies will begin assessing facility compliance for compliance.

Tom Herrmann, J.D., served over 20 years in the OIG Office of Counsel and for the past ten years has been a compliance consultant, specializing in nursing home compliance programs. He noted that many nursing facilities lagged behind in developing effective compliance programs because it was viewed as cost prohibitive. Those that implemented programs following the OIG guidance will have little difficulty in meeting the standards. For those who delayed program development, time is running out. State survey agencies will conduct compliance audits following the CMS State Operation Manual “Guidance to Surveyors for Long Term Care Facilities”.  Survey protocols and guides for State Survey Agencies have also been posted by CMS and can be reviewed by nursing homes in preparation for the reviews.  When building or improving the compliance program, CMS requires an annual review of its compliance and ethics program to assess the resources needed for an effective compliance program that includes mandatory training for all covered persons. For more information regarding advisory services in building effective compliance programs, Tom Herrmann can be reached at therrmann@strategicm.com or via phone at (703) 535-1410.

Kash Chopra, JD, provides compliance staffing for clients. She explained that many nursing homes may not require hiring a fulltime compliance office, however, designating someone on the staff to act as a compliance officer as a secondary duty is not a good idea and seldom works satisfactorily. Invariably, the primary duties drive out time for the compliance responsibilities.  One solution that should be considered is using an expert as a Designated Compliance Officer (DCO) to quickly, efficiently, and inexpensively build and manage the program. The OIG in its compliance program documents specifically advises: “For those companies that have limited resources, the compliance function could be outsourced to an expert in compliance.”  For more on staffing compliance officers, Kash Chopra can be reached at 703-236-1291 or at kchopra@strategicm.com

Daniel Peake of the Compliance Resource Center said that many nursing home clients have found an economical solution to the costs of building and managing their compliance program by outsourcing key elements, such as hotline services, sanction screening, compliance training, code and policy development. These services can take a big bite out of the work of building an effective compliance program at a very small price for most organizations providing nursing or long term care. For more information about the cost and benefits of outsourcing key compliance elements, Daniel Peake can be reached at (dpeake@compliancereource.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 © 2018 Strategic Management Services, LLC. Published with permission.