Kusserow on Compliance: Using sanction-screening tools vs. outsourcing the entire process

In order to save time and costs, more and more health care organizations have been moving to outsource functions that are not core business activities. Compliance programs have been part of that trend: (1) 80 percent of compliance offices use vendors to provide hotline services, (2) 50 percent of compliance offices use vendors to provide policy development tools, and (3) two-thirds of compliance offices use vendors to provide E-learning tools. Included in the growing list of outsourced tasks has been the movement to address the rapidly growing cost and time commitment obligations related to sanction-screening. Two-thirds of compliance offices use a vendor search engine tools to assist in sanction-screening that saves an organization from downloading the sanction databases and developing a search engine. This is a trend driven by the rapid development of many new databases against which to screen employees, medical professionals, contractors, vendors, etc., including the following:

  • OIG List of Excluded Individuals and Entities (LEIE)
  • GSA Excluded Parties List System (EPLS)
  • 40 Medicaid states now have sanction data bases requiring monthly screening
  • Drug Enforcement Administration (DEA)
  • FDA

All this has increased the burden of sanction-screening exponentially, not only for the compliance office, but also human resource management for new hires and periodic screening of current employees and procurement with vendors and contractors. Medical credentialing is involved as result of having to screen physicians who are granted staff privileges. Using vendors has been a great help, but the most difficult part of the process is resolving “potential hits.” This can be a considerable effort and many organizations have to dedicate staff for investigation and resolution of these hits. It is complicated by the fact that most sanction data does not provide sufficient information to make positive identification. As a result of this heavy burden, many have moved beyond simply using a vendor tool to outsourcing the entire process to vendors. The following address selecting a sanction-screening vendor and outsourcing the process.

 

Tips for selecting sanction-screening vendor

 

Tips for outsourcing the sanction-screening process

  • Determine the cost of moving from use of a vendor search engine tool to outsourcing the screening, along with investigation and resolution of “potential hits.”
  • Inquire as to the methodology they follow in resolving potential “hits,” a critical part of any screening effort.
  • Ensure the vendor provides a certified report of the results that can be made part of the compliance office records.
  • Review an example of the type of reports they would provide to determine if it meets the documentary needs of the organization.

 

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: Temporary staffing and interim compliance officers

When individuals from a compliance office, including compliance officers, retire, move to new organizations, or are replaced for any reason, it can leave a gap in the day to day management of the compliance efforts that can create a serious risk. This underscores the importance of not only finding a suitable replacement quickly, however, that process can be time consuming. As such, it is not surprising that many organizations turn to engaging temporary expert assistance, including acting the use of Interim Compliance Officers (ICOs). This decision is often made with the realization that having a gap in the program over a period of months, or designating someone internally to do the work can be dangerous. Smaller organizations are not likely to have anyone sufficiently qualified to carry out all the duties. It is also risky to have someone making decisions, or failing to make decisions, that may create liabilities. The worst decision is selecting someone to take on the role of compliance officer as a temporary set of secondary duties to his or her current job. This will always lead the individual to continue giving priority to their regular job and do as little as possible in compliance.

Temporary staffing has the advantage of quickly filling immediate needs, including addressing any pending issues or problems. Properly experienced professionals can hit the ground quickly and be effective, not just be a placeholder. This approach will permit the organization to continue its search for the permanent replacement.  Using a properly qualified outside expert presents a lot of advantages. The expert can 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 been invested in any prior decisions, nor have they been aligned with any parties in the organization. Most importantly, the expert brings “fresh eyes” to the program. An outside expert can provide an objective assessment on the state of the compliance program, offer suggestions, and give guidance for improvements.

Finding the right ICO with a lot experience and technical skills can make significant improvements for any compliance program in a relatively short order.  In fact, it may be the most economical means to have an independent evaluation of a compliance program. However, care needs to be taken when deciding on an expert. It is important that someone is not hired who is a “cast off” from another organization. As such, it is important that references be checked carefully to be assured of someone who is competent and reliable. It is important to design the engagement to bring maximum return of benefit for the cost. Therefore, in the case of an ICO, consideration should be given to the added scope of work. Organizations should expect to have the outside expert:

  • provide an independent assessment of the status of the compliance program;
  • make an assessment of high-risk areas that warrant attention;
  • be able to efficiently and effectively address compliance risk issues that may arise;
  • offer suggestions to build a firmer foundation for the compliance program;
  • review the existing Code, compliance policies, and other guidance;
  • evaluate the quality and effectiveness of compliance training;
  • develop a “road map” for the incoming compliance officer to follow;
  • assist in identifying and evaluating candidates for the permanent position;
  • assess resources needed to effectively operate the compliance program;
  • identify or build metrics that evidence compliance program effectiveness; and
  • develop comprehensive briefings for management and board on the state of the program.

Finally, for even fairly large organizations, a true compliance expert can hold things together for several months without having to be full time on site. Most organizations can keep their compliance program operating with many of the added benefits noted above, using an expert for 50 to 80 hours per month. After all, the ICO is holding the compliance program together, not building it.

 

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: Measuring the compliance culture

The OIG, DOJ, and other oversight agencies believe the compliance program should be a change agent in promoting a culture of compliance that creates an environment less likely to have regulatory or enforcement problems. This means establishing a culture where everyone in the work environment embraces and adheres to a set of shared attitudes, values, goals, and practices that characterizes an institution or organization when it comes to compliance with laws, regulations, rules, standards, codes of conduct, and policies. The OIG in its compliance-program guidance for hospitals states that “fundamentally, compliance efforts are designed to establish a culture . . . that promotes prevention, detection and resolution of instances of conduct that do not conform to federal and state law, and federal, state and private payor health care program requirements, as well as the hospital’s ethical and business policies.” Today, however, both the DOJ and OIG continue to encounter organizations that have a compliance program on paper, but lacking in quality, commitment, and ethics—a culture of compliance. It is therefore logical that compliance officers find means to evidence that the culture of the organization matches the compliance goals and be able to evidence this, if and when, they are challenged to do so.

One way to gain understanding of the compliance culture is through a survey which tests understanding and acceptance of the compliance program. This is among the best means for evaluating, evidencing, and benchmarking the overall compliance program effectiveness. Using surveys is also one of the two methods suggested by the OIG in its Compliance Program Guidance for Hospitals and Supplemental Guidance for Hospitals.  The OIG noted that “as part of the review process, the compliance officer or reviewers should consider techniques such as . . . using questionnaires developed to solicit impressions of a broad cross-section of the hospital’s employees and staff.” The OIG further reinforced this by stating it “recommends that organizations should evaluate all elements of a compliance program through “employee surveys.” In the 2018 SAI Global/Strategic Management Compliance Benchmark Survey of compliance programs, respondents indicated that one-third of organizations with compliance programs survey their work force on compliance issues. However, only a minority of them use professionally developed and tested surveys, relying upon internally generated and administered ones that do not carry the same level of credibility.

Steve Forman, CPA has been using compliance culture surveys for the last twenty years as a compliance officer and as a compliance consultant. He believes that one of the best and most inexpensive methods for evaluating, evidencing, and benchmarking compliance program effectiveness is through a compliance culture survey that measures employee perceptions of ethical culture and/or the compliance program. He likes using this type of survey, alternately with a compliance knowledge survey that tests employee knowledge of the program. Results from a professionally administered survey provide a very powerful and credible report to the compliance oversight committees, as well as to any outside authority questioning the program.  Such surveys can also identify relative strengths in the compliance programs, as well as those areas requiring special attention that are invaluable for compliance officers.

Jillian Bower Concepcion has many years experience in administering compliance surveys, as well as serving as interim compliance officer. She explained that culture surveys focus on the beliefs and values which guide the thinking and behavior of employees within an organization. They are usually presented in a Likert Scale format that offer a series of gradation where respondents are asked whether they “Strongly Disagree,” “Disagree,” are “Neutral,” “Agree,” or “Strongly Agree,” with the statement presented in each item. She notes it is highly advisable to use a valid and independently web-based administered survey that has been tested over many organizations and ensures participant confidentiality. Using a professional survey service specializing in health care compliance is surprisingly inexpensive and less costly than developing and delivering a survey in house, that doesn’t carry the same level of credibility. The Compliance Resource Center (CRC) has been using the Compliance Benchmark Survey© since 1993 and has been employed with hundreds of health care organizations and a surveyed population of over a half-million. Clients find that comparing their results with the universe to be the most beneficial information. Survey reports are typically about 50 pages in length and provide advice on each topical area and question as to how improvements may be made.

Carrie Kusserow, Managing Senior Consultant for Strategic Management, has been using compliance surveys to assist with benchmarking the progress of compliance program. Such benchmarking was called for by the OIG when it stated in its compliance guidance that “the existence of benchmarks that demonstrate implementation and achievements are essential to any effective compliance program.” She has found surveys can be used to meet that standard, two ways. First, if the survey being used is anchored in a database of users, the organization can benchmark them against that universe, viewed as very important by most organizations. Second, an initial survey can establish a baseline from which future surveys can be used to benchmark progress of the compliance program and measuring change in the compliance environment over a period of time.

Carrie Kusserow and Jillian Bower Concepcion will be available to discuss this subject in more detail at the HCCA conference in Las Vegas, booth 412

 

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: 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.