Lack of Federal Guidance, Varying Organizational Structures, Contribute to Weak Commitment to Compliance, AIS Newsletter Finds

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The Feb. 23 issue of Atlantic Information Services’s Report on Medicare Compliance lists some of the factors identified by compliance experts that contribute to a compliance officer’s ineffectiveness, including an organization’s internal structure and a lack of guidance from the government.

For some compliance officers, the job doesn’t live up to expectations, says Atlantic Information Services, Inc.’s (AIS) Report on Medicare Compliance (RMC). The Feb. 23 issue of RMC found some of the reasons that contribute to a compliance officer’s ineffectiveness, as identified by compliance experts.

Some compliance officers report to the general counsel instead of to the CEO or a board of directors, even though the Department of Health and Human Services’s Office of Inspector General’s (OIG) compliance-program guidance frowns on it, Mark Pastin, president of the Council of Ethical Organizations, tells RMC. Such a hierarchy poses a direct challenge the compliance officer’s independence. Legal counsel and compliance officers both need direct access to the board and CEO, Julie Chicoine, senior assistant general counsel at Wexner Medical Center at the Ohio State University Medical Center, tells RMC. “Legal departments are charged with advising an organization as to viable options and business strategy, and protecting the organization’s problems with the attorney/client privilege, whereas compliance is generally charged with monitoring and minimizing the risks associated with such activity,” Chicoine says. “Both have the organization’s interests at heart, but they come from different perspectives.”

But even if a compliance officer reports directly to a CEO or board, getting these executives to appreciate compliance poses another challenge. “[Some senior leaders] know they should have a compliance function, it is something the government wants, but they don’t get it,” Pastin says. Chicoine thinks leadership accepts compliance, but “sometimes cannot grasp the depth of a problem” and can deny that there’s an issue. “Indirect facts and anecdotal information about a problem can go on for a long time until something big happens and unfortunately the organization belatedly scrambles to get ahead of disclosure when they are already way behind in even understanding the problem,” she says.

The HHS OIG requires organizations to have compliance programs, but guidance is still forthcoming. “The Affordable Care Act made the compliance program mandatory, but it won’t happen unless there is a regulation that explains what you need to do,” says one compliance officer, who asked to not be identified. “If the government wants this, they have to step up. Otherwise, if there is room to wiggle, there will be wiggling going on.”

Visit http://aishealth.com/archive/rmc022315-02 to read RMC’s full list of five factors that subvert the work of compliance officers.

About Report on Medicare Compliance
The industry's #1 source of timely news and proven strategies on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers, the award-winning Report on Medicare Compliance identifies and provides valuable guidance on dozens of high-risk billing and documentation problems and foreshadows the next moves of federal enforcers and their armies of RAC, ZPIC and MAC auditors. “The best information there is for hospital compliance officers,” the 8-page weekly newsletter includes insights and strategies not available anywhere else.

Since 1992, Report on Medicare Compliance has been written by Nina Youngstrom, who has a reputation for being one of the most knowledgeable journalists and incisive writers in the field. With excellent Contact s at the IG's office and at CMS, and strong relationships among industry experts and compliance officers, each issue of Report on Medicare Compliance contains exclusive, inside news. Visit http://aishealth.com/marketplace/report-medicare-compliance for more information.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.

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