This article by Seth Anthony, Chief Revenue Officer at LW Consulting, Inc., was originally published at LW-consult.com and is reprinted here with permission.
Let’s be honest with ourselves.
For years, many organizations have viewed having a comprehensive compliance program as “check the box” activity. If there was a binder on the shelf labeled “Compliance Program,” then organizational leadership felt like they were covered.
Then, along came the role of Compliance Officer, and it became that person’s issue. Except, the comprehensive compliance program was one problem among many. While the compliance officer was busy putting out fires, programs moldered on shelves, with few tangible updates. Meanwhile, compliance requirements grew exponentially, with little opportunity for corporate leadership to integrate those changes into their daily operations in a holistic way.
Then, there was the pandemic. Businesses went from “firefighting” compliance into full operational triage. Now, as the pandemic fades, the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS), Office of the Inspector General (OIG) and the Department of Justice (DOJ), are getting serious about enforcing compliance failures.
And they are going to hold you personally responsible.
In the September 15, 2022 policy revision, DOJ made substantial changes relating to personal accountability, outside monitors, misconduct, voluntary disclosures, and expectations around the integration of compliance into the culture of an organization. Deputy Attorney General Lisa Monaco made it very clear that a new era of “personal accountability” has dawned at the DOJ by stating, “[R]esourcing a compliance department is not enough; it must also be backed by, and integrated into, a corporate culture that rejects wrongdoing for the sake of profit.”
That is certainly some tough talk! But what should it mean to operators and leaders, especially those working in healthcare settings?
DOJ has said that when bringing a criminal complaint, their agents will consider a broad range of issues, including reward and compensation metrics tied to compliance, the imposition of financial sanctions for compliance failures, and the role leaders play in allowing those failures to occur. Active participation is no longer the key issue; passivity or inaction will likely be just as damning evidence going forward.
What’s a provider to do?
The answer is simple. Pick up that Compliance Program binder and get to work!
DOJ shared that an effective, updated, and independently reviewed compliance plan is the best strategy to ward off misconduct and such a plan will likely be considered if a compliance breach comes before DOJ officials. If your plan does not include actionable compliance incentives, such as those tied to compensation, promotion, and hiring practices, you are likely already behind the proverbial “8 Ball.”
Ethical behavior and compliance are no longer a “corporate” problem. It’s a “you” problem. Your career may be on the line for compliance failures if you do not take an active role, right now, in making sure your programs are comprehensive, effective, implemented, and enforced.
Is your Compliance Program up to date, or do you need assistance with reviewing your Compliance Program? Contact one of the experts at LW Consulting Contact one of the experts at LW Consulting to learn more about how they can help.