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Compliance 201KeyComplianceProgramMetrics
CindyMatson,BS,CHC,CHPCVPCorpCompliance,SanfordHealthRuthKrueger,MS,RRT,CHC
CorpComplianceProgramManager,SanfordHealth
Objectives
Review elements of an effective Compliance Program Yates memo DOJ Compliance Counsel
Discuss measurement tools – what are the metrics? Identify key performance indicators as guidelines for resource
allocation What are your program goals – baby steps? What does an effective program look like?
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What are the Measures that Matter?
7 elements – basics still very important
Compliance 201 steps it up Show program is more than words on paper
Tells the story of your program
Objective, data driven information
Compliance as strategic advisors
Roy’s Words Roy Snell SCCE Blog
“A compliance program is not a complex concept. All the elements are quite simple concepts that everyone can understand (i.e. hotline, auditing, monitoring, education, etc.) What is difficult is making sure all elements of a compliance program are working at all times. The tough part of compliance is the coordination of multiple compliance efforts and filling the gaps.”
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Other Perspectives
https://www.youtube.com/watch?v=hseKD9QY8Wk
Effectiveness 101 -7 Elements
Policies, Procedures and Standards of Conduct Compliance Program Oversight Training and Education Communication Auditing and Monitoring Consistent Discipline Corrective Actions
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Compliance Effectiveness 101
Understand OIG Compliance Program Guidance
Utilized key performance measures i.e. Toll free HOTLINE – anonymous, no retaliation, confidential
Treat complaints seriously
Investigate
Close the loop with the reporter
Impose sanctions
Effectiveness 201
What are the measuring sticks?
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201 DOJ Effectiveness
Do directors and managers offer strong support for corporate compliance policies?
Do compliance personnel have stature in the company?
Do the compliance teams get the resources they need?
Are compliance policies clear and in writing? Are they easily understood and translated?
201 DOJ Effectiveness cont.
Are the compliance policies updated & effectively communicated to employees? Are they easy to find and do employees get repeated training?
Are there ways to enforce the compliance policies and is compliance incentivized and violators disciplined?
Are third parties informed of compliance expectations?
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201 Yates Memo
Turn over information on individual wrongdoing = Cooperation Credit
All investigations, both criminal and civil, start with individuals within a company
Assign both criminal and civil lawyers on corporate cases who will share information freely
No individual protection without DOJ approval
Individual actions must be resolved before corporate actions can be resolved
Civil actions against individuals will be pursued even if they can’t pay a substantial fine
Trouble
Headlines…
DOJ Reports 80 Percent Civil Fraud Recovery as a Result of Whistleblowers
CIA Columbus Regional Healthcare System
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201 - New Hire Hui Chen
DOJ Compliance Counsel Responsibilities:
Review effectiveness of compliance programs under investigation
Develop appropriate program benchmarks & remediation measures
Guidance on Fraud Section assessments of a company’s required compliance and remediation efforts
DOJ Goals
Place accountability on the individuals who perpetrated the wrongdoing
Deter future illegal activity
Hold appropriate party responsible for their actions
Promote the public’s confidence in our justice system
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Effective Culture
Is the tone at the topStrongVisibleExplicit
Does the compliance team have:StatureFundingResources
Effective Governance
Principles are in writing
Easily found
Understandable
Translated
Reviewed and updated often
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Effective Education
Are your training and communications directed at service lines and compliance risks?Delivered frequently/bursts of information
Provided to 3rd parties
Practical – Instruct what to do and who to call
Do you benchmark education completion rates?
Good to Great-Risk Assessment
101 Effectiveness Protective Checklist Reactive Event driven Question everything Fear/Sky is Falling
201 Effectiveness Expansive /Service line involvement Dynamic Proactive/monitors Mission/Strategy driven Consider everything Analytics/precision
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Chicken Little Syndrome
Accountability/Disciplinary Action
Does your organization consistently and fairly
Reward good behavior
Punish bad behavior
Hold 3rd parties accountable
Hold service lines accountable
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Plan Your Indicators
Hard to go backwards
Identify goals
Benchmark
Identify areas for improvement
How to Measure
Plan how you will report what you measure
Informative aide in decision making
Clearly delineate the metrics you choosemeasurable, meaningful, quantifiable, predictive
Limit what you measure
Select only metrics that offer quantifiable information
Set thresholds and goals
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Are You Effective?
What do your trends show?
Benchmarks
Employee survey
Compliance team autonomy
Compliance effectiveness review and dashboard
Ideas for Indicators
Audit your audits
Evaluate Reporting Mechanisms
Assess Organizational Culture
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Consider Employee Survey
Employee awareness of compliance resources
Employee’s opinion of manager’s ethical leadership/tone from the middle
Is employee comfortable reporting misconduct
Does employee feels pressure to commit misconduct
How to Report
succinct
meaningful
actionable
timely
visually engaging
organized
Refine type and level of information pertinent to audience:
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Data Overload
Be careful about data dumping
Combine metrics to give good overall look
Less is more
Audit the Audits
0
10
20
30
40
50
60
70
2013 2014 2015
CAP w major findings
CAP w minor findings
No Findings
Total audits/FY
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Repayments Related to Audits(exclude RAC)
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000
2013 2014 2015
MAC
Medicaid
Other Gov't
Audit Financial Impact by Market
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
Market 1 Market 2 Market 3 Market 4
FY2015
FY2014
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Audit Closure
FY 2015
CAP w major findings (n8)
CAP w minor findings (n20)
No findings (n32)
Open (n3)
Work Plan Completion
Audit Risk Area Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun FindingsEmployee Licensing High ALL X Minor w/ CAP
340B Pharmacy+ High Pharmacy X Minor w/ CAP
Provider Based Status High Hosp/Clinic X Minor w/ CAP
Provider Licensing High HSDMedical Director Pmts High HSD T
LTC Personal Funds Mod LTC Minor w/ CAP
DME PMD Mod DME X Minor w/ CAP
Research Billing Mod Hosp/Clinic X Minor w/ CAP
Wound Care Mod Hosp/Clinic X Significant
Medical Device Credits Mod Hospital X Significant
Rural Health Clinics Mod Hosp/Clinic X Minor w/ CAP
*Added mid-cycle+External AuditScheduledX = CompletedT = Tentative completion
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Benchmarking
0
50
100
150
200
250
300
350
400
450
500
2013 2014 2015
Vol
ume
of c
alls
Trended Hotline by Category
Total
Privacy
Compliance (coding,billing)
Ethics/HR
Other Risk,Quality, Vendor
Culture
0
2
4
6
8
10
Awareness ofcomplianceresources
Manager ethical Reportingcomfort
Pressure tocommit
misconduct
2013
2014
2015
Rates question on 1-10 scale
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Compliance Programs that Work Roy Snell SCCE blog 12/12/15
…Compliance programs work because they are simple, elegant, and effective. Many people want to make compliance programs complicated, but when they do, they ruin their effectiveness.
Compliance programs work because they are the obvious solution with a purpose to prevent, find, and fix ethical and regulatory problems.
Questions?
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