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A New Compliance Resource From the HHS-OIG

Following the publication of "Practical Guidance for Health Care Governing Boards" (April 2015), and The DOJ's report entitled "Evaluation of Corporate Compliance Programs" (February 2017), the HHS-OIG has issued a new publication: "Measuring Compliance Program Effectiveness: A Resource Guide."

The Guide was published March 27, 2017, and is now posted on the OIG website.  The Guide was developed as part of a collaboration between OIG representatives and compliance officers convened at an HCCA-OIG Compliance Effectiveness Roundtable Meeting in January 2017.

Although evaluating and measuring compliance program effectiveness is a long-standing expectation, there have been few regulatory resources to support evaluation and measurement activities.   The Guide includes more than 400 metrics for compliance effectiveness that are intended to be selected based on the size of the organization and the scope of its compliance program.  The metrics are organized and presented in keeping with the seven elements of effective compliance programs.

This flurry of publications—all directed to various aspects of compliance program effectiveness—send a strong message about the OIG's expectations for compliance programs.  Organizations without a well-developed compliance program meeting the requirements of the seven essential elements are at risk of being subject to a corporate integrity agreement in the event that the program is reviewed by regulators.

Most important of all, effective compliance programs act as a deterrent to serious  regulatory issues.  Also, when issues arise, a robust compliance program is more likely to detect the issue early, saving significant resources in comparison to situations in which erroneous billing or other compliance issues take place undetected over long periods of time.

Internal compliance reviews and self-assessment are effective to a degree.  However, it is recommended that every organization invest in a periodic external review to gain the benefit of objectivity and specific compliance expertise.

Julie A. Knutson

 

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