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Compliance 2.0

on Monday, 22 May 2017 in Health Law Advisory: Zachary J. Buxton, Editor

DHHS Inspector General Daniel R. Levinson’s keynote address at the 2017 Health Care Compliance Association (“HCCA”) Compliance Institute in late April focused on the future of compliance, targeting several key themes:

  • This is Compliance 2.0. IG Levinson noted that the compliance industry is about 20 years old and we are entering a “second era” of compliance.
  • The recently published Measuring Compliance Effectiveness: A Resource Guide is a “game changer;” an encyclopedia for compliance officers looking as each of the seven components of an effective compliance program. IG Levinson’s comments made it clear that the Resource Guide will be a key piece of guidance in evaluating the architecture of compliance and in evaluating compliance programs.
  • The enactment of HIPAA was historically significant for compliance because it created a much larger office of the IG and “bulked up” its ability to fight health care fraud, working in concert with law enforcement under the shared budget account with the Department of Justice. 
  • HIPAA also fostered the issuance of Advisory Opinions and the development of voluntary compliance program guidance to inform and educate health care providers and suppliers as well as working in partnership with private insurers.
  • The size of Medicare and Medicaid programs has tripled in 20 years making fighting fraud more important than ever to protect taxpayers dollars to prevent patient harm.
  • The IG’s compliance story is not hierarchical—it is horizontal, seeking partners who can best assist in fighting fraud, waste and abuse in various partnerships.
  • Technology and the human factors are equally important. Evolving technology in investigation permits earlier detection of  fraud than ever before.
  • Organizational culture is marshaling the human factor in organizations to make the best use of human resources in compliance efforts. IG Levinson provided data from a study conducted by the National Bureau of Economic Research (March 2017) that queried a large number of organizational CEOs in and outside of health care.  Ninety-one percent said that culture is one of the top three to five drivers of value for an organization; yet only 16 percent thought their organization’s culture was where it should be.
  • Levinson described a positive culture as involving trust and cooperation, accountability for decisions, passion, diversity, quality, integrity and honesty. The OIG thinks that culture is a critical factor in compliance.
  • Areas of current priority for the OIG are prescription drug abuse, home health agencies and Medicaid program integrity.

In summary, the gist of the address seems to be that much more is expected of compliance programs than during the first 20 years. Programs and those involved with them must be significantly more sophisticated and capable of taking compliance beyond the basic levels set out in the compliance guidance of the 1990’s. Vast resources now exist on the OIG website and it is expected that providers and suppliers will avail themselves of these resources to incrementally refine, update and improve their compliance programs on an ongoing basis.  

Julie A.  Knutson

 

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