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Paul Willging Says...

January 1, 2004
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Corporate Compliance Isn't Just "More Government"

Corporate Compliance Isn't Just 'More Government'

BY PAUL R. WILLGING, PHD There are those who see corporate compliance as just another example of overzealous government intrusion. In so thinking, they are running a risk-not just of government retribution but also of losing market share. Because corporate compliance, when you come right down to it, is good business.

Admittedly, an adversarial environment does seem to have enveloped much of long-term care over the past few years, arising from government's punitive approach to its legitimate monitoring and oversight responsibilities. "Stopping fraud and abuse" have become the watchwords of federal government involvement in the country's healthcare programs. The early years of collaboration between government and providers have been supplanted by a relationship built on hostility and mistrust.

I understand how easy it is to dismiss corporate compliance as just one more onerous burden laid on providers by an out-of-control federal government. But we'd be wrong to do so. Corporate compliance is not a federal mandate or regulation; from the government's standpoint, it is more a "safe harbor," mitigating liability in cases of alleged malfeasance. The bottom line, however, is that corporate compliance is simply good business.

Let's face it, the concept of resident assessment doesn't lose any of its validity simply because it was mandated by OBRA '87. And would anyone argue that the training of nurses' aides loses its relevance to the provision of quality long-term care just because Congress mandated it in that same legislation? Prior to 1987, with no mandate, those providers failing either to assess their residents properly or train their caregivers were simply providing poor care.

So, what is corporate compliance? Let's begin by describing what corporate compliance is not. It is not just another book or manual to be relegated to the back shelf, unread and gathering dust. Its application is not limited to relationships with payers, such as Medicare and Medicaid. It is not simply a way to "get off the hook" when accused of legal transgressions. Nor, in the last analysis, is it someone else's responsibility.

Rather, corporate compliance consists of those policies and procedures that govern the operations of the entire enterprise in accordance not just with all known legal responsibilities, but with the highest standards of professional and ethical conduct. Assuming that your corporate mission is one that you can be proud of, corporate compliance formalizes your company's mission, as well as the standards and guidelines by which that mission is to be achieved.

Looked at in this way, corporate compliance has always been important. Certainly its importance can be seen in government's increased enforcement activities, but those external forces are, perhaps, even less significant than compliance's role in fulfilling the corporate mission and, ultimately, in serving the customer of healthcare services. The best justification for a corporate compliance plan, if appropriately designed and implemented, is improved operations and, thereby, improved quality of the services provided. Those are, in a nutshell, its ultimate goals.

How does one establish an effective corporate compliance program? While outside help might be useful, an effective and acceptable corporate compliance program consists of seven basic elements that can be attended to by the organization itself (i.e., no need to reinvent the wheel):
  • First and foremost, of course, the organization has to define and document acceptable standards of conduct and ethical behavior. Some of them, to be sure, will be oriented toward government's requirements ("Thou shalt not submit false claims"). But, I would suggest, the more important rules will relate to your dealings with your customers. Appropriate standards will emphasize the importance of forthright advertising and full disclosure, the requirement for honest assessments of patient conditions and needs, and the imperative of treating residents with dignity and respect. All those procedures, reflecting ethical and professional behavior, should be clarified and written down so that misunderstandings regarding appropriate employee behavior can be avoided.
  • Once standards of appropriate conduct have been documented, staff must be trained to adhere to them. Documenting the training is not enough. Staff's actual familiarity with the standards is critical, as is their understanding of the procedures to be followed when they happen to observe violations. A plan without staff buy-in is of little use to anyone.
  • Effective lines of communication must be established and assured. There can be no barriers that might interfere with the flow of information-in either direction. Managers must be open and honest in conveying requirements and expectations to staff. Staff must feel comfortable in both questioning and informing management regarding relevant issues. Intimidation, actual or perceived, has no place in an effective corporate compliance program.