Regulator Expectations & US Healthcare Compliance Programs

April 19, 2018

 

Highest risk areas identified by DOJ and OIG are not among the highest priorities of compliance officers; budgets remain stagnant

CHICAGO, IL, April 19, 2018 - SAI Global, a leading provider of integrated risk management solutions, today published key findings from its ninth annual survey of healthcare compliance professionals, which underscore the growing pressure compliance departments are facing in the ongoing monitoring and auditing of high-risk areas.  

The study, conducted jointly by SAI Global and Strategic Management Services, a leading expert in corporate compliance, was designed to gain an understanding of issues currently confronting compliance programs and how compliance officers are responding to them. Data was gathered from 388 healthcare organizations across all sectors, from physician practices to large integrated hospital systems.

Overwhelmingly, respondents reported dealing with data breaches as their highest-ranked priority; HIPAA privacy and security among their chief concerns.  However, the top two regulatory and enforcement priorities by the Office of Inspector General (OIG) and Department of Justice (DOJ) are corrupt arrangements with referral sources and false claims.  These represent virtually all the major enforcement actions and penalties imposed by the government.  To date they have resulted in far greater liabilities to healthcare entities than privacy and security breaches.  Arrangement with referral sources was ranked fifth in priority and claims accuracy third place among compliance professionals included in the survey.  
 

"The question has to be asked as to why, in the face the enforcement agencies’ priorities, compliance officers are placing these high risk-areas in a lower priority. The takeaway from the survey is that compliance officers should be prepared to better align their priorities and programs with those set out by the regulatory and enforcement agencies."

Richard Kusserow

Former HHS Inspector General and CEO of Strategic Management Services

A trend found in the SAI Global surveys is the accretion of new duties and responsibilities for compliance offices surveyed. In addition to HIPAA privacy and security, most offices are also responsible for internal audit and some for legal counsel.  However, there is little evidence of added resources to accommodate.  Half of respondents are not expecting any additions to their budget this year, while 10 per cent were even looking at budget reductions. Nearly three quarters of responding organizations reported their compliance offices having five or fewer staff with one-third having only one full- or part-time person.

"The 2018 Healthcare Compliance Benchmark Survey gives us a better understanding of compliance program development in the healthcare sector and suggests that effectiveness is being measured in terms of output, rather than outcome. It is abundantly clear that there is a need for healthcare organizations to remove barriers and increased responsibilities being laid on their compliance offices that distract from the development of effective risk controls."

Peter Granat

CEO, SAI Global

 

About the 2018 Healthcare Compliance Benchmark Report

This report represents SAI Global's ninth annual survey gathering data from healthcare industry compliance professionals. It builds on eight years of prior data to provide useful insights on trends that will impact compliance priorities in 2018 and the seven elements of an effective compliance program. Click here to download the full report.
 

About Strategic Management Services

Strategic Management Services was founded over 25 years ago by Richard Kusserow, the former DHHS Inspector General, and was the first consulting firm to focus on health care compliance, years before the government had even issued any formal compliance program guidance documents for the industry.  The firm has assisted over 2,000 thousands of health care organizations with a full range of regulatory compliance services. 
 

 

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