April 7, 2017

OIG Help for Measuring Compliance Program Effectiveness

Holland & Knight Healthcare Blog
Shannon Britton Hartsfield

On March 27, 2017, the OIG released a 54-page guidance document regarding how to measure the effectiveness of a compliance program. The guidance is the result of a roundtable meeting on Jan. 17, 2017, where a group of compliance professionals and OIG staff met to discuss how to asses a compliance program's effectiveness. The guidance includes hundreds of measurement options that could be used by a wide variety of entities. Organizations are not required to use the guidance as a checklist and do not have to make sure each one is utilized in evaluating a compliance program. The OIG recognizes that "[u]sing them all or even a large number of these is impractical and not recommended." Instead, "[a]n organization may choose to use only a small number of these in any given year," and "[a]ny attempt to use this as a standard or a certification is discouraged by those who worked on this project; one size truly does not fit all."

Some of the interesting suggestions in the resource guide include the following:

  • Measure the effectiveness of the organization's standards, policies and procedures by conducting a survey of employees to determine whether the policies and procedures assist the employees in doing their jobs effectively;
  • Determine whether the compliance program's administration is effective by conducting an audit to determine how involved the compliance officer is in training, policy development, and other business operations;
  • Evaluate whether employee, physician and vendor screening is effective by auditing performance evaluations to make sure compliance obligations are clear and the employee's compliance performance is measured;
  • Measure effectiveness of compliance training and education by verifying that at least one compliance related topic is included in each of the organization's educational presentations and programs;
  • Monitor the effectiveness of the organization's internal auditing and reporting systems by verifying whether hotline calls and matters are brought to the attention of the compliance department and whether trends are reported to the compliance committee and board;
  • Verify the effectiveness of the organization's disciplinary measures by interviewing employees to determine whether they understand that there are disciplinary consequences for noncompliance; and
  • Assess the effectiveness of the organization's investigations and remedial measures by determining whether the process is "transparent," which, according to the resource guide, means that "not everything [is] placed under attorney client privilege."

Related Insights