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Guidance for Health Care Boards

OIG's Chief Counsel Gregory Demske promotes compliance

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I'm Greg Demske and on behalf of the Office of Inspector General, I want to discuss the role of healthcare industry Boards of Directors and Trustees in promoting compliance.

Boards play a vital role in health care organizations. They promote economy, efficiency, and effectiveness. In this regard, we share a common mission.

The emergence of new payment models that reward quality, value, and the reduction of waste, presents opportunities and risks. Going forward, health care organizations will need to use new tools to collect and analyze data and improve clinical effectiveness at lower costs.

Last year OIG held two roundtable meetings with representatives of entities operating under Corporate Integrity Agreements. These CIAs result from fraud cases. We asked for feedback on compliance best practices. The message we heard was clear. Boards have the power to enhance compliance through involvement in oversight activities and by integrating compliance throughout the business.

You may oversee a small non-profit community provider or a large multinational corporation. Your compliance staff may consist of one person or a broad network of professionals. Whatever the case, you play a critical role.

Here are three key roles of a health care board member: compliance oversight, structuring your compliance program, and evaluating effectiveness of your compliance standards and processes.

First, let's start with the Board's role in compliance. Serving on a health care board requires a unique skill set. Board members should:

Be engaged. The best Boards are active, raise questions, and exercise some degree of skepticism in their oversight responsibilities.

Be experienced. Is your board composed of people with diverse areas of interest and expertise, compliance, clinical and financial auditing expertise can be useful.

Be informed. How does your organization identify, audit, and monitor risk areas? Does your Board learn of all significant compliance issues? Is someone responsible for keeping the Board informed?

Be involved. Demonstrate a commitment to compliance. For example, attend employee compliance training and speak to staff regarding compliance issues.

And be adaptable. Healthcare delivery and reimbursement are changing. Is your organization looking at new risk areas and developing appropriate safeguards?

Next, let's turn to compliance program structure. As a Board member you serve a key role in evaluating the design and implementing your compliance program. Ask yourself these questions to determine how far-reaching and effective your organization's compliance structure can be.

Does your Compliance Officer report directly to the Board? Does the compliance o fficer have sufficient prominence and influence within the organization?

How does your organization encourage communication between compliance staff and the rest of the organization?

Are compliance goals periodically adjusted to account for payment reforms and new quality standards?

How does the Board encourage managers to incorporate compliance considerations into day-to-day decision-making?

Does the Board hold key employees accountable for following compliance standards and processes?

Finally, how do you know whether your organization's compliance program is effective?

A Board should routinely review compliance efforts across its organization to determine if its program is effective. Here are some questions to ask to assess the effectiveness of your compliance program:

What metrics are used to evaluate the company's compliance with laws and regulations? How were those metrics selected?

How does your organization identify gaps in quality and areas for quality improvement?

Is the organization routinely conducting internal compliance audits?

Is the organization's response to specific problems sufficient? Does it track corrective action plans to make sure the proposed changes are implemented?

Has your Compliance Officer identified hurdles to compliance, such as resource constraints or lack of management support?

We hope these questions will help you fulfill your important oversight responsibility as a Board member. We look forward to continuing our discussion with industry about how we can improve the economy, efficiency, and effectiveness of the health care system.

Thank you.