As a healthcare employer, documenting compliance policies and training employees that it is their duty and responsibility to communicate suspected violations are critical to a vigorous compliance program. But it is not enough to have clear policies in place. You should also have user-friendly means for employees to communicate compliance concerns and remind employees of these methods regularly.

Your team is busy; don’t expect them to dig up a compliance manual to track down the correct process. Emphasize your open-door policy to encourage accurate and honest communication. The OIG looks for and considers clear lines of communication when investigating suspected violations.

What Is OIG’s “Gold Standard” Compliance Program?

The Department of Health and Human Services Office of the Inspector General (OIG) has never provided a model compliance program. Why? Because the OIG acknowledges that every organization is different.

However, there are seven basic elements that OIG has long identified as fundamental to any compliance program:

1. Conducting internal monitoring and auditing through the performance of periodic audits;

2. Implementing compliance and practice standards through the development of written standards and procedures;

3. Designating a compliance officer or contact(s) to monitor compliance efforts and enforce practice standards;

4. Conducting appropriate training and education on practice standards and procedures;

5. Responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate government entities;

6. Developing open lines of communication, such as (1) discussions at staff meetings regarding how to avoid erroneous or fraudulent conduct and (2) community bulletin boards, to keep practice employees updated regarding compliance activities; and

7. Enforcing disciplinary standards through well-publicized guidelines.

Best Practices for Effective Communications in Healthcare Compliance

The OIG considers open lines of communication essential to an effective compliance program, especially in smaller practices. Don’t leave it to chance.

Avoid water cooler talk with these best practices for maintaining effective lines of communication:

• Use a bulletin board to post important updates to regulations and compliance programs.

• Encourage providers and staff members to communicate problems, concerns, questions, and opinions on any issue to a compliance officer or contact. If that person is not onsite, publish their contact information in a conspicuous location.

• Make it clear that the compliance officer’s duties include answering routine questions regarding compliance or ethics issues.

• Set up a hotline or comment boxes to permit anonymous reporting of non-compliance. Maintaining anonymity is not always feasible in smaller practices. In these cases, it is important that employees know who they can turn to for assistance without fear of retribution.

• Emphasize that staff members making good faith efforts to report non-compliance will be protected from retaliation or retribution. Document this policy in your compliance handbook.

• Routinely discuss compliance at staff meetings with an emphasis on how to avoid non-compliant or fraudulent conduct and review the reporting procedures.

• Make sure employees understand that reporting non-compliance is an affirmative duty, and not a “nice-to-do”. Communicate and document that failure to report erroneous or fraudulent conduct is a violation of the compliance program.

• Be transparent with staff members reporting issues about how the matter is handled. Make it clear that their report was taken seriously and acted upon. Publicize any follow-up action taken at the practice level, such as changes to the compliance procedure or new training. 

If your practice uses a medical billing contractor, maintain clear lines of communication between the contractor and the member of your staff responsible for coordinating billing and compliance activities. Communication can include, as appropriate, lists of reported or identified concerns, initiation and the results of internal assessments, training needs, regulatory changes, and other operational and compliance matters.