Reprinted from REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers.
When a newspaper article pushes the worry button of board members at North Shore-LIJ Heath System, they sometimes call Greg Radinsky, vice president and chief compliance officer. After reading about a hospital somewhere settling a false claims lawsuit or a new Medicare or Medicaid audit or investigation, board members want assurance that the Great Neck, N.Y., academic health system has controls in place to prevent a similar mishap.
“You should have a relationship with the board so they can call you up,” Radinsky says. “It should be a two-way street.”
That’s doesn’t mean there aren’t lots of formal meetings with the board and board committees as well. After Jim Sheehan, formerly New York state’s Medicaid Inspector General, issued guidance in 2009 stating that board members could be hit with sanctions for their organizations’ compliance failures (RMC 5/4/09, p. 1), “we further enhanced our reporting obligations beyond the industry best practice,” Radinsky says. “I talk to the board a lot” — almost monthly, in one form or another. Every quarter, he meets with the board’s audit and compliance committee. Radinsky also meets with the full board, and there are several gatherings a year with the executive committee.
“Compliance officers should always feel comfortable going to the board and should have that direct relationship,” he says. Amendments to the Federal Sentencing Guidelines in 2010 stated that individuals with operational responsibility for the compliance program must have direct reporting obligations to the board.
Compliance officers are doing fairly well in this area, according to a survey released Jan. 22 by the Health Care Compliance Association (HCCA) and the Society of Corporate Compliance and Ethics (SCCE). The survey, which focused on the relationship between compliance officers and their boards, found that 66% of health care compliance officers had four or more regularly scheduled meetings with the board every year. More than 60% of compliance officers in health care report directly to the board. Among those who don’t, 62% report to the CEO, 12% to legal and roughly 3% to the CFO.
Here are a few other survey findings:
59% of health care compliance officers “felt that the board values the compliance and ethics program a great deal.” For all survey respondents, inside and outside health care, the “numbers were highest (63%) among publicly traded companies, perhaps reflecting greater pressure for boards to support compliance,” HCCA and SCCE say.
64% of health care compliance officers say their reports are not “pre-screened or edited” by the general counsel or others before being presented to the board.
77% of compliance officers across all industries said they are “responsible for escalating very serious allegations and/or investigations of noncompliance to the board.”
Compliance officers were also asked what “attributes” are most important to their jobs. In the survey, they were asked to rate seven attributes on a scale of one to five: assertiveness/decisiveness, consensus-building, confidence, empathy/ability to assess a situation, independence, relational/interpersonal, and ability to influence. The three that received the top rating were independence, confidence and assertiveness/decisiveness.
Radinsky places a premium on “presenting the facts in a fair and balanced manner so the organization has the information to act.” It’s up to the board and management to decide how to handle matters brought to their attention, and “it’s the compliance officer’s job to present the facts and do investigations thoroughly” so the deciders have the requisite information.
View the survey at www.hcca-info.org.
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