Medicare Compliance & Reimbursement

The HCCA fears compliance officers could be scapegoats for operational breakdowns.

The Health Care Compliance Association made itself clear to the U.S. Sentencing Commission: One compliance officer does not a compliance program make.
 
In a Feb. 16 letter, the HCCA spoke up on behalf of compliance personnel who could bear the brunt of the blame for their company's shortcomings -- if proposed sentencing guidelines go through unchanged. The HCCA told the commission that as it stands now, a portion of the guidelines inappropriately place total responsibility for the implementation and effectiveness of a compliance program squarely on the shoulders of compliance officers -- a policy that the HCCA charges is counter-effective.

"Compliance can only be achieved if the operating management of an organization (at all levels) performs the roles and responsibilities assigned to it through the compliance program," the letter reads. "The proposed amendments could be read as relieving management of the job of ensuring the organization is complaint."

The HCCA argues that in order to create incentives for management to buy into compliance, the culpability must be spread out over the entire organization.

HCCA also says that a compliance officer's duties should be specified as follows: to coordinate the design of a compliance program,
to oversee its implementation, and
to evaluate and report to management and the board on its effectiveness. That is, officers do not exist to take the fall for an organization that has not hopped aboard full compliance.

Another wrinkle to be ironed out: In the event that a high-level person commits an offense, the existing guidelines impose a presumption that compliance controls were ineffective. However, the HCCA counters that when it is the organization that identifies the compliance failure, coming forward with such information should be rewarded, not punished.

In that scenario, the presumption should be that the compliance program was effective, and the organization should be dealt with accordingly.

Compliance officers now await a final response from the USSC.