Measuring Compliance Impact: Worry About the Big Stuff First

We are all in the grip of this year’s terrible flu epidemic. This year’s flu vaccine has only been 10% effective so far (the season probably won’t end until late March), and we have seen startling, tragic cases of previously healthy folks, including children, quickly getting very sick and even dying. This horrible outcome, despite the fact that most of the victims did everything that the best science says to do: get vaccinated, wash hands frequently, be vigilant, and take flu symptoms seriously.

Sometimes, taking even the best steps cannot prevent a bad result. You do everything you’re supposed to do, implement the protective measures agreed upon by experts, and the bad, and even awful outcome, happens. Thankfully, that is rarely the case in healthcare compliance. Or even compliance in general.

There’s no shortage of obvious examples. Tuomey Healthcare shopped for an expert opinion until it finally found one to support its illegal physician compensation arrangements. Health South worked every conceivable type of fraud to hide its true financial picture from investors. Most recently, Synermed, a California management services organization, suddenly closed its doors after a presumed whistleblower exposed the company for its longtime, routine practice of not issuing required right to appeal notices to Medicaid beneficiaries, then papering their files with fraudulently backdated ones.

There are also plenty of non-healthcare compliance cases. Enron’s leadership orchestrated a massive financial fraud scheme that blew up the company. VW scammed regulators to hide its real carbon emissions. And the Wells Fargo sales machine openly pressured associates to outright lie about sales of financial services and products to meet its audacious sales goals.

These are all blatant cases of clear misconduct, which almost any decent controls and a reasonably supportive culture, would have prevented. They are not, repeat not, incidents that would’ve required complex, sophisticated systems to detect and fix problems.

That’s an all too common scenario in healthcare compliance. Of course, you never hear about, or at least not often enough, the successes of effective compliance programs (which is most of them), which result in few problems, at least not serious ones. What you hear about are the blowups, big gaps in programs, structurally or culturally, which resulted in big compliance gaffs, legally, financially, and unfortunately, sometimes criminally. The solution for those of good faith is, of course, simple: serious reflection, seasoned insight, and a genuine commitment to compliance, hopefully proactively, rather than only after something drastic happens.

Reid Pearlman, JD, CCEP, is an independent healthcare compliance consultant and principal of True Compliance Consulting, LLC. He can be reached at Reid@MyComplianceOfficer.net.