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Health Care Blog

Best Practices in Compliance Program Operation

Authored by John H. Fisher, II
Posted on April 4, 2017
Filed under Health Care

Given the increased importance of compliance, it is helpful for providers to get a feel for what constitutes “best practice” when operating a compliance program.  “Best Practices” is a term thrown around all of the time in the business world.  It is used in many contexts and takes on a variety of meanings depending on who is using it and for what purpose.  Wikipedia defines “best practice” as follows:

Best practices are generally-accepted, informally-standardized techniques, methods or processes that have proven themselves over time to accomplish given tasks. Often based upon common sense, these practices are commonly used where no specific formal methodology is in place or the existing methodology does not sufficiently address the issue.  The idea is that with proper processes, checks and testing, a desired outcome can be delivered more effectively with fewer problems and unforeseen complications. In addition, a "best" practice can evolve to become better as improvements are discovered.  Best practice is considered by some as a business buzzword, used to describe the process of developing and following a standard way of doing things that multiple organizations can use.  http://en.wikipedia.org/wiki/Best_practice

As I was thinking about the concept of “best practices” in health care compliance, the Wikipedia definition seems to fall a little short of what I would have in mind when discussing “best practices” in health care compliance programs.

The Miriam-Webster Dictionary defines “Best” as the superlative form of “good.”  “Best” means “excelling all others” and “offering or producing the greatest advantage, utility, or satisfaction.”  I believe the definition from Wikipedia is an accurate depiction of what the term “best practices” has become in the business world.  The term has been thrown around loosely to the point it no longer carries the meaning of the plain words that make up the two word “buzzword.”

In the health care compliance context, I believe it is not advisable to direct your efforts toward the standard “buzzword” meaning of “best practices.”  Instead, you should focus attempting to achieve the meaning of “best practices” that is tied to the superlative form of the word “good.”  You should not focus on the “we are doing what everyone else is doing” or the “what we are doing will pass by in most cases” version of best practices when looking at your compliance plan.  The consequences of that approach could easily come back to bite you in the superlative.

In reality, you may never be able to meet the truly “best” standard.  However, the point of the compliance program requirement is you are trying to make your compliance program and your organization “the best” when it comes to compliance.  Here are a few tips to help you attempt to meet the “best practices” standard:

  1. Act as if you are under a Corporate Integrity Agreement.  Always assume the government is looking over your shoulder and you will be called upon at some point to justify the effectiveness of your compliance program.
  2. Follow the government guidelines to the “t”.  Familiarize yourself with the Federal Sentencing Guidelines and Office of Inspector General Industry Guidance and integrate these requirements into your compliance plan.
  3. Stay current with government releases, speeches, regulations, comments, advisory opinions, and all other communication that help to define your obligations.
  4. Make your compliance plan a “living and breathing” documents that is continually up for revision based on specific things you learn about your specific organizations.
  5. Make sure your compliance officer focuses on compliance and does not wear other hats that compete for time, attention or perspective.
  6. Make certain sufficient resources are devoted to compliance.  Adopt the view it is better to spend money on compliance than to pay for mistakes down the road.

If there is an area where you are not able to achieve “best practices” for financial or other reasons, be prepared to justify your shortcomings.  Key to all of this is to operate as if you will someday be required to defend the effectiveness of your compliance program. 

These are just a few tips to get you thinking about your compliance approach.  Health care reform has made compliance programs mandatory for the first time.  There are also multiple indications the government wants organizations to devote more to compliance as a way to save health care costs.  It is clearly time for organizations of all types and sizes to re-focus their efforts on compliance within their organizations.