Healthcare Compliance and Integrity Issues: How You Can Be the First to Know

Compliance issues can be problematic in the healthcare industry —HIPAA violations, Medicare fraud, drug diversions, falsifying records, ethical issues, and work environment concerns are all important. Any concerns in these areas or others must be monitored and addressed; however, some compliance issues faced by the healthcare industry for example, consistently mixing medication incorrectly, can be potentially life-threatening to patients.

The Compliance Action Tool (CAT) created by Strategic Programs, LLC is an online reporting system that tracks perceived compliance issues mentioned in workforce survey feedback.  CAT helps companies to increase awareness and investigate these perceived compliance issues so that they can be managed before they become a problem.

When the board of directors of one of Strategic Programs’ healthcare clients was made aware of a severe harassment issue long before the human resources team heard about it, the client realized they needed a compliance tool. The harassment claim helped them realize that although they were conducting surveys to gather workforce feedback, without a system or tracking tool in place, they weren’t able to actually manage compliance issues. That’s when they began working with Strategic Programs to develop CAT.

Catch compliance issues before they become costly

CAT provides an online reporting tool to easily track issues identified through workforce surveys as well as other sources such as hotlines, employee relations, and social media. The tool allows users to view issues by level of action required and assign accountability. Based on the identified requirements, CAT offers:

  • Built-in prioritization, so the most important matters are quickly identifiable
  • The ability to import compliance issues from other sources (compliance hotline, emails to HR, etc.)
  • Customizable reporting
  • User-defined access to ensure information is secure

CAT not only helps companies identify red flag issues related to compliance and integrity, but it also provides a system of record for online tracking and monitoring of action. The client who first brought this need to Strategic Programs has seen a return on their investment.

They estimate that the tool has helped them stop litigation potential with at least one case each year,” said Megan Younkin, Consulting Director at Strategic Programs.

What makes CAT unique is that while it is an online tracking tool, it fits seamlessly into the survey process by compiling data collected through online and phone surveys. During the survey process employees are asked: “Are there any compliance or integrity issues you want to report?” As feedback is collected, Strategic Programs interviewers are monitoring feedback for any compliance matters about which their clients need to be aware.

If any other issues come up when responding to other survey questions, the interviewer will follow-up regarding those issues as well. Qualitative feedback collected via the Internet is also reviewed for compliance matters. If there is evidence of a compliance issue that indicates someone would cause harm to themselves or others, Strategic Programs immediately contacts the employer to make them aware.

Taking action

Authorized users within the company—often the legal or HR teams—can log in at any time to review and address issues, as well as assign them to the appropriate person for follow-up. Thanks to the built-in prioritization, users have a dashboard of compliance-related comments and can quickly act on any red-flag issues. The standard for action recommended by Strategic Programs is:

 

  • Priority 1: Take action within a week.
  • Priority 2: Take action within two weeks.
  • Priority 3: Take action within four weeks.

For CAT to be useful there needs to be an established plan in place for managing these issues, whether it’s following best practices that the team at Strategic Programs shares, or a company-specific process that helps ensure issues are monitored and appropriately assigned for follow-up. The power of the tool lies in not just being aware and collecting the feedback, but also in acting on it in a timely manner to address red-flag issues such as Medicare fraud, patient safety concerns, sexual harassment, bullying, and racism.

Unfortunately, it’s impossible to completely avoid compliance issues—they will come up in any business. However, keeping track of these issues can save your organization millions of dollars. Addressing the compliance issues helps you avoid expensive litigation and protects your company’s work environment and reputation.