While implementing an effective compliance program[1] is not a guarantee of fraud, waste and abuse prevention, it does help mitigate the risk of improper conduct. One key element of an effective and successful compliance program is oversight and defined reporting.  Below are tips to consider when implementing or evaluating the oversight and reporting structure of your compliance program.

An effective reporting structure:

(1) plays a vital role in creating and fostering a culture of compliance within the organization;

(2) sets the tone that compliance is the responsibility of all employees; and

(3) keeps the lines of communication open.

• All compliance activities should fall under a Compliance Officer (“CO”) (or officers depending on the size of the organization) to ensure that compliance activities adhere to federal and state laws and regulations.
  • A CO or officers should administer and oversee compliance activities.
  • If the scope of the CO is broad because of the size of your organization, consider hiring additional compliance staff (e.g., compliance managers) to conduct compliance audits and to monitor compliance activities on the ground.
  • Form a Compliance Committee (“CC”), if feasible for the size of your organization, to advise the CO and assist in the implementation of the compliance program/plan and be accountable to the CEO and Board.
    • CC members should have various backgrounds and expertise (e.g., representatives from general counsel, revenue cycle, HIM, clinicians, quality, etc.).
    • Draft a CC charter that outlines the purpose of the committee, including their responsibility to review and approve all audit reports and corrective actions.
  • Consider engaging a physician compliance liaison/champion.
    • The physician liaison/champion should be a member of the CC and actively participate in educating physicians when non-compliance is found, e.g., incomplete/missing documentation.
    • The physician liaison/champion can also assist with oversight and enforcement for compliance initiatives creating a culture of compliance, maintaining open lines of communication regarding compliance and supporting public relations between the compliance program and clinicians.

• The CO should report and be accountable to the organization’s CEO, General Counsel or other senior management and the Board. The CO should not report to revenue cycle senior management as it may be perceived as a conflict of interest.
  • Draft an organizational chart outlining the reporting structure of the compliance program and distribute to all employees.
  • The organizational chart should have a solid line demonstrating that the CO and compliance department directly report to the CEO (or other senior leadership) and the Board. The CO should have a dotted line to the compliance committee.
  • The CO should report periodically, i.e., monthly or quarterly, at minimum, to the CEO and CC (as applicable) on activities and status of compliance program, including issues investigated, identified and resolved by compliance program.
  • Compliance activities should be an agenda item in all Board meetings.
  • All compliance staff should directly report to the CO.

The above tips will assist your organization in developing a compliance organizational and reporting structure that fits your environment, supports compliance and fosters a culture of compliance. Compliance must be a priority of every employee to protect themselves and the organization from risk of improper conduct.

[1] See OIG’s guidance on elements of an effective compliance program at  http://oig.hhs.gov/compliance/compliance-guidance/index.asp