The importance of being compliant
OIG encourages the use of anonymous hotlines
With so many federal enforcement priorities switching to fraud and abuse allegations, hospitals are realizing the significance of implementing a compliance program. But not all providers are convinced that a hotline is a necessary element in a strong program.
The Office of Inspector General (OIG) in Washington, DC, recommends otherwise. In its Compliance Guidance for Hospitals, the OIG has a section referring to "hotlines and other forms of communications." As stated in this section, "the OIG encourages the use of hotlines, e-mails, written memoranda, newsletters, and other forms of information exchange to maintain these open lines of communication. If the hospital establishes a hotline, the telephone number should be made readily available to all employees and independent contractors, possibly by conspicuously posting the telephone number in common work areas."
The section goes on to state that employees should be permitted to report matters on an anonymous basis. "OIG puts the reporting channel in its guidance to satisfy an element of the guidelines of the U.S. Sentencing Commission [in Washington, DC], which suggest that for an effective compliance program, you need a reporting channel that employees can use without fear of retribution," says Andrew Joseph, JD, assistant vice president of Strategic Management Systems, an Alexandria, VA-based health care consulting firm that develops compliance programs for providers.
"Realize that when you want to have a communication channel that people can use without fear of retribution, the government has basically set up a subjective standard," he says. "How do you prove you have a communication channel that anyone can use without fear of retribution? Clearly, the government feels the only way to satisfy that is to use a hotline anonymously. There's really no other way to meet that standard in most estimations." (For information on how to set up a hotline, see p. 146.)
The best way to implement a compliance program is to meet the expectations of the federal government, Joseph says. "If anything goes wrong in your organization, you can at least say, 'I had an effective compliance program. One problem fell through the cracks but give me credit because I was doing the best I could. I was following everything you told me to do.'"
Management of health care organizations often think that if they set up a hotline, the phone will ring off the hook - sometimes with false allegations. Instead, employees use it for largely what it is meant to be, he says. "If you have 1,000 employees, you're probably going to receive one call per month from those employees."
The key to a successful hotline program is education, Joseph says. "You have to educate employees that they should use the regular communication channels normally and only under specific circumstances should they turn to the hotline."
Employees should learn what the hotline is for, when it should be used, how it should be used, and what safeguards are being used to ensure their privacy.
Providers also need take some time to educate themselves before setting up a hotline. "There a lot more issues that affect that hotline than meets the eye," says Stacey Schleifer, Esq., director of business development for National Hotline Services, also in Alexandria. "For example, there are issues such as how to retain records and how to work with legal counsel to come up with a retention policy."
Editor's Note: For more information about the Office of Inspector General's Compliance Guidance for Hospitals, see OIG's Web site at http://www.dhhs.gov/progorg/oig.
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