Compliance Commitment

A marketing rep for a large medical equipment supplier was telling me about an overly aggressive marketing campaign that raised significant concerns under Medicare law and the antifraud rules. I asked him who he was supposed to discuss these problems with, according to his company's internal compliance program. “I have no idea,” he replied.

A therapist alerted me to problems in a different company. He knew who he was supposed to talk to about the issues, but, he said, “all of the management people are part of the problem. They are all in this together. I don't know who to trust.”

When the government scrutinizes a compliance system's “effectiveness,” they look first and foremost at whether the company's personnel understand how the program is supposed to work, and whether it actively polices itself. For both legal protection and continuing quality improvement, Rung Three of the ROPE Ladder is key.

One strand on the rung — reporting errors — is harder than it may first appear. HME companies rely on employees to communicate wrongdoing via in-house channels, but research indicates that workers are more likely than not to remain silent about legal and ethical violations in the workplace. According to a national business ethics study sponsored by Indianapolis-based Walker Information and the Hudson Institute, six out of 10 employees who know of or suspect ethical violations in their organizations do not report them.

For companies facing the double challenge of a regulatory structure and rigorous scrutiny from the HHS Office of Inspector General and the Department of Justice, along with the specter of damages and fines under the False Claims Act, the importance of encouraging employees to report compliance problems is especially acute. According to the Walker-Hudson study, common reasons for employee reluctance to report violations include fear of retaliation, lack of an anonymous reporting mechanism, perceptions that management would not respond and a belief that it is “none of their business.”

But effective compliance means convincing employees that it is not only their business — it is their obligation. Set the expectation that if people want to work for your company, they are responsible for reporting suspected errors, non-adherence to policies or ethical concerns. Explain that it is just as bad to see something and not report it as it is to do the bad thing itself. That must be your clear message, and should be incorporated into your training and code of conduct.