Whistleblowers often feel compelled to turn on their employers when they become frustrated by perceived unfair and inconsistent treatment. One common example is when an HME company creates (or borrows from elsewhere) compliance rules that don't fit its ways of conducting business. Inconsistency can be dangerous, because it breeds whistleblowers.
One common area of inconsistency is conflicting written policies. Home care companies will sometimes create standards of conduct or other internal compliance rules without taking into consideration pre-existing written guidance in policy and procedure manuals, employee handbooks and the like.
A company with inconsistent procedures will have difficulty enforcing its rules generally. Not only will specific inconsistencies need to be resolved, but a pattern of inconsistency will lead to the impression among employees that the organization is confused and incapable of focused, effective self-assessment and self-improvement.
Clearly, this is not the message to give when a home care company needs its staffers to help with problem-identification and problem-solving in its fraud/reimbursement compliance program.
Another area where a company's inconsistency can breed whistleblowers is with rewards and punishments, known more broadly as incentives and disincentives. It is unfortunate, in a way, that the government's compliance guidelines impose a punishment-oriented disciplinary context onto an anti-fraud compliance program.
Punishment — especially if timely and even-handed — can provide appropriate behavior incentives and an atmosphere of accountability, which is necessary for ethical behavior. But, it is even more important to reward appropriate behavior.
Many companies combine a corporate policy requiring internal disclosure of compliance concerns with a level of formal and, perhaps, public rewards for compliant behavior by company personnel. Here are four examples:
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This recent notice appeared in the staff newsletter for XYZ Mobility, August 2006: “Special thanks to Mary Smith, who alerted us to a reimbursement error involving power wheelchair coding. Mary utilized our compliance program procedures and helped us avoid costly errors before bills were sent out. Keep up the great work, Mary!”
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ABC Respiratory has set aside a bonus pool equal to 5 percent of the employees' aggregate salary, payable annually to those employees who have operated effectively within the company's compliance program. Individuals who contributed to compliance problems do not share in the bonus pool.
Further, 25 percent of the pool is available for discretionary bonuses by the company's board of directors to award special effort in furtherance of the company's compliance efforts, in an amount up to $500 per each noteworthy employee.
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This appeared in a bulletin distributed internally by Goodhealth Medical Equipment Supplies: “Congratulations to everyone for maintaining and improving our compliance efforts, and helping us achieve high standards of ethical behavior.
“For the first six months of 2005, we received information from you that resulted in 24 internal investigations under our accurate billing and fraud prevention program. This doubled the number of inquiries from the prior six months, and demonstrates your commitment to helping us monitor the accuracy of our claims submissions. Keep up the great work!”
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Conversely, from an October 2006 bulletin distributed to employees of Better Health Homecare: “Congratulations to everyone for maintaining and improving our compliance efforts, and helping us achieve high standards of ethical behavior. For the first six months of 2006, we received information from you which resulted in 24 internal investigations under our accurate billing and fraud prevention program. Of those 24 inquiries, only eight uncovered recurring problems that required significant fix-up. This is half the number of problems we identified in the prior six months. Keep up the great work!”
Materials in this article have been prepared by the Health Law Center for general informational purposes only. This information does not constitute legal advice. You should not act, or refrain from acting, based upon any information in this presentation. Neither our presentation of such information nor your receipt of it creates nor will create an attorney-client relationship.
Neil Caesar is president of the Health Law Center (Neil B. Caesar Law Associates, PA), a national health law practice in Greenville, S.C. He also is a principal with Caesar Cohen Ltd., which offers compliance training, outsourcing and consulting and the author of the Home Care Compliance Answer Book. He can be reached by e-mail at ncaesar@healthlawcenter.com or by telephone at 864/676-9075.
