The third rung of the ROPE Ladder includes an effective reporting system so that your personnel can alert you to potential problems efficiently and effectively.
While it is best when personnel can communicate problems known firsthand with clear and thorough data, potential problems are often identified through partial or indirect information, including rumors. Like it or not, your compliance team needs to pay attention to rumors, since news of fraud and abuse often surfaces in gossip before it does in authorized reporting channels.
However, all rumors are not created equally. Your compliance team should take three steps to address some basic questions when deciding how to respond to the myriad rumors circulating at every home care company.
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First, examine the severity and type of issue involved. Assess whether the rumor, if true, could result in extreme penalties, such as exclusion from government programs or stiff sanctions. If so, the matter clearly needs to be examined. It's worse in the government's eyes if your compliance team had knowledge of a potential compliance problem and failed to take action on it. On the other hand, if the potential repercussions are insignificant, your compliance team probably has more relevant issues to address. Reports of an employee placing personal calls from the office, for example, would not merit additional inquiry.
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Second, examine the source of the rumor. Ask: Does the source have merit? How widely circulated is the rumor? Definitely examine widespread rumors. After all, it's important to dispel falsehoods and disseminate the facts to employees. Conversely, if a rumor is known only to a relatively small group, your compliance team should consider how and why they heard the rumor. Also, if a pattern of rumors centers on a particular department, it's likely time to perform an audit of that department.
It may be difficult to pinpoint the source of a rumor since people often are reluctant to name names. To zero in on a rumor's credibility, ask an “informant” questions such as:
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When did you first hear about this issue? How long has this been going on? Follow-up with questions related to specific time and location.
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Do you know of anyone else who knows about this? Who is in charge of the area the rumor concerns? Who was present during a conversation about the rumor?
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Is there anything in writing concerning the rumor, such as a memo, form, e-mail, letter or meeting minutes?
Repeating an informant's answers back to him or her will help clarify the issue and may lead to additional information.
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Third, after talking to an informant, you or your compliance team frequently will want to interview a person who may have been exposed to the suspected fraud and/or works in the department the rumor concerns. Comparing the similarities and differences between the original information and the additional source can be quite valuable.
Once you identify the source of the rumor and the informant's problem, the rumor should be treated as if it were an actual report of a compliance issue. Even if you learn from the source that there is no actual problem, you should conduct the kind of investigation that is required under your compliance program. Treat it with the utmost seriousness so it is clear to everyone internally that you are taking care of it.
Does this mean you'll receive some rumors created maliciously, or that you risk hearing from troublemakers or personnel craving attention? Quite possibly. But to an extent, such communications are a necessary cost for an effective reporting system, however inappropriate they may be.
In general, we must accept the unfounded, and even the silly, rumors in order to address the legitimate issues lurking behind the innuendo. If you can incorporate these three ideas into your compliance system, you will be better able to handle rumors with maximum effectiveness.
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.
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.
The ROPE Ladder
Rung 1: Articulate the way you want things to run, and note how they run now. Then, tweak your systems as necessary to comply with “The Rules.”
Rung 2: Teach your operating systems to your employees.
Rung 3: Implement a clear and simple method for dealing with problems — identify them, report them, investigate them and fix them.
Rung 4: Give your compliance staff resources to help them keep up-to-date with internal and external changes that may sometimes require you to refine your operating systems.
Rung 5: Monitor your operating systems to make sure they continue to run as you intended.
