What is Compliance Program Effectiveness?

Boards must retain a compliance expert to perform an effectiveness review.

Compliance program effectiveness continues to be a focal point of compliance programs and governmental investigators.

In June 2020, the United States Department of Justice (DOJ) Criminal Division updated its guidance document, Evaluation of Corporate Compliance Programs. The second update came only three years after its original publication of this guidance and the soon-after published HCCA-OIG joint-authored Measuring Compliance Program Effectiveness: A Resource Guide. Despite such robust guidance, there continue to be significant compliance concerns across the healthcare industry, as evidenced by ongoing DOJ settlements, new corporate integrity agreements, and other findings and activities.

A somewhat new element in various Department of Health and Human Services (DHHS) Corporate Integrity Agreements (CIA) with providers includes a requirement for Boards to retain a compliance expert in the field of Federal health care program requirements to perform a review of the effectiveness of that provider’s existing Compliance Program and include the Compliance Expert’s report in its annual report.

To bolster its intent regarding the reason for this requirement, CIAs also require the Board to adopt a resolution indicating that they have made a reasonable inquiry into the provider’s operation of its Compliance Program, including the performance of the Compliance Officer and Compliance Committee. “Based on its inquiry and review, the Board has concluded that, to the best of its knowledge, the provider has implemented an effective Compliance Program to meet the Federal health care program requirements and the obligations of the CIA.

”DHHS’s CIA requirement of appointing a Compliance Expert to review the effectiveness of a provider’s Compliance Program underscores the tone at the top guidance the DOJ has previously issued and the Board and Senior Leadership’s role in knowing how the Compliance Program operates. A proactive and periodic compliance program effectiveness review is a great tool to assist the Board in meeting this hearty obligation.

Download our white paper on Compliance Program Effectiveness

Related Insights