Is your compliance program effective?

OIG publishes compliance program metrics for healthcare and beyond.


By Rene Savarise

On March 27, 2017, the Office of the Inspector General (OIG) released a resource guide for measuring compliance program effectiveness aptly titled “Measuring Compliance Program effectiveness: A Resource Guide.” The resource guide, the result of collaboration between the OIG and the Health Care Compliance Association, contains over 400 performance measures.

The assessment tool set out in the resource guide is customizable, covering what and how to measure each of the seven elements of a successful compliance program. The OIG expects providers to select those metrics which best suit the provider’s individual needs.

According to the OIG, it would be neither practical nor recommended for a provider to use all 400 measures to assess a single compliance program. This is because each provider’s compliance program will be different. The measures used and the frequency of measurement will depend on the characteristics of the provider. Those characteristics include the “…risk areas, size, resources,
and industry segment” applicable to that provider.

No Excuses
By now, all providers should have adopted pro-active and effective compliance programs. The OIG’s release of the resource guide underscores this expectation. By offering an array of customizable metrics, the OIG is sending providers a message. Their size and type does not matter in the world of compliance.

Providers now have few excuses for failing to have an effective compliance program. While the OIG is not conducting compliance program assessments, if a compliance issue arises the OIG will undoubtedly use this tool to assess the efficacy of the provider’s compliance program. Providers should take heed and get busy assessing the effectiveness of their compliance programs.

The Resource Guide is organized by the well established seven elements of an effective compliance program. Those categories are further subdivided into more than 70 subcategories. Highlights from each category include:

1. Standards, policies and procedures
2. Compliance program administration
3. Screening and evaluation of employees, physicians, vendors and other agents
4. Communication, education and training on compliance issues
5. Monitoring, auditing and internal reporting systems
6. Discipline for noncompliance
7. Investigations and remedial measures

—Rene Savarise is partner at Bingham Greenebaum Doll in Louisville, Kentucky.