The Inspector General of Health and Human Services discusses the importance of compliance

[ Applause ]
>> Thank you.
Thank you, thank you and good morning.
>> Good morning.
>> Is there a compliance officer in the house?
Wow, it's so nice to be here with you at our Orlando, Florida meeting.
There is just something magical about being in Orlando.
Believe me, I was shocked, I was surprised when I showed up last night just before dark
in the cab, checked in to the hotel and there in front of the hotel is this humongous pyramid
and the first thought I had was, wow, I hope the hotel didn't go to too much trouble to work
with my slide presentation but it's an incredible coincidence and it's a reminder
of how much we human beings like pyramids and the interesting thing
about pyramids is they represent, I think, stability.
It's difficult to topple over, you know.
They don't come and go.
They tend to be very permanent and that is I think a very important message
to convey this morning, the permanence of compliance and so what I want
to do this morning is actually go into our compliance pyramid and think
about the five major building blocks that make for the compliance pyramid.
Let's go in to the, I guess, the bottom left part of the pyramid.
We're now talking the foundation of what we do, two parts to that foundation.
The part on the left is establishing an effective compliance program.
Let's go into that.
Setting a tone that may look like I just wanted to have something at the top
but setting a tone is so terribly important.
If' there's one takeaway this morning is that what you do is extremely important but is not
about us, it's about our function, it's about the purpose of what we do so we need
to incorporate that in everything that we do.
We don't need to take ourselves seriously but we certainly need to take the function seriously.
So we set a tone by understanding that we really are very important to the enterprise.
Strangely enough, there are plenty of organizations still
that don't understand the importance of compliance.
If it's important, it's not important just to us, it's most important that it be shared
and that it be shared in ways that are understandable to everybody, so we need to focus
on our plain English in providing useful and relevant and applicable codes and policies.
They're written out.
People can read them and understand them.
Training and outreach, it doesn't matter if we have in the books
if people aren't given an opportunity to read and then to engage with them,
to understand how they work in practice.
So we devote a lot of attention, don't we, to training people and to providing the outreach
so that every corner of the organization is aware of what we're doing.
We're there to address problems.
We're not a problem for our enterprise.
We're there to address the problems that the enterprise faces and it faces them everyday.
These are institutions that are operated by us imperfect human beings.
We're there to help them address problems and we keep things clean and operational
by engaging an internal auditing and monitoring.
Utilize available resources.
If one half of our foundation is establishing an effective compliance program,
the author half is making sure that we're taking advantage of all of the tools necessary.
Compliance program guidelines, most of you perhaps with the exception
of some newbies are familiar with the facet
that OIG has been promulgating compliance program guidance since 1999
and those guidances are on our web site,
they cover nearly every corner of the healthcare industry.
Everything for nursing homes, to hospitals, to physicians, you name it.
There is a compliance program guidance that you can find easily available on our website.
Also on the website, advisory opinions, fraud alerts, open letters.
We note especially in this part of the pyramid May 18th
because we're gonna be doing a national webcast that will allow everybody, you don't have to be
in Baton Rouge, you don't have to be in any particular city that we're holding this series.
You'll be able to take advantage of what we're doing just by going on the web
and of course it's very important to keep up with all of the resource guides,
a recent publication which again is available on our website
that is what we call a physician's guide to avoiding medicare and medicaid fraud and abuse.
Let's move up to the middle area of the pyramid and this is where we're looking at the things
that are coming around the bend now, the new staff.
We have our foundation of a compliance program that we know is permanent, permanently based
and is critical to the organization.
We know how to take advantage of the resources that are available both
within our office and externally.
Let's look at some of the new challenges that we all face in our field.
Uh! We're definitely on a government page.
Yeah we see the eagle, the eagle side of the seal of the United States
so there must be some government stuff here.
So let's look at these points, the Affordable Care Act.
The Affordable Care Act has a lot of new requirements coming down the road.
We all need to be familiar with it.
Let's capture the idea in the three key words - transparency, compliance, and accountability.
I note the shift from pay and chase.
As many of you know, especially the veterans, for many, many years we have had a system
that was too relaxed and the mandatory compliance, well as I said earlier,
it's one of the key reasons why we're engaged in such aggressive outreach
on compliance training is that looking down the road not just the larger players in our field
but nearly everyone has to be thinking about how to structure an effective compliance program.
We'll move over to the left side of the middle of our pyramid
and that's understanding the consequences of noncompliance.
We're working on getting the right stuff done in the right way
and we also have a good understanding of the consequences of noncompliance.
Handcuffs, that's a little bit overly dramatic from this audience.
I think we're trying to come up with a visual that would gain attention,
be relevant to at least of the points.
That is not a point of intimidation but we did want to give me a chance
to note how actually pleased we are with the successes
of our Medicare Fraud Strike Force work 'cause over the last several years,
we have really through better data collection and realtime data use,
we've really been able to make substantial inroads.
We have brought to the treasury billions of dollars over the last several years.
Not just millions but billions of dollars.
On false claims act liability and director and officer accountability,
we note that because again mistakes if anything are getting higher when it comes to insuring
that compliance is done appropriately.
You know, with a requirement now that overpayments be accorded within 60 days
of their having been found it's more important than ever to understand that a failure
to be active on the compliance front has significant false claims act exposure.
So we need to be on top of that.
On self-disclosure protocols and corporate integrity agreements, there's a certain yin
and yang there because I do think it's better to self-report
to have an effective compliance program that finds the overpayment,
that finds the improper claim that can find these issues before government needs
to detect them and at the top of our pyramid our purposes
to maintain an ethical and healthy organization.
That's what is really the umbrella for what I've been talking about this morning is
that you're thinking comprehensively
and when I say you're thinking comprehensively these are the four elements that we think
of when we go into the top of our pyramid.
We're thinking of training not as a one time exercise but as something that's ongoing
and I was really struck when I said that there were 52 conferences,
that's essentially a conference a week that HCC has held over the last year.
That's a good example I think of organizations thinking about the importance not
of just doing a training session and then checking that box but thinking of training
as something that needs to go on all the time.
It's very, very dynamic.
Best practices really is tied to the ongoing training
because it really gives you the opportunity to think about how
to develop your compliance program in a way that is optimum and you do that really
by attending the training and by putting on the training and then by making sure
that everybody is communicating with everybody
and when I say internal communications what I'm talking
about is using communications horizontally, vertically, diagonally, using the new social
that is now available whether it's twitter or facebook or stuff
that is certainly beyond my capacity to understand but it's everything can go viral
in a very good way when it comes to compliance so take advantage of internal communications
and the last point, acknowledging compliance excellence.
You know, that again is not a throw away point.
I have no doubt that there are very, very effective capable people certainly in this room
but in your organizations back home as well who should be recognized for their excellence
in this compliance professional field and I am not in a position to recognize them.
I'm just the inspector general but you can do it and that brings us to the very tiptop
of our pyramid and lo and behold we have another pyramid.
Where have you seen that pyramid?
[ Inaudible Remarks ]
>> Oh, you know that it's on there.
So when you go back to the office and they say, what did the IG talked about,
you can say, he showed us the money.
Well, he showed us part of the money.
He showed us part of the money.
It's on the left side of the greenback part of the dollar bill.
You know, earlier, we saw the eagle of the seal and this is something that Franklin Roosevelt
who actually put this on the dollar bill really appreciated.
The seal of the United States is like a coin really and so the eagle is
where the president's profile would be.
If you turn the seal over, it's the pyramid.
What's the pyramid doing there?
Well, it's an ancient symbol.
I see there's a Latin there.
That Latin actually dates back to Virgil and the Aeneid.
The bottom of the seal is loosely interpreted as a new order for the ages and it was meant
when it was designed in the 18th century by the founders
to say young American republic getting on without kings and queens.
It's a new order for the ages and I think it has some relevance to us
because with the affordable care act and now quality involved with payment.
We have something of a new order for the ages and if we look up at the top we see--
well, we see eye and you know 3000 years ago an ancient Egyptian seeing
that eye would have assumed you were talking the eye of Horus,
H-O-R-U-S which was a divine presence for Egypt but that was--
that symbolism was reinterpreted in the 18th century.
There is certainly a lot of freemason involvement with it as well
but it was reinterpreted in the 18th century as the eye of providence and what I would
like to do this morning with you is to reinterpret it for the 21sth century as the eye
of compliance and who is the eye of compliance.
You are the eye of compliance, you are the eye of compliance.
[ Applause ]
>> You have that eye, you are aware of what it's taken to get us to this point
and you have a great sense of where we're gonna need to be as healthcare reform unfolds
and the field gets complicated but as important as ever as far as what we do so you are the eye
of compliance and that Latin expression on the top.
In the 18th century, it was meant to say the Almighty has favored our undertaking and I would
in a sense reinterpret that for our 21st century to say that in whatever capacity
and whatever power I have as the IG you should know that this morning we favor your undertaking
as effective and empowered compliance officials and with that thank you again for inviting me.
I always love to be here and best wishes for continued success.
Thank you.
[ Applause ]
>> Thank you.