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COMPLIANCE

Compliance officers must establish credibility with consistent, well-documented decision-making

One of the tougher issues a non-lawyer compliance officer faces is a challenge to their decisions and recommendations by other members of the management team. This happens more often when the person is new to the company or the position. In a large proportion of these challenges, the challenger cites a lawyer’s comments or an interpretation they saw in a newsletter or on the Internet, or something they believe a competitor is doing. In the worst of all cases, the challenger is the chief executive.

The laws and regulations governing health care change often and can have unique interpretations when applied to medical offices as opposed to say, a clinical laboratory. A person unfamiliar with these differences can misinterpret something that is intended for a different sector of health care. Additionally, most compliance decisions, particularly in the area of anti-kickback and Stark, are based on the facts and circumstances unique to a particular situation.

5 ways to avoid or deal with challenges

If the compliance officer does not effectively deal with these challenges, it can undermine their authority and make their job harder or even impossible.

Here are some recommendations that will help you avoid or deal with this should it happen to you:

  1. Establish good working relationships with other members of the management team. Let them know you are there to support what is best for the practice, not only from a legal and regulatory perspective but also from a business perspective.
  2. Never automatically assume that you are right and they are wrong.
  3. If you don’t already know, ask for the source of their information so you can research it. Even if you think you know, ask anyway in case they are looking at something else and misinterpreting it.
  4. State the reasons for your decision clearly and concisely and provide documentation to support them.
  5. Create a library of questions and cases that come up, your response and the documentation you provided at the time. Many times the same or similar questions will come up again and again. Consistency in your responses is an important aspect of establishing credibility. If your answer is going to be different make sure you include the reason it is different.

Conclusion

Credibility and trust are two of the compliance officer’s most important traits. A track record of good decisions based on thoroughly researched and documented responses will go a long way toward establishing those traits with your management team.


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