GZ: After earning your JD, you worked as an attorney for the Social Security Administration (SSA) Office of Hearings and Appeals for four years before becoming a compliance professional with a hospital. At what point along the way did compliance as a career path become something of interest?
KZ: The U.S. Department of Health and Human Services Office of Inspector General’s (OIG) original hospital compliance guidance document for hospitals came out during my last year with the SSA Office of Hearings and Appeals. It was at that point that I told my dad that I wanted to switch career paths.
GZ: What was it about compliance, and healthcare compliance in particular, that attracted you to it?
KZ: Without a doubt, two things attracted me to compliance, and in particular, healthcare compliance. The first thing that drew me towards compliance was my undergraduate degree at the University of Oklahoma. The degree is called a letters degree, which is like a classics degree on steroids. The degree focuses on philosophy, languages, and history. The idea that I could help organizations create an ethical culture or that I could help create processes that would make it easier for individuals to do the right thing was intoxicating to me.
The thing that drew me towards healthcare compliance was the mission. Coming out of law school, I wanted to “wear the white hat,” work for the federal government, and help taxpayers. Working for the SSA Office of Hearings and Appeals, I felt like I was helping people in need. When I went to work for a safety net health system at the beginning of compliance programs, the mission was palpable. I could see the patients and their families. I could see how I could recognize risk, mitigate it, and help the system serve its mission better. I fell in love with the idea that I could essentially deputize every employee I interacted with, how they could influence the employees they interacted with, and how we could empower employees to do good.
GZ: You’ve been in compliance advisory roles for the last 20 years. What have been the most significant changes in the challenges faced by healthcare compliance professionals over this time?
KZ: That’s a complex question that depends on lots of variables. In general, I would say the sophistication of government and commercial payer data analytics systems are a challenge to the compliance industry. Physicians, leadership, operational employees, and compliance professionals are often unaware of the extent to which individuals have transparency into coding and billing issues, especially federal payers and enforcement. Additionally, the Centers for Medicare & Medicaid Service’s Open Payments data provides transparency regarding physician behavior. The above, combined with the U.S. Department of Justice’s (DOJ) desire to hold individuals accountable, poses a challenge to healthcare providers. However, I believe one of the biggest challenges to compliance professionals across the country is to what extent compliance officers are positioned appropriately within their organizations. And this issue of correct placement and correct reporting structure can be extremely complex.
Often, leadership is unaware of appropriate reporting structures. This can be a bit of a “catch-22” scenario because if compliance officers aren’t at the right level, they might not be in a position to educate leadership regarding appropriate reporting structures. And compliance officers might not be capable of delivering the message that they should be at a certain level and that they should be a “strategic adviser to leadership.” This is where I tell compliance officers to rely heavily on industry guidance documents like DOJ’s compliance document and OIG’s multiple compliance guidance documents (including its most recent compliance document). Throughout my career, I’ve interviewed many CEOs. When I let them know that the government would expect to see certain things regarding reporting structures or the position of the compliance officer within their organization, and when I let them know that OIG and DOJ attorneys would ask certain questions based on the previously mentioned documents during depositions, they usually make changes to improve the position of the compliance officer.