Compliance Today - October 2020

Element 1: Information intake system

First and foremost, there must be a reporting channel—including, but not limited to, a telephone line or a designated web page—dedicated to this cause. Numerous government-issued publications and guidance have emphasized that organizations should establish a disclosure program that includes a mechanism (e.g., a toll-free compliance line) to enable individuals to disclose to the compliance officer—or some other person who is not in the disclosing individual’s chain of command—any identified issues or questions associated with the organization’s policies, conduct, practices, or procedures with respect to a federal healthcare program believed by the individual to be a potential violation of criminal, civil, or administrative law.^[1]

However, merely having a phone number is not sufficient. Many other pieces, like system integration, data analytics, information security, status tracking, and case notification, should also be taken into consideration. Whether you are internally developing a new information intake system, shopping for one among many options on the market, or evaluating an existing system, there are some assessment questions that should be asked.

Cost and budget:

• What is the cost of initial setup and annual upkeep? Since this is likely to be one of the critical deciding factors in whether the company chooses a particular platform—in-house or outsourced—having a general idea about the cost, including labor, time commitment, technical upgrade, regular maintenance, etc., is helpful in allocating adequate resources and selecting appropriate tools.

• How much is budgeted for this? You may need to categorize your wants and needs. Differentiate desirable, discretionary, and optional features. Balance what your office can afford and what you really need.

User experience and technical support:

• Is the system user-friendly for all parties concerned (i.e., reporters and investigators)? Easy navigation is a must. As we can imagine, people are already upset when they feel the urge to call the hotline. Making it difficult for them to file a report will only frustrate them further and likely worsen the situation.

• Does the system integrate information from other reporting channels (e.g., online portal, email, fax, text)? With the development of modern technology, there are more and more ways for people to share information. Reporting channels are no longer limited to a telephone line. Many systems allow reporting via text, fax, online app, etc., thus making it convenient for reporters. Regardless of the intake method, in order to streamline the process, ensure consistency, and maintain documentation, it is best to have a centralized database to store all your hotline information, including the complaints, investigative records, outcomes, and actions taken.

• Does the system interface with other software programs? With reports received from various channels and fed into a centralized platform, having everything in one place will not only save you a huge amount of time, but also enable your organization to have an accurate, holistic view of the risk and cultural health of the whole organization. Departments across the organization can manage their investigations according to their own standard operating procedures while all the critical documentation and investigation outcomes are stored within the centralized database, which can preserve continuity, accuracy, and consistency.

• Are there live representatives available 24/7 to answer calls? No matter how advanced our technologies have become nowadays, nothing can replace person-to-person interactions. Sometimes, the mere fact that someone is listening to you makes you feel better instantly, because a little human touch carries magic.

• When the organization encounters a glitch and needs to seek technical support, what is the usual turnaround time? Customer service, such as responsiveness and quality of service, always matters, regardless of the industry you are in.

Capability, functionality, automation, customization, and data security:

• From the hotline greeting to the website layout, does the system allow you to individualize your hotline as well as the compliance program information? It is your platform. This is a great opportunity for you to state your values and convey your message to reporters. Remember, it will be the first thing that they see or hear; first impression is the last impression, so make it count.

• Does it have the ability to automate the case triage process based on preset parameters as well as allowing manual entries, if needed? That way, it can ensure consistency and objectivity while maintaining flexibility.

• What data analytics features does the system have? Does it allow customization to meet the needs of leaders at different levels (e.g., the board, C-suite executives, department heads)? Can it produce summaries, numbers, and graphs to show trends and patterns? As we now live in the age of data, all the information that surrounds the complaints should be captured and be part of the data points. The system should be able to transform seemingly separate complaints into meaningful data and allow them to be sorted by different factors (e.g., issue type, location, region, division, department). Robust analytics can provide enterprise-wide data to identify potential risks and gaps in policy, process, and operations.

• Where are the data stored? Is the system secure? In the healthcare sector, it is not surprising that many complaints are centered on patient care and clinical issues. Hence, much of the data are relating to patients’ personal health information. The organization must exercise caution and institute reasonable measures to safeguard such protected information.

Since each organization’s line of business, as well as its compliance team’s approach, varies, there is no one-size-fits-all system. But hopefully, the aforementioned factors will assist you with evaluating your existing intake system or selecting a suitable one for your organization.

Element 2: Reporters

Once you have an information intake system in place, then what? Naturally, the next step will be to publicize the hotline. Many companies’ focus has been solely on establishing a toll-free number, which allows them to simply check the box. However, just because there is a hotline in place does not necessarily mean it is truly effective—nor does it guarantee that people will use it. The key is to promote the hotline and maximize its efficacy to the fullest extent. Without knowing about the existence of your hotline, people are less likely to contact you. Knowledge is power; the more people know about it, the more they tend to use it. Sharing the hotline information and educating people on the function and purpose of it are often a missing link to a valuable disclosure program. Last year, our organization revamped our compliance messaging as part of our effort to continually advocate for compliant behavior. Throughout the year, we rolled out a series of well-thought-out compliance campaigns and activities, in which a wide range of people participated. Below are some ideas for your reference:

• Engage a professional marketing firm to design a unique compliance logo and a hotline poster (if your budget permits). Alternatively, you could host a logo design contest open to all employees, which can spark interest, ideas, and discussions.

• Give your hotline a catchy name. Instead of using a plain or generic phrase, call it something different that reflects your compliance’s characteristics and values. After all, compliance is not all about negative outcomes, stiff penalties, or dire consequences. It can be friendly, humorous, and positive while delivering a serious message.

• Form a work group and invite employees of diverse backgrounds and experiences to participate in the hotline system evaluation and/or vendor selection process. Gather their feedback on the disclosure program and share updates with the entire workforce.

• Organize an easy-to-participate compliance slogan contest and invite all in the community to join. Give out prizes and announce winners. It may be a cost-effective way to share the hotline information with the community in which you serve.

• Develop a visually appealing incident reporting reference guide or a simple cheat sheet (with the hotline information included) that is posted in prominent locations throughout the company’s office buildings and facilities.

• Publicize the compliance hotline via company publications, including the periodic newsletters, announcements, and alerts.

• Include a one-page information pamphlet about the compliance hotline and the investigative standards in marketing materials for patients and vendors.

• Contact reporters individually to thank them for sharing their concerns with the compliance department and giving the organization an opportunity to look into a potential issue.

In the meantime, it should be kept in mind that a hotline is not just a phone number for people to dial; rather, it’s an avenue through which people communicate their concerns to you.

Furthermore, it’s no secret that various governmental agencies (e.g., Department of Justice, U.S. Department of Health & Human Services Office of Inspector General, Office for Civil Rights, Centers for Medicare & Medicaid Services, and state agencies) all have a hotline of their own. What makes your hotline so appealing to reporters that they choose to call yours? What assurance does it provide so reporters feel your organization will indeed listen to them and address their concerns? Below are some ideas you may find useful.

• Publish your missions, values, and ethical standards on the hotline web page and in company publications.

• Be transparent about your guiding principles and investigative protocols.

• Follow and apply your policies and procedures consistently.

• Develop a list of Q&As to provide general guidelines to share with reporters as to what will happen next and what they can anticipate.

A hotline might be perceived by many as a negative line through which people tell on each other, but it does not have to be that way. Instead, present compliance as the uplifting, inspiring, and dynamic function it is. Making things fun is the best way to engage everyone. Understanding how your organization can use and leverage tools and resources like a hotline can benefit the organization and strengthen its culture and reputation in the community.

Element 3: Internal investigators

I once heard someone say, “The greatest uninsured asset of an organization is its reputation.” A tagline I would add to it is: “The best safeguard is compliance.” Fostering a corporate culture of compliance cannot be accomplished overnight, just as Rome was not built in one day. Setting up a hotline and publicizing it are just the first two steps of a long journey. The long-term success of a disclosure program also depends on continuous attention, cross-functional collaboration, and a sustainable approach that focus on departmental buy-in, teamwork, and continuing education.

Although it is an independent function, the compliance team is not and should not be working in silos. Recognizing other departments’ expertise, seeking their input, and/or inviting them to be part of the investigative team are crucial to a thorough and comprehensive investigation, provided that there is no conflict of interest. In order to truly integrate compliance into the organization and make it part of the corporate culture, engaging fellow colleagues from various departments is essential. They are more likely to support follow-up actions and ensure the implementation if they were involved or consulted in the process. They also offer different perspectives, thus giving the investigative team an opportunity to view things from different angles. Moreover, after they have gained the firsthand knowledge and experience about the system, the compliance team will be able to seek direct feedback from them on the efficacy and usability of the hotline as well as the disclosure program as a whole.

In addition, it is equally important to provide training and education to internal investigators. While investigators bring their unique talent to the table, not all investigators have the same level of experience, subject matter expertise, and skill sets. Oftentimes, a hotline complaint can contain multiple facets involving complicated issues, such as clinical care, personal conflicts, fraudulent billing, privacy rights, retributions, etc., or real concerns can be presented as general inquiries. It is of vital importance that investigators have the ability to dissect intractable problems. Therefore, developing an investigative checklist, implementing standardized protocols, and conducting periodic training will undoubtedly enhance internal investigators’ skills and significantly improve the overall investigative methodology, thereby upholding the quality and integrity of the disclosure program.

Resolving hotline concerns involves working alongside operations in corporate governance, damage control, and risk management. A successful program never relies on one single person or department. Collaboration is key. Likewise, continuing education for investigators is also an integral step toward building a vigorous disclosure program, because it will not only help the individuals with their own investigative skills and professional growth, but also benefit the compliance program, as well as the organization, in the long run. Benjamin Franklin once said, “An investment in knowledge always pays the best interest.”^[2] It still rings true today and in this case.

Conclusion

Maintaining open lines of communication is fundamental to the successful implementation of the compliance program and reduction of any potential unlawful or unethical behavior. An information intake system that is equipped with strong data analytics capability, reporters who are well informed of the hotline and willing to use it, and internal investigators who are proficient at addressing and resolving issues are the three crucial elements of a successful disclosure program. By establishing an effective information intake system, fully communicating the information to all concerned, and providing ongoing training to internal investigators, the compliance hotline will surely become “hot.” When people are willing to report potential problems to the compliance department, it will considerably reduce the organization’s exposure to disputes, lawsuits, and sanctions.

As to the nine-year-old’s questions, my answer was, “Yes, my hotline is very HOT. It helps people, protects my organization, and promotes compliance. That’s why it’s called a ‘HOT-line.’”

Takeaways

• A hotline is a triangular framework with three basic elements that are closely correlated: information intake system, reporters, and investigators.

• Merely having a telephone line is not sufficient; the key is to promote it and maximize its efficacy to the fullest extent.

• Having all the information in one system enables you to have a holistic view of the risk and cultural health of the entire organization.

• The best way to engage people is to make things fun, so be creative.

• Periodic training for investigators will enhance their skills and improve the overall investigative approach.