A colleague at Compliance Shield was recently talking with a physician about our 2-day intensive “train the compliance officer” workshop and on the importance of having a compliance program. To which the physician responded, “Tell me why I should be concerned about compliance”?
Just say “I forgot”
Needless to say, I was surprised and reminded of the old Steve Martin joke on how to make a million dollars and never pay taxes. Steve says that when the taxman comes to your door to collect, you just say two simple words “I forgot”.
Although the joke may be funny to some, I’m sure that if this was a real case the government would not feel that way. And when it comes to your practice, believe me, you don’t want to get in the crosshairs of law enforcement because you are not compliant with the law.
Increasing health care regulation similar to evolution of vehicle regulation
Since 1908 when Henry Ford launched the Model T automobile, more and more people owned cars. This, in turn, led to increasing accidents due to negligence, weather, etc. Eventually, something had to be done and part of the solution was that drivers’ licenses and car insurance became mandatory. So now, if you want to drive a car, you must have a license and car insurance.
The same can be said for healthcare. In the beginning, practitioners were trained in their fields and opened their practices. Years later it became mandatory that they be licensed in their profession and obtain malpractice insurance.
The law today requires compliance programs
Today, the law requires healthcare providers to have compliance programs as well.
- Since 2003, providers that transmit healthcare information to carry out financial or administrative activities related to healthcare are required to comply with the Health Insurance Portability and Accountability Act (HIPAA).
- In 2005, HIPAA required providers to implement controls to ensure the confidentiality, integrity and availability of their electronic protected health information.
- In 2009, the Affordable Care Act required providers that participate in programs such as Medicaid and Medicare, to have a compliance program.
Providers sometimes paralyzed by indecision on compliance
According to Ian Campbell, CEO, and founder of ThePathCentral.com, “indecision is truly the greatest disease and #1 killer known to man”. Many healthcare providers are paralyzed with indecision when it comes to implementing an effective compliance program.
Some seem to believe that using Steve Martin’s two simple words, “I forgot”, will help them avoid fines and penalties for non-compliance or provide an adequate excuse if the practice experiences a data breach.
Others are too ashamed or embarrassed to engage a compliance professional to stand up their compliance program. Maybe they simply feel that understanding and rolling out a comprehensive and ongoing compliance program is too time-consuming or simply too difficult.
Risking practice and career by neglecting compliance issues
The fact is that the years of training invested by a doctor or other provider, the satisfaction, community standing and revenue are all in jeopardy when he or she neglects compliance – so why risk it?
Perhaps they just don’t know better.
- Their practice is too small, so compliance is not required
- They’re too busy to worry about compliance
- They’re “good” people and don’t break the law and don’t need compliance
- They purchased a set of policies and that’s all they need
- They participate in annual training and that’s sufficient
- They’re retiring or selling the practice and won’t need a compliance program
I am always reminded of an old photo that shows Muhammad Ali posing in a fight scene with basketball legend Wilt Chamberlain. While I wouldn’t bet on Wilt beating Ali in a boxing match, I also wouldn’t count on Ali beating Chamberlain in one-on-one basketball either. Each is a different game.
Need compliance expertise
And so it is with healthcare providers: their training and experience providing care doesn’t give them advantages when it comes to compliance.
So, the next time some healthcare provider needs to be convinced that they require compliance, understand that it’s probably an awareness issue, an education issue and maybe even an Ali and Chamberlain issue: being in the wrong arena with the wrong skills.
Compliance is mandatory, the same as having a drivers’ license and car insurance.
Big or small, compliance is mandatory
It doesn’t matter whether you have a small practice or large multi-site practice network.
In short, if you don’t want to have a comprehensive HIPAA and corporate compliance program to provide training, policies, guidance and processes for handling breaches, audits and other common practices situations that are bound to occur, be prepared to risk losing everything that you have worked so hard and so long to obtain.
Greg Ewing is the President of Texas Dentists for Medicaid Reform and a health care compliance expert. His company, Star Compliance Services, is holding compliance workshops in both Houston and Dallas in the near future. Full details on the workshops can be obtained at http://www.compliancemastery.com.