Corporate Compliance

Tip: How to handle instances of noncompliance

Healthcare Auditing Weekly, September 2, 2008

Deciding what to do when there’s an instance of wrongdoing may be the hardest part of an auditor’s or compliance officer’s job. Although handling these situations can be tricky, there are some commonly used guidelines for collecting and handling reports of noncompliance.
  1. Report problems to the appropriate place. When you uncover an instance of noncompliance, consider the best place to report the problem, such as management. If it’s a simple billing mistake, analyze why it happened and send the money back to its rightful entity. Take a corrective action so the problem does not happen again.
  2. Know and follow your organization’s protocol. In most cases, auditors report compliance problems to the hospital’s compliance officer. Professional standards and some laws may require you to go to the company’s board or governing entity.
  3. Advocate for your position. If you are a compliance officer or an auditor trying to convince the board of directors to authorize an investigation, know that your presentation style could affect your decision.
  4. Get professional assistance. If a situation calls for self-disclosure, providers should rely on counsel—either in-house or outsourced—to assist with the process.
This tip is adapted from The Healthcare Auditor’s Handbook. For more information about the book or to order your copy, visit HCMarketplace.

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