Keep the lines open with a compliance hotline

Taping not good idea with anonymity requirement

Maintaining open lines of communication is an important part of any hospital's compliance program. Federal agencies have encouraged the use of anonymous hotlines as a way for providers to hear about possible fraud and abuse problems from employees. (For more information about federal guidelines for hotlines, see p. 147.)

Providers can choose to operate their hotline in-house or outsource it to a third-party company. An important aspect of either strategy is to maintain the anonymity and/or confidentiality of each caller, says Stacey Schleifer, Esq., director of business development for National Hotline Services (NHS), in Alexandria, VA. NHS specializes in the development, implementation, and operation of employee hotlines.

Two legal issues are involved in the implementation of hotlines, she says. One is the issue of protecting the caller. Taping the hotline calls or accepting handwritten letters may be convenient for the provider, but it allows the provider to potentially identify the person reporting the problem.

"Anything that could potentially identify someone compromises the anonymity function of the hotline. How can you prove anonymity when you have a voice on a recording?" Schleifer says.

"If employees know they that their voices are being taped, yet they want to be anonymous, they are not going to feel comfortable calling that number and leaving a message with their voice recorded on it," adds Andrew Joseph, JD, assistant vice president of Strategic Management Systems, a health care consulting firm, also in Alexandria, that develops compliance programs. Strategic Management Systems is NHS' parent company.

It's best if you have an operator to take hotline calls, Schleifer says. "When a live operator is not available, you should have some sort of message telling the caller when the hotline operator will be available."

For example, an operator could answer the phone during business hours. After hours, a queue message could state the hours of operation and ask the callers to call back. "You definitely don't want callers to leave a voice-recorded message," she adds.

Not allowing the opportunity for identification will protect the caller, but it also will protect the company, which is the second legal issue.

"One of the major compliance issues is that employees cannot be retaliated against for reporting perceived wrongdoings through proper chains of command," Schleifer explains.

"[For example], someone reports a problem to the hotline. This person is involved in the wrongdoing and identifies himself during the call. Then through a perfectly normal chain of events, this person is terminated. The hospital has now opened itself up to the potential of the person coming back and saying you retaliated against him for making a hotline call."

Hospitals can avoid this scenario by not allowing the caller to identify him- or herself. "You can [then] say, 'We didn't retaliate against you. We didn't even know it was you. Your anonymity was maintained.' If you have to go to court on that issue, it's always harder to disprove a negative than it is to say something in the affirmative such as, 'I've never had that caller's identity.' If you have to say, 'Yes, I had that caller's identity, but this is why we didn't retaliate,' it's a harder case to prove."

Setting the ground rules

Hotlines work best when callers learn the ground rules at the beginning of the call. NHS uses a prerecorded message that the callers hear prior to speaking with an operator.

"The message [explains] the rights and responsibilities of the hotline caller," Schleifer says. "We have found that the prerecorded message is instrumental in helping callers understand what they should expect from the hotline and what is expected of them." Here is what callers are told:

· The call is not being recorded and no attempt is being made to determine the number or location from which they are calling.

· They cannot be retaliated against for making this call.

· The compliance office has a duty to protect all parties involved so they may not be aware of what action has been taken with respect to their call.

The operator who takes their calls should be trained in compliance issues and should follow a strict protocol established by the provider's compliance officer and legal counsel to ensure that the information is taken accurately. The operator should also know what calls to bring to legal counsel's attention immediately.

"You can't just sit someone down and ask them to take calls," Schleifer says. "Operators have to understand the issues that affect the health care regulatory environment. If someone calls and says, 'I'm putting in these codes, and my supervisor is yelling at me that I'm not putting them in fast enough. Yet sometimes I can't read the doctor's writing to see what the diagnosis is and she tells me to wing it.' You need to be trained enough to say, 'This is a compliance issue, and this could have a serious impact on this company.'"

The employee hired to be an operator should not be involved in day-to-day operations of the company - or better yet, should work off-site.

"Having an in-house person could be problematic if the person could recognize voices," Schleifer says.

"Focus groups [we have held] say that if they chose not to follow the standard chain of command to report a problem, they would rather talk to a third party [or someone removed from the daily operations of the organization] who keeps reports gender-nonspecific," Joseph adds.

You should also not use your regular phone lines for the hotline. "If you have an 800 number and you receive a bill for it, the bill will tell you every extension and every phone number that has dialed into that 800 number. It would be better to set up a completely separate line into their hospital so that it's not all tied into the mainframe phone system where it can be printed out," Schleifer says.

Benchmarking the calls

Once a call comes into a hotline that NHS is monitoring, the company writes up a report on the information and sends it to the client's office by the next day. NHS also sends out monthly reports that benchmark the types and subjects of calls it has received.

"Because we specialize in health care, we benchmark all of our clients so that they can see what types of calls they are receiving in relation to other companies in the industry," she says.

"We're able to help compliance officers when they ask, 'Is this rare to my company?' We tell them we have heard it all."

Editor's Note: For more information about National Hotline Services, call (703) 683-8345. Or visit its Web site at