Ethics can coexist with corporate compliance

Integrity approach can be more cost-effective

Now that most health care institutions have accepted the idea of having a corporate compliance officer, some are discovering that a good approach is to place corporate compliance under the larger rubric of "corporate ethics." While the two concerns are not necessarily the same, they can work well together, says Mary Ann Bowman Beil, MS, corporate ethics and compliance officer at Memorial Health in Savannah, GA.

Beil spoke on the issue at a recent meeting of the American Society for Healthcare Risk Manage ment in San Diego, telling attendees that many providers set up their corporate compliance programs under the heading of corporate ethics, business conduct, or business practice. That can work if you follow a strategy based on integrity and not simply a strict legal compliance, she says. "Legal compliance and corporate ethics are not the same, but they can coexist. Under stand ing the difference between having a legal compliance program only and having a compliance program implemented in the context of a broader commitment to corporate ethics are two entirely different approaches to implementing compliance."

An integrity-based program is more likely to create an "authentic compliance posture" rather than just putting on a good face based on the most recent recommendations or enforcement patterns, Beil says. That approach also assumes upper management will integrate compliance in day-to-day business conduct, instead of a strictly legal approach that sets up the compliance officer as the corporate watchdog. "The corporate watchdog may get things done right now, but that is a far less-effective compliance strategy in the long term," she says. (Beil also offered a few compliance tips from her experience as the ethics and compliance officer at her institution. See box, p. 11, for some of her advice.)

Integrity can save money

Beil says an integrity-based approach can be even more cost-effective for the institution. If compliance is completely integrated within upper management, there is no need to create a new cost center with additional staff. Placing corporate compliance within the ethics heading also meets the federal recommendations that the corporate compliance officer not be part of the office of legal counsel. Placing the corporate compliance officer within the ethics division instead of the legal department draws a clear distinction, but it also creates some problems.

"The relationship between the compliance officer and legal counsel is a complicated one," Beil says. "The very nature of performing the most remedial tasks of compliance in the current health care environment is of concern to counsel. The requisite levels of education and the discussions of this complex regulatory environment with employees increase the amount of conversation and speculation of what may or may not be fraudulent in the institution. This conversation and speculation in and of itself is cause for concern."

Legal counsel also might find written communications from employees to the compliance officer are a serious danger, she says; the communications will be filled with allegations, all discoverable. "The truth of the matter is that while counsel is dedicated to protecting the institution from any and all risks, the compliance officer introduces a function that is largely antithetical to the basic premise of the legal counsel."

Such problems can’t be dismissed lightly, she says, but an integrity-based approach to corporate compliance still is a better approach than one that emphasizes short-term technical compliance with laws and recommendations from the government. "Long after the fraud and abuse investigations have died down, an integrity-based compli ance program will enhance the quality, the patient satisfaction, and the management of the institutions in which the programs were implemented."