Healthcare Compliance

This is not about health insurance fraud. There are plenty of articles about that. Healthcare compliance is compliance with law, regulations and policies of running healthcare institutions.

New York City Sanitary Inspection Grades
New York City Sanitary Inspection Grades

Compliance in healthcare has always been driven by regulation. When it concerns life, people are not too afraid of having more regulation. Unlike business professionals, who are always concerned about the happiness of their customers/clients, doctors are more concerned with health, even if the patient is not happy with the care provided. That is to say, most doctors will do what s/he can to keep a patient alive and well even at the cost of the patient’s happiness. This is where regulation does not contribute well. And the solution isn’t to add more regulation.

Corporate policies about how to handle scenarios with patients and the public is best served by taking a page from business professionals. Keeping patients happy can contribute to patients being more compliant with drug regiment, faster payment and less time in the exam room discussing not healthcare-related matters, like the annoyance of the drug regiment and dislike for paying of invoices. While the following policy suggestions mostly lack enforceability, simply having them will require a discussion of them at implementation, training and performance evaluations. That is good enough to start affecting change in the institution’s culture. After all, compliance is only effective if it is embedded to the culture.

  1. Eye contact when answers to questions are being provided,
  2. Physical touch to show connection, a handshake will do,
  3. Patient speaks first, do not cut off a patient mid-sentence,
  4. Thank the patient for something, anything,
  5. Apologize to the patient for even the slightest delay or interruption,
  6. Spend the full appointment time with the patient, if exam is completed early, complete notes in the room – patients often forget something,
  7. Ask about other people in their lives – sometimes the medical solution is addressing the environment, not the body,
  8. Always use medical terminology to explain or prescribe, but also use vernacular – use of vernacular terms sometimes cause liabilities but if used to clarify or emphasize medical terminology, the liability is gone,
  9. Inquire about what activities the patient enjoys for no other reason than to get an idea about the patients inclinations when given a choice,
  10. Share something personal so that the healthcare provider is human to them, you are human, after all.

About the Author: Marcus Maltempo is a compliance professional with more than a decade of experience helping banks, law firms and clients manage investigations and regulatory responses. He is the author of the forthcoming book History of Money Laundering: How criminals got paid and got away.


Whistleblower’s Tight Rope

Whistleblowers are a tough issue to deal with in terms of compliance. On one hand, they usually have to break a lot of corporate policies to blow the whistle. On the other hand, they are a witness to criminal or immoral activity in the workplace. Ideally, whistle blowing is not necessary. Ideals are not the reality.
from Human Capital Catalyst

Generally, corporations are good business entities that do not break the law or harm others. Society benefits by having legal entities that can continue a business even when the founders are no longer willing or able to run it.

For the whistleblower, a wrong must be performed to expose another wrong. Regardless of corporate policy, sharing the secrets of the corporation is legal and immoral. So, whistleblowers need compelling reasons to cross that good-bad line. Obviously, letting one’s superiors and the corporation’s compliance department is important. But if nothing is being changed, then the whistleblower is compelled to cross the good-bad line. Who to contact next is difficult to figure out. Some industries or activities do not have regulators. In such a situation, the default government entity to contact is the Federal Bureau of Investigations, FBI. The FBI may advise the whistleblower on what to do next. The FBI may even advise the whistleblower that the suspect activities related to them are not crimes. But the FBI may suspect the whistleblower is/was somehow involved and wants to get out of a bad situation in the whistleblower’s own interest. In the last situation, the FBI has had a reputation of protecting bad actors who report bad behavior if they own up to their bad behavior when reporting large crimes. Whistleblowers may still be tried for their crimes, but might get reduced sentences, vacated sentences, immunity, or delayed prosecution agreements, DPA. DPA’s are generally reserved for financial institutions, though, not individuals. And also DPA’s are effectively a pass on conviction. There maybe a hefty fine associated with it but it still means a clean criminal record, which is of great value in many part of the developed world.

Whistleblowers really need to think these things through. Speaking with a knowledgeable and trusted attorney would be advisable before crossing corporate policy. Should one doesn’t know of an attorney through his/her network, then reading the Wall Street Journal to see who have protected whistleblowers in the past are also a good way to find them.


One bit of business: I would like to interview compliance practitioners in financial services. If you think you have something worth sharing, I would like to speak with you.

About the Author: Marcus Maltempo is a compliance professional with more than a decade of experience helping banks, law firms and clients manage investigations and regulatory responses.