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Failing and/or Thriving

CI 2013 Zeko presentation
by

Brian Beard

on 10 September 2014

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Transcript of Failing and/or Thriving

A Fine Tuned Engine – Organizational Structures for the Compliance Department
500 day rule
:

500 days
from the date that you feel complacent as a Compliance Officer your employment will be terminated, eliminated or you will resign in frustration.

Don't become complacent!
Placing Compliance
within Compliance
Create a vision and
strategy for compliance
•What does your executive leadership team think the vision and/or strategy is?
•What is the Board’s understanding of these issues?
Do the above visions align with the 8 elements?
•What if I don’t have a vision or strategy for compliance?
Could your program withstand external scrutiny?
Ask the following questions:
• Have we assessed the program?
• What would an assessment look like?
• What type of monitoring and auditing is occurring?
• Do we have a robust operational compliance committee?
• What does our org chart look like/what's the perception?
Could your Board attest
to the following language:
“The Audit Committee has made a reasonable inquiry into the operations of
the Compliance Program including the performance of the Chief Compliance
Officer and the Compliance Committee. Based on its inquiry and review, the Audit
Committee has concluded that, to the best of its knowledge, the Company has
implemented an effective Compliance Program to meet Federal health care program
requirements, and the obligations of the CIA.”
Who are
you
?
How do you know
you are
effective
?
Worst Case Scenario
It can go ugly quickly-
You will be deposed.
Your computer will be imaged.
“I have been trained on and understand the compliance requirements and
responsibilities as they relate to [department or functional area], an area under my
supervision. My job responsibilities include ensuring compliance with regard to the _____ [insert name of the department or functional area.] To the best of my knowledge, except as otherwise described herein, the ______ [insert name of department or functional area] of the Company is in compliance with all applicable Federal health care program and FCA requirements, and the obligations of the CIA.”
“I have been trained on and understand the compliance requirements and
responsibilities as they relate to the Company. My job responsibilities include oversight of the Company. I have made reasonable inquiry regarding the Company’s compliance with all applicable Federal health care program requirements, and the obligations of the CIA. To the best of my knowledge, except as otherwise described herein, the Company is in compliance with all applicable Federal health care program requirements, and the obligations of the CIA.”
Ken Zeko, Director,
Navigant Consulting, Inc.
ken.zeko@navigant.com

Joel Dziengielewski, Director,
Navigant Consulting, Inc.
joel.dziengielewski@navigant.com

Compliance offices must be able to effectively narrate or evidence the existence of the organization’s compliance efforts. To do so, we suggest utilizing the following sample table of contents to assist in accumulating already existing documentation and/or creating documentation where needed to more effectively tell the story of compliance:
Manuals, plan, or other documents that describe the entity’s approach to managing the compliance program, such as:
Organization chart
Budget
Board meetings
Compliance program document
Compliance program roles, responsibilities
Code of conduct
Annual report 
Boards’ resolutions, agendas, or minutes that describe Boards’ roles in overseeing compliance:
Board audit/compliance committee charter
Compliance committee charter
Compliance department charter
Operational compliance committee charter
Operational compliance committee and Board audit/compliance committee agendas and meeting minutes that the committees’ roles in overseeing compliance program 
Summaries of self-reporting, disclosures, incidents and corrective action plans:
Tracking, trending (areas responsible for overpayments)
Disciplinary measures, if any associated with incidents
Savings to entity
Compliance policies and supporting documents, such as policies related to:
Self-disclosure
Investigation
Non-retaliation
Corrective action
Training
Conflict of interest
Risk assessment
Hotline information, such as past year’s:
Reports
Tracking, trending metrics
Significant incidents reports
Efforts undertaken to raise hotline awareness 
Policies for enforcing compliance standards:
Discipline policy
Tracking/trending areas responsible for infractions
Additional information regarding compliance effectiveness:
Data analytics
Integrity surveys
3rd party audits (governmental, legal, consulting)
Return on investment consideration
Repayments, self-disclosures, corrective action plans
Compliance awards
Compliance, Legal, Risk, Quality
“The Third Line”
Independent Compliance Oversight and Internal Audit will provide Independent oversight and monitoring.
“The First Line”
Management is accountable for identification of risks, internal controls, and compliance activities and monitoring in order to be compliant with laws and regulations.
“The Second Line”
Compliance will provide compliance management program, framework and policies
Three Lines of Defense
Business Compliance Ownership
What is a Compliance Officer?
The Compliance Officer
shall
be responsible for developing and implementing policies, procedures, and practices designed to ensure compliance with the requirements set forth in this CIA and with Federal health care program requirements. The Compliance Officer
must
have sufficient compliance experience to effectively oversee the implementation of the requirements of this CIA.

The Compliance Officer
shall be a member of senior management, shall report directly to the Chief Executive Officer, shall make periodic (at least quarterly) reports regarding compliance matters directly to the Board of Directors, and shall be authorized to report on such matters to the Board of Directors at any time. The Compliance Officer shall not be or be subordinate to the General Counsel or Chief Financial Officer.
The Compliance Officer shall be responsible for monitoring the day to-day compliance activities as well as for any reporting obligations created under this CIA. Any noncompliance job responsibilities of the Compliance Officer shall be limited and must not interfere with the Compliance Officer’s ability to perform the duties outlined in this CIA.
OIG Expectation
Everyone Else Expectation
The Compliance Officer shall be responsible for developing and implementing EVERYTHING imaginable to ensure compliance with
every known and unknown provision
of a law, regulation, COP, policy, NCD, LCD, letter by the agencies, etc... This includes a
clairvoyant knowledge
of every possible unforeseen regulation to be considered. The Compliance Officer must be an
Expert in everything
to effectively oversee the implementation of the requirements.

The Compliance Officer shall be a member of senior management, shall report directly to the Chief Executive Officer, shall make periodic (at least quarterly) reports regarding compliance matters directly to the Board of Directors, and shall be authorized to report on such matters to the Board of Directors at any time. The Compliance Officer shall not be or be subordinate to the General Counsel or Chief Financial Officer
, but

should never cross them.
The Compliance Officer shall be responsible for monitoring the day to-day compliance activities as well as
any other operational activity where people might make a mistake
. Any noncompliance job responsibilities of the Compliance Officer shall be limited and must not interfere with the Compliance Officer’s ability to perform their duties.
Most importantly the Compliance Officer must have a
cheerful disposition
so that everyone likes them.
The bottom line is:
A Compliance Officer shall run an effective compliance program.
Failing to build relationships
with operational personnel
Competing priorities are always an issue, but:
Are the 8 elements present and imbedded?
Is the program maintaining momentum?
Is the culture conducive to compliance?
Are you in the right meetings?
Are you an executive?
Are you becoming complacent?
Compliance risk assessments:
Risk assessment process
Risk assessment results
Linkage to auditing, monitoring, education and budgets 
Compliance auditing/monitoring, such as
:
Auditing/monitoring findings
Reports
Corrective action plans
Key Compliance and Operational metrics focused on outcomes.
Compliance Training and communications regarding compliance:
Training modules
Newsletters
Updates
Tracking/Trending (what happens when 100% don’t complete) 
Documentation describing how business areas with compliance risks interact with the compliance program:
Mini-compliance plan documents for areas that have compliance risks
The departmental compliance plans should be based upon the traditional “eight elements” of effective compliance programs and should evidence what the areas are doing regarding compliance roles/responsibilities, specific training (if any), risk identification, and monitoring activities
Independent
Oversight
Self Assessment
Peer Assessment
3rd Party Assessment
Becoming Complacent
Ask the Tough Questions
Could your CEO attest
to the following language:
Could your operational leaders attest
to the following language:
Gather the Documents
and Tell the Story
Stay on the path
and do it again
The views and opinions expressed in this presentation are those of the presenters and do not necessarily reflect the official policy or position of our employer. Examples of analysis performed within this presentation are only examples. They should not be utilized in real-world analytic products as they are based only on very limited and dated open source information.
Questions
Are you doing Compliance from behind the desk?
Are you interacting with operational departments?
Do they understand Compliance and their responsibilities?
Chasing issues (putting out fires)
instead of teaching the program
Full transcript