Compliance Perspectives

Post By: Adam Turteltaub

Kerry Klewer (LinkedIn) is Director, Global Compliance Program for Tala, a Fintech firm providing financial services to the underserved in Kenya, the Philippines, Mexico, and india. These individuals, she explained, don’t have access to traditional credit sources, typically because they lack a credit score.

With Tala, individuals can apply for credit through an Android app. The company also offers card and account products. In addition, the company has recently partnered with Visa to offer crypto services to its customers.

The compliance challenges for Tala are substantial, she explains, with key risk areas such as consumer protection, tax, privacy and anti-corruption. Adding to the complexity: with many bad actors in this market, the number of laws have increased, and so, too has scrutiny.

The company has responded by launching a global compliance program. It conducted its first global risk assessment, and each country has its own risk assessment, as well. The common themes that emerged included data privacy and working with third parties in emerging markets.

Another challenging area is artificial intelligence. It raises a host of issues about how to handle data ethically and the need for a data ethics policy. To mitigate that risk, the data science team regularly checks for algorithm biases.

The company also recently launched a data governance committee to define what data is being collected, why and if it is accurate.

It’s not just data that is a risk, of course. People issues are also a factor and require the team to train and provide the proper tools for the workforce to do the right thing. These include ethics workshops to help individuals understand what can make or break a compliance culture, especially in a purpose-driven company. That’s a challenge when the corporate culture is spread among so many global cultures.

Listen in to learn more about Tala, and perhaps find lessons that can help improve your own compliance program.

Post By: Adam Turteltaub

As diversity, equity and inclusion efforts proliferate, Stephen Paskoff, President and CEO of ELI, warns in this podcast that organizations need to be mindful of existing equal employment laws. Allowing for differential treatment, no matter how well intended, can lead to claims of discrimination.

The intentions of DE&I programs are not, in and of themselves an issue, he explains. The issue arises from how these initiatives are pursued. Some employers have permitted conduct that can be seen as disparate treatment, even bordering on fostering a form of systemic discrimination. He notes that it can be highly problematic if systems of advancement give an advantage to one group without sufficient grounding in legal principles.

He recommends keeping the law clearly in mind since it is both supportive of DE&I initiatives and can help avoid problems.

He also advises looking to the organization’s value. Respect, inclusion and fairness are typically included and provide an opportunity to put the DE&I initiative in context, including that these values helps build a stronger, more successful enterprise.

He also argues passionately for an emphasis on civility. Setting standards of what one can can’t say, and how people act, is essential not just in this area but in others as well. It promotes proper communication, including helping people raise issues and speak up freely.  That, in turn, can help diffuse issues and enable the organization to deal with problems before they grow too large.

Civility, according to Stephen, also provides a platform of consistency that everyone can sign onto as citizens of their organizations.

Listen in to learn more about civility and how to ensure that your DE&I initiative doesn’t run afoul of labor laws.

Post By: Adam Turteltaub

Kim Brandt, partner at Tarplin, Downs & Young has long provided the healthcare community with her expertise in all things Washington, having spent substantial time at CMS, the OIG at HHS and on Capitol Hill.

She’ll be leading a general session at the Health Care Compliance Association Healthcare Enforcement Compliance Conference, which takes place November 8-10. In this podcast she provides a preview f her talk with insights into all that’s coming and likely to happen both from the Biden Administration and Congress.

Starting with CMS, which is in its regulatory cycle once again, expect big changes in physician fee payments. There is a 3.75% reduction across the board in the offing, with the goal of giving a bump up to primary care physicians. That means, she explains, reduction in payments to specialty care providers by as much as 8-10%. This will be on top of a delayed 2% sequester.

Telehealth, which became a standard part of care during the pandemic, will also see changes with proposals to make permanent rules permitting it for mental and behavior health, including audio-only treatment. Video will not be required.

Up on Capitol Hill she reports that Congress is considering expanding Medicare Part B to include hearing, dental, and vision. These had never been covered by Medicare before and come with a large $300 billion price tag over 10 years.

Also under consideration is increased support for home and community-based services, along with increased funding for them.

Another area of focus is likely to be the Medicaid gap. Thirteen states have not implemented a Medicaid expansion.  Under consideration are measures which would allow local governments in those states to contract with CMS to expand Medicaid.

Finally, she discusses the personnel changes at CMS and the OIG at HHS. The new administration has brought changes in people, but they are not exactly new, having served in the government before.

Listen in to learn more about what’s going on in healthcare in Washington, DC. Then be sure to be a part of the 2021 Healthcare Enforcement Compliance Conference.

Post By: Adam Turteltaub

It’s been an interesting and challenging times for efforts to encourage employees to speak up, reports Neta Meidav, co-Founder and CEO of reporting tool provider Vault Platform. Despite the increase in employee activism, there has been a decline in year-over-year helpline volume, which she attributes to both the nature of traditional help vehicles and a deficit of trust in the workplace.

Other factors having an impact are: a desire of employees to report to external avenues, COVID-related changes in the workplace, and a new focus on ethics and purpose. This last factor goes hand in hand, she argues, with a growing tendency of social issues to become business issues.

Regulators have also been stepping in. For some time, of course, the SEC has encouraged reports to its Office of the Whistleblower. The EU Whistleblower Directive has acted as a catalyst across the Continent, with countries in the midst of creating their own laws, with varying protections likely. She expects this to drive increased accountability and transparency.

In this podcast she encourages compliance teams to think about the activist sentiment in Europe, what it means and how it differs from the US. And, of course, organizations need to recognize the complications posed by GDPR.

She also advocates for a reassessment of how compliance teams encourage employees to report internally. With open door policies no longer relevant in a time of remote working, she believes it’s time to find new tools and increase efforts to promote psychological safety.

Listen in to learn more about how to foster a speak-up culture in the current era.

Post By: Adam Turteltaub

Codes of conduct are ubiquitous these days, and they are often digital. It’s a way to make them more accessible, and more in line with how people work.

But what if you took that virtual approach up a bit? That’s what TAQA and its Head of Ethics & Compliance Abdul Rahman Al-Ja’abari (LinkedIn) did. They created a Code of Ethics & Business Conduct that is experienced as a virtual reality walk through of representations of the some of the company’s facilities, in addition to a more conventional PDF.

TAQA had recently undergone a large merger that created one of the largest listed entities by market cap in the United Arab Emirates (UAE). The newly-formed company needed an ethics and compliance program that would both help it meet regulatory requirements and unify the culture.

Because the company operates around the globe, the code of conduct had to be put in a format that would be accessible to everyone. But, they also realized there was an opportunity to use it as a unifying tool. So, they created a version of it that employees could literally explore. They navigate room to room, as Abdul Rahman explains, where they see what different locations of the company look like and are able to explore different elements of the code.

This creative approach has received very positive feedback.  It was also a way for the compliance team to deliver on the company’s core value of innovation.

For anyone inspired by this approach, Abdul Rahman recommends beginning by building alignment with management on the approach, objectives, budgets and resources required. The communications team needs to be brought on board to help ensure you stay in line with their communications plan.

Of course, the IT group is also a crucial partner, helping ensure that the solution is compatible with the organizations systems and is readily accessible to the employee base.

Finally, be prepared for a positive reaction. People tend to see compliance as a staid, boring group.  Developing something creative, he explains, can help change minds very dramatically and for the better.

Listen in to learn more, and then spend some time exploring the TAQA Group Code of Ethics & Business Conduct.

Post By: Adam Turteltaub

The calls keep coming in to the helpline, which is great, unless you miss that all important, high risk one amidst all the minor issues. How do you avoid that problem? In this podcast, Mia Reini, Senior Manager-Corporate Compliance and Enterprise Risk Management at The Home Depot and Monica Lopez Reinmiller, Managing Corporate Counsel-Legal Affairs, Compliance at T-Mobile provide some intriguing answers.

Mia reveals that Home Depot has made a bot a part of its compliance team. Working with IT they developed software which scans helpline calls in real time, looking for buzzwords that correlate with high-risk incidents. If it finds them, they go straight to corporate compliance for review.

Launched in December 2020, the bot averages several cases a day by looking for terms such as SOX, FCPA, DOT, EPA and hazmat.

For the compliance team it’s proven invaluable since it is always at work, including on nights and weekends. But, they warn, vigilance is still required. Like all software, sometimes the bot goes down.

Of course, not every organization can have a bot, and for those, Mia and Monica advocate a risk-based approach. That includes watching out for terms that a bot might, but also having someone with the requisite skills to triage the calls and flag those needing an escalated response to the board or requiring an attorney to oversee the investigation.

Both Mia and Monica also argue for a root cause analysis as part of the investigation. The US Department of Justice has been encouraging them, but that’s not the only reason they are valuable. They can help in fostering a programmatic, preventative approach to compliance that is more disciplined.

And speaking of discipline, pushing for organizational justice, they explain, is key.

It is all a part of an active approach to managing employee helplines that helps foster a healthy compliance program.

Post By: Adam Turteltaub

As if Stark Law and the Anti-Kickback Statute aren’t complicated enough, they can also lead to False Claims Act issues, explains Charles Oppenheim, Partner at the law firm of Hopper, Lundy & Bookman and author of the chapter “The Stark Law and Anti-Kickback Statute as FCA Risks” in the new HCCA book False Claims in Healthcare.

In the case of Stark Law, where there is strict liability, something as simple as faulty paperwork can be highly problematic. If the documents don’t match up, no matter how innocent the mistake, an entity is prohibited from billing for services. And, when it comes to the Anti-Kickback Statute, the law is intent-based. So even if the remuneration is fair market value, corrupt intent can have drastic consequences.

To prevent issues from occurring, and effectively remediate them should they occur, he offers several recommendations in this podcast. First, have well-designed policies and procedures when it comes to entering into new relationships, including policies for when not to enter into a relationship. Second, document how fair market value is determined, how you entered into the relationship and alternatives considered.

Should a potential violation be identified, bring in experts who understand the subtleties of these very complex laws. And, he notes, don’t despair. It is quite possible that the relationship falls into an exception. For example, CMS has proven more flexible of late in its documentation requirements.

Should you need to make a disclosure, consider the Self-Referral Disclosure Protocol (SRDP). It can take some time, but the outcomes can be more positive than many think.

Finally, he advises healthcare entities to remember that we will one day come to the end of this pandemic emergency. During this crisis CMS issued a narrow waiver on Stark Law that many took advantage of while medical practices were in deep financial troubles. It’s important to document what you did and be prepared for the end of the emergency and, quite possibly, the end of the waivers.

To learn more, listen in to this podcast, and check out our new publication False Claims in Healthcare.

Post By: Adam Turteltaub

There are a lot of skills that compliance professionals need – communication, persuasion, negotiation, patience, and even legal – and now Lisa Beth Lentini Walker, CEO and Founder of Lumen Worldwide Endeavors and Stef Tschida, Founder, Tschida Communications, are suggesting another: organizational scholarship.

The co-authors of the book Raise Your Game, Not Your Voice suggest in this podcast that, to be effective in their roles, compliance professionals need to be skilled at navigating the organization. To do that requires a deep understanding of the organization.

They advocate for taking the time to understand the company’s strategy and culture. Consume as much information about the company as possible: the website, publicly filed documents, earnings calls, even what the marketing people are saying on social media. Is the company just sending out messages, or is it engaged in a dialogue?

Also, look to what others are saying on sites such as Glassdoor. Are people saying good or bad things?

If you are new to the organization, they recommend having a plan for your first quarter there to quickly build your knowledge base. Connect with key people, understand what the key relationships are, and what drives behavior.

Then, look beyond the walls of the organization to understand what is going on in the industry as a whole to better understand what are the key forces, what may happen next and how your company compares to its peers. And be sure to set alerts for news about competitors, as well. A crisis in one could provide clues for what to watch out for in your own organization.

Finally, take the time to learn how compliance is perceived. You only get permission to speak, they explain, when you first take the time to listen. If the business people know that your ears are open and that you are sensitive to their needs, they are much more likely to pay attention to what you have to say.

Post By: Adam Turteltaub

As the compliance profession matures an increasing number of professionals in the industry are thinking about going out on their own and setting up a consulting firm. In this podcast we learn from three people who did just that and are willing to share their wisdom and experience:

* Kristy Grant-Hart, Spark Compliance Consulting

* Kirsten Liston, Rethink Compliance

* Joe Murphy (LinkedIn), Compliance Strategists and one of the founders of Integrity Interactive

Recently they wrote the book The Compliance Entrepreneur’s Handbook, and in this podcast they share insight into what they call the four corners approach to determining what the sweet spot is for your business. It’s difficult to be all things to all people, especially when first starting out. By looking at the four corners, they believe, you can narrow your focus to where you bring the most value to the market.

The corners are:

Function

Rather than focusing on all elements of a compliance program, you can narrow your focus to those areas you have the most expertise in. That helps you become known for bringing in certain pieces of the puzzle.

Risk Area

Privacy, anti-corruption, antitrust, and Stark Law are just a few of the areas that can be ripe for building a business around.

Geographic Region

Do you want to serve a city, state, region or work globally? Think about where the market is and isn’t saturated. Ask yourself how much you want to travel. An international client base can be very enticing, but it means many days away from home, calls at strange hours of the day and night, and much jetlag.

Industry

Choosing industries to focus on can be a tug of war. You want to leverage your expertise in a given industry or two, but you don’t want to set your sights so narrow that there are too few opportunities available.

In sum, it’s a complex calculus when it comes to going out on your own, but it doesn’t have to be overwhelming. It also takes great persistence and a strong network to get your business off the ground.

And one final piece of advice you will hear in this podcast: don’t forget it’s a business, with all the issues that brings.

Listen in to learn more and help you decide how to start your own compliance business, or whether you are better off staying right where you are.

Post By: Adam Turteltaub

Much has changed in the world of compliance, especially of late, but when it comes to healthcare investigations, not all should, says Pamela Para (LinkedIn) RN, MPH, CPHRM, ARM, DFASHRM, President and Chief Content Officer at CE Companion. According to Pamela the historical approach still works. And, interestingly enough, she notes that it relies heavily on several nursing techniques developed by Florence Nightingale, herself:  assessment, diagnosing, planning, implementing monitoring and evaluation.

In the podcast she lays out three P’s for investigation (and a few additional little “p’s” too):

Policies: Be sure to match up your policies, procedures and protocols with national standards of practice and regulatory requirements. Then make sure you are doing them in practice.

Paper: Documentation is critical.  Document your finding for the record and any corrective actions taken.

People: Get the right people involved in the investigation, and be sure to have a methodology for gathering them. Who will be on the team will vary depending o the type of investigation. And don’t forget to go back to the previous “P” and document your selection process.

Listen in to learn more about how to improve the effectiveness of your healthcare investigations, including how the investigatory process can and should be a part of the enterprise risk management and strategic plans.