Breaking Compliance News Blog

What’s worse: a bad policy, or no policy?

Posted by Margaret Scavotto, JD, CHC on 7/13/21 9:15 AM

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The CEO of a group of pain clinics was sentenced to 15 years in prison for his role in a $150 million health care fraud scheme. He was also ordered to pay $51 million in restitution. 

What happened

The Department of Justice reported that the CEO’s crime was “developing and approving a corporate policy to administer unnecessary back injections to patients in exchange for prescriptions of over 6.6 million doses of medically unnecessary opioids.” For some patients, these injections increased their pain.

What does your policy say?

We can all agree this is a bad policy. A policy that requires administering medically unnecessary drugs, that results in fraudulent billing, that is overtly illegal, and that causes patient harm, is definitely bad. I love it when compliance is easy!

Fortunately, most providers don’t have bad policies – or at least not policies that are illegal-bad.

What do you have? A good policy? Or… no policy?

What’s worse – a bad policy or no policy? I think it’s a tie.

Here’s an example. One of the FAQ’s that comes across MPA’s desks relates to vendor gifts. Healthcare clients often call us with scenarios involving a gift, event, or perk offered by a vendor, and their question is: What do we do? Can we accept the Yeti mugs offered by the ambulance company during nurses’ week? What about the expensive meal brought in by the pharmacy?

I always answer their question with a question: “What does your gifts policy say?”

The gifts policy will hold the answer. Ideally, the gifts policy aligns with OIG guidance about beneficiary inducements, and has bright-line guidance, such as: “We do not accept vendor gifts,” We only accept vendor gifts valued at no more than $___,” and/or “all vendor gifts require prior approval by the Compliance Officer.”

A gifts policy like that should provide an answer to most if not all vendor gifts questions.

What if there’s no policy?

Sure, you can call me, or someone else, and ask for guidance. But what about everyone else in your organization? If there’s not a policy on vendor gifts, there’s probably not training on vendor gifts. Which means employees are unguided. Without guidance, employees are far less likely to know that vendor gifts can be problematic. It’s hard enough to turn over a Yeti mug when you DO know it’s a compliance issue. But how likely is someone to turn in that Yeti mug when they DON’T know it’s a compliance issue?

Policies lead to training. Training leads to awareness. Awareness helps you identify compliance problems and fix them.

In other words, NO policy can be just as risky as a bad policy.

Do you have a to-do list that includes policies that need to be put into place? As providers move into a new stage of the pandemic, and many are able to increase their attention to compliance, now is the time to revisit your policies – and replace the missing policies with good ones.


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Topics: compliance

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