In a pattern familiar to U.S. healthcare providers, a number of foreign governments are trying to crack down on fraud -- and they are considering U.S.-style corporate compliance programs as a way to help.
U.S. healthcare companies operating overseas should help their host countries develop national compliance programs, says L. Stephen Vincze, president of Vincze & Frazier, an Atlanta-based law firm specializing in compliance issues.
"In doing so, international healthcare organizations will, in substance and in form, be partnering with government efforts to defeat a common enemy -- fraud and abuse," Vincze told a healthcare compliance conference in Washington in March.
Foreign firms increasingly are using compliance programs in industries such as manufacturing, but their use in healthcare has lagged behind, says Christina Brecto, executive director of the Alexandria, Va.-based Council of Ethical Organizations, which represents Fortune 500 companies.
"Countries in Europe and Asia have been slow, but that is going to change," Brecto says. "Even in Japan, where politics and business have been linked, things are beginning to change."
Alan Yuspeh, senior vice president of ethics, compliance and corporate responsibility for Columbia/HCA Healthcare Corp., says he has not begun working on compliance programs for the Nashville-based company's half-dozen foreign hospitals.
"But most people who are knowledgeable about these things think many of the challenges of the future are in foreign countries," Yuspeh says.
There is no doubt that foreign markets offer huge opportunities to many sectors of the healthcare industry. According to U.S. government estimates, healthcare spending will top $3 trillion by 2000 in the world's developed countries.
But with the opportunities come great risks. When dealing with foreign countries, ethics issues are not always clear-cut, Vincze said at the conference.
"The whole notion of compliance and ethics is fraught with pitfalls when you attempt to move to other countries," Vincze said. "People in foreign countries aren't sure this stuff really works. You have to be able to show empirically that compliance programs result in reduced costs."
The key is to get companies and foreign officials to "look at it not only from an ethical standpoint but also from a pragmatic business standpoint," he added.
Vincze has created a model international compliance program he said can be customized to fit each country's system. It is based on the compliance model HHS' inspector general's office gave U.S. hospitals earlier this year (See chart above).
Strong fraud controls decrease costs and in turn reduce the size of the black market over which companies and officials have little or no control. Better fraud control also gives foreign investors confidence that the market is safe.
One thing spurring countries to change is a move toward American-style healthcare reimbursement systems. According to a recent study, a half-dozen countries are looking at some form of reimbursement similar to diagnosis-related groups in the U.S.
"The significance of this finding is that a compliance program for medical billing that is designed in the U.S. should be applicable in a global context," Vincze said.