Healthcare organizations have shifted their anti-fraud compliance efforts from simply avoiding enforcement authorities to making fundamental changes in the way they do business, said Health Care Compliance Association President Brent Saunders.
The nature and focus of hospital compliance programs have evolved, said Saunders in an interview at the HCCA's annual convention in Chicago in October.
Regarding the future role of compliance in healthcare organizations, Saunders asked, "We put out the fire, now what do we do? I think the answer is we use compliance as a vehicle for change."
Compliance shouldn't be limited to preventing investigations and ensuring compliance with healthcare laws; it can also be used as a management tool to improve business operations.
Saunders said two years ago he would have predicted that the compliance profession would eventually be stamped with an expiration date: Once everyone had a program up and running, compliance officers would work themselves out of jobs.
"Now it's being viewed as a sound business investment," he said. "Compliance has brought training and respect to coders, for example, who were often considered the poor stepchildren of hospitals. Now hospitals (with good compliance programs) are seeing savings reaped from (proper coding). There are solid business benefits to compliance. We need to quantify and demonstrate those benefits and identify efficiencies and savings to our boards."
Saunders said healthcare compliance has become a corporate religion, as these facts show:
* Compliance is a $600 million to $700 million per year industry.
* HCCA membership has grown to 1,700 from two in 1996.
* The average annual compliance budget is $313,000.
* The percentage of companies staffing corporate compliance officers increased from 91% in 1998 to 96% this year.
An HCCA member survey also found that compliance officer salaries ranged from $50,000 to more than $300,000, depending on the size of the organization and the individual's experience. The average was $94,000.
James Sheehan, who heads the civil division of the U.S. attorney's office in Philadelphia, said having an integrated compliance program inoculates an organization against internal whistleblowers and helps prevent fraud.
"Ten years ago you'd look at hospitals, and it was hard to tell who the good guys and bad guys were," he said. "With the growth of compliance efforts, it's getting a lot easier to tell the good guys from the bad. The bad guys are now outstanding in their field."