OIG resource guide on compliance program effectiveness

In March of this year, the OIG posted a Resource Guide that included ideas about compliance programs, not a “checklist” to assess a compliance program. It was generated to provide as many ideas as possible, while being broad enough to assist any type of organization and permit each to choose which ones best suit its needs. Some ideas may not apply to some entities. The Guide provides ideas from which an organization may choose a small number in any given year. The Guide does not follow the OIG compliance guidance documents in detail, except that it addresses the seven standard elements. As such, many items listed cannot be found or tracked. This list provides ideas for measurement options to a wide range of organizations with diverse size, operational complexity, industry sectors, resources, and compliance programs.

Using all the ideas or even a large number of these was deemed impractical and is not recommended. The OIG notes that how the list in the guide can be used depends on those using it. Some of these suggestions might be used frequently and others only occasionally. The frequency of use of any measurement should be based on the organization’s risk areas, size, resources, industry segment, etc. Each organization’s compliance program and effectiveness measurement process will be different. The following compliance program elements were addressed by the participants in work groups over a series of sessions:

1. Standards, Policies, and Procedures;
2. Compliance Program Administration;
3. Screening and Evaluation of Employees, Physicians, Vendors and Other Agents;
4. Communication, Education, and Training on Compliance Issues;
5. Monitoring, Auditing, and Internal Reporting Systems;
6. Discipline for Non‐Compliance; and
7. Investigations and Remedial Measures.

It is worthwhile remembering that effectiveness is related to “outcome,” not output.   For example, having compliance training for all covered employees is a process outcome metric. How well the participants learned the lessons and retained them is a factor of outcome or effectiveness of the training. When reviewing the lists provided in the Guide, remember most of the items relate to process. Another important factor to consider is how determinations relating to items on the listing will be made, and by whom.