Health system audit and compliance committees will want to review the new compliance program guidance recently issued by the Fraud Section of the Department of Justice (DOJ). While not specific to the health industry, it nevertheless provides a practical set of benchmarks against which the audit and compliance committees, in consultation with the general counsel and the chief compliance officer, can evaluate the effectiveness of the health system’s compliance program.
The Guidance is presented in the form of a series of substantive compliance-focused questions that the DOJ frequently considers when evaluating a corporate compliance program. Questions particularly relevant to health care organizations include those that focus on the conduct of senior and middle management; the internal stature of the compliance function; the autonomy of the compliance function; program funding and resources; corporate response to expressed compliance concerns; the process for responding to investigative findings; consistency of disciplinary measures; and periodic updating of procedures and practices. Important questions focus on the board’s exercise of its compliance oversight duties—including whether relevant expertise is available on the board, and how compliance-related information is provided to the board.
The release of this Guidance is a significant development in terms of assuring the most effective corporate compliance plan possible. It is directly relevant to the fiduciary obligations of the board’s audit and compliance committee; to which the health system general counsel, in consultation with the compliance officer, may provide a briefing.