DOJ New Rules: Stop Violations, Finance Your Compliance Plan

With so many improvement areas competing for resources, a sufficiently financed and living breathing compliance plan has not been high on your priority list. But new guidance released June 1 from the Department of Justice (DOJ) that determines penalties based on these added requirements means you must update your compliance program now to avoid massive fines or criminal charges.

Including new language to make sure your compliance program is dynamic and adequately resourced, The recently updated Evaluation of Corporate Compliance Programs gives judges and prosecutors specific factors to review to determine penalties. So, if your practice ever gets cited for a compliance violation, your penalty amount will be based on how well you have implemented—or not implemented—compliance in your daily operations.

Use the following questions to evaluate and modify your practice’s compliance program so you can be sure to show your practice’s commitment to compliance and integrity, should you ever face a charge.

Is the Program Adequately Resourced and Empowered?

This update modified the question to include the language “adequately resourced and empowered to function effectively” because even the best compliance program can fail if not provided with proper resources or empowered to make change. Your compliance program shouldn’t merely be on paper, it should be effectively implemented, reviewed, and revised as necessary, and your employees should be educated about the compliance program and aware that criminal conduct won’t be tolerated.

To evaluate if your compliance program is adequately resourced and empowered to function effectively based on this new guidance, ask yourself these questions:

Empowerment: Do individuals who oversee the day-to-day compliance operations have adequate resources, appropriate authority, and direct access to the governing authority at your practice?
Development: How do you invest in further training and development for your compliance personnel?
Data Access: Do compliance and control personnel have enough access to relevant sources of data to allow for timely and effective monitoring and or testing of policies, controls, and transactions?
Data Limitations: Do any impediments exist that limit access to relevant sources of data and, if so, what are you doing to address the impediments?

Is the Corporation’s Compliance Program Well Designed?

The DOJ will examine how effective you are at preventing and detecting wrongdoing, and if your compliance program sends a clear message to employees that misconduct is not tolerated. Management staff should be enforcing the program, not encouraging or pressuring employees to engage in misconduct.

New in this updated guidance, the DOJ wants to know:

Risk Assessment: Is the periodic review of your risk assessment limited to a “snapshot” in time or based upon continuous access to operational data and information across functions?
Lessons Learned: Do you have a process for tracking and incorporating into your periodic risk assessment lessons learned from your own issues or from another company in the same industry or geographical region?
Policy Updates: Has the periodic review led to updates in policies, procedures, and controls?
Policy Publishing: Have your policies and procedures been published in a searchable format for easy reference?
FAQ Protocol: When training for your compliance program, whether online or in person, is there a process by which employees can ask questions relevant to the training?
Hotline Effectiveness: Are employees are aware of your confidential reporting hotline, and do they feel comfortable using it? Do you periodically test the effectiveness of the hotline, for example, by tracking a report from start to finish?

Source: DOJ Evaluation of Compliance Programs June 2020 Update

You likely need practical strategies to put in place a living breathing, fully-funded compliance plan that will meet prosecutors and judges’ increased expectations. Get step-by-step advice to better demonstrate your practice’s commitment to integrity during the expert-led online training “Implement New DOJ Compliance Rules to Avoid Massive Penalties,” by healthcare attorney, Jeana Singleton, JD. She’ll help you improve your operations to avoid massive compliance violation penalties.