10 Essential Strategies For Healthcare Companies To Prepare For And Respond To Government Investigations

Previously published in Corporate Compliance Insights.

For companies operating in the healthcare industry today, it is not a question of if, but when, they will face a government inquiry. Complex regulations, the rising costs of healthcare programs as part of the federal budget and ever-increasing enforcement resources have combined to increase the number of healthcare investigations and enforcement actions.

There are, however, ways for healthcare providers to reduce their risks. The 10 strategies discussed below can help healthcare providers avoid the violations that result in government inquiries, effectively respond to those inquiries when they arise, and resolve resulting conflicts in the most favorable way possible.

1. Assess the Risks Actually Faced by the Company

   While the best way to avoid a government investigation is to prevent legal and regulatory violations, this is not always possible. Given the myriad laws and regulations governing healthcare providers, it is likely that a violation will occur at some point. This likelihood requires companies to have a way to detect and address violations in their infancy.

   The best practice is to implement a corporate compliance program aimed at educating employees about relevant legal guidelines and applicable company policies, while encouraging and providing guidance about reporting compliance concerns.

   The particulars of a corporate compliance program will vary depending on company size, the breadth of its operations and healthcare sector in which it operates. However, every program should begin with a thorough and candid risk assessment. This must be carried out in a manner that allows the healthcare provider to identify the who, what, where, when and how of the intersections between the company's activities and applicable guidelines.

   Skipping the assessment stage of the process often results in a shotgun approach to compliance initiatives. Worse yet, some providers simply adopt "cookie cutter" compliance programs – an approach that is not only ineffective but harmful.

   Government investigators will review the company's compliance program early in the investigation. A "cut and paste" program – adopted without regard for the provider's particular structure and operations – is unlikely to reflect a genuine commitment to compliance. Rather, investigators will view such a program as little more than window dressing.

   To avoid this problem, providers must tailor their compliance programs to their...