Compliance Manager in the Healthcare Industry Term Paper

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Compliance Manager


Compliance Manager in the Healthcare Industry

Job Description

The Compliance Manager oversees compliance throughout the healthcare company as an objective and independent function (ACHE, 2012). He makes sure that the board of directors, the management and all the employees thoroughly comply with the rules and regulations of regulatory agencies; that the company policies and procedures are completely followed; and the behavior in the organization follows its standards of conduct. His office receives and endorses compliance matters and issues to the appropriate person or office for investigation and implementation or resolution. It is also the final internal resource to deal with when all formal channels and resources have been exhausted. The Compliance Manager or Officer is a member of the staff of the CEO and the Board of Trustee's Corporate Compliance Committee. He monitors and reports the results of the compliance actions and provides guidance and background information to the Board and senior management on all compliance matters, issues and situations. He and the Corporate Compliance Committee are authorized to pursue all necessary actions in fulfilling the effective implementation of the compliance program of the company (ACHE).

Duties and Responsibilities

In accomplishing the objectives of his position, the Compliance Manager or Officer performs clear-cut duties and responsibilities. He develops and initiates policies and operational procedures for a healthcare compliance program to avoid illegal, unethical or improper conduct inside and outside the organization (ACHE, 2012; Scrofano, 2012). He manages the day-to-day implementation of this program, maintains and updates it on a regular basis in coordination with the human resource or personnel department. He develops, reviews and updates the organization's standards of conduct in order to keep them current and relevant in guiding management and employees. He coordinates and collaborates with the other departments in the investigation and resolution of compliance matters and issues. He consults with the company's legal counsel or attorney in the resolution of legal issues involving compliance. He acts on violations of these rules, regulations, policies, procedures and the organization's standards of conduct. He does this by evaluating the procedures or recommending investigation. He performs an independent review and evaluation of these rules and regulations, procedures and standards of conduct, focusing on issues and concerns. In doing so, he identifies vulnerable aspects and probable compliance risks and then acts proactively by instituting preventive action. If the problem aspects or issues already exist, he devises and implements corrective action. He regularly reports to the Corporate Compliance Committee of the Board and the senior management on the status of compliance in the organization. He furthermore makes sure that both actual and potential violations are reported to the duly authorized enforcement agencies (ACHE, Scrofano).

Legal and Regulatory Tasks

The Compliance Manager's comprehensive responsibility for regulatory compliance is to make sure the company or organization complies correctly and promptly with relevant federal regulations on healthcare (Scrofano, 2012). The simple objective is to avoid potential liabilities and avoid penalties, sanctions and other legal punishments. This is why he coordinates with the pertinent departments in the organization in creating and implementing organizational policies, standards and procedures, which will comply with inside and outside regulations. He also imposes standards through disciplinary policies in insuring the company's compliance of government regulations and their maintenance. Finally, the Compliance Manager establishes and maintains communication lines with decision-makers and stakeholders in keeping all involved parties informed about changes in regulations (Scrofano).

Issues and Challenges in Healthcare

The most important among these are medical malpractice suits (Lister, 2012). The Compliance Manager develops strategies, which should limit the possibilities of such lawsuits. Compliance strategies include hiring only the most qualified who will observe the most adequate safety protocols in the hospital. He creates plans to reduce medical errors to the barest minimum (Lister).

Another is patient safety (Lister, 2012). Patient mortality happens in every hospital or emergency medical facility. The Compliance Manager works to limit patient mortality rate to the barest minimum possible and to confine such cases where the medical staff will not become medically liable. He does this by creating patient safety protocols. These include informed consent for medical procedures and triage criteria for treatment, which establish medical priority and provide that the sickest patients receive treatment first (Lister).

The Harvard University Medical School suggested the establishment of criteria for the hiring of medical personnel in order to reduce risks in healthcare (Lister, 2012). This is to respond to the challenge and issue of medical staff hiring. Doctors, nurses and other medical staff members should be properly credentialed and licensed. This reduces the risk of medical errors from a lack of qualification. The company should not hire medical professionals with a high rate of medical malpractice claims. A credential manager who can perform extensive license screening and credential research on health professional applicants will be a sound risk strategy (Lister).

Considering high-risk areas is another issue and challenge to the Compliance Manager (Lister, 2012). The Harvard University Medical School says that 62% of all malpractice claims are concentrated in four high-risk areas, such as surgery, obstetrics, diagnosis and medication. The Compliance Manager installs strategies, which limit risks in the specific areas. Medical personnel in operating rooms should make sure these are completely clean. Only surgeons with strict safety ratings should be allowed to perform the procedure. He may also set up software that actively monitors patient medications and potentially harmful interactions will likewise prevent or reduce errors in delivering or administering medications (Lister).

Reporting Responsibilities

Internal Reporting

Within the company or organization, the Compliance Manager maintains reporting relationships with specific departments. He develops, initiates, implements and updates operational procedures in cooperation with the Human Resource Department (ACHE, 2012; Scrofano, 2012). He taps the cooperation of other departments in the investigation and resolution of compliance matters and issues affecting these departments and sends them progress reports. He consults and coordinates with the company's legal department or attorney in resolving legal issues involved in compliance. He regularly submits status reports to the Corporate Compliance Committee of the Board and to the senior management on the compliance situation of the organization. In cases of violations, he likewise report on both actual and potential violations to the authorized enforcement agencies (ACHE, Scrofano).

The Compliance Manager also sends reports to the Internal Auditor (Ruppert, 2006). They share similar responsibilities. Both conduct risk assessment and set risk levels; understand relevant laws and regulations; secure or identify policies for specific issues or areas; educate the organization on these policies and regulations; monitor compliance with laws, rules, regulations and policies; audit high-risk areas; and re-educate the organization on regulations and issues. If their positions are separate, the Compliance Manager's reporting relationships include the organization's board through an audit or Compliance Committee; a Board-approved program or charter authority; the organization's CEO; the entire organization, especially Compliance and internal audit professionals (Ruppert).

External Reporting

The Compliance Manager is in charge of filing certain forms and shelf registrations with the SEC (New Scientist, 2012). He also researches on, implements new accounting standards required and periodically seeks answers to technical accounting on a global sphere. The SEC documents are financial statements, which are useful for management review. He also represents the company to all regulatory authorities and fulfills all their regulatory requirements. These include disclosure documents, coordinated findings on the company's internal audits. Additionally, he facilitates external audits by regulatory agencies (New Scientist).

Ethical Issues

Many of these issues confront healthcare workers and the Compliance Manager,

depending on the specific area of the industry (Thibodeaux, 2012). Examples are a practicing doctor's dilemma about euthanasia, a health insurance agent assessing claims, conflicts of interest, distortion of medical facts, exorbitant or inconsistent billing, poor privacy, security of patient records and information and compliance with local, state and federal health regulations. Current solutions include legislation, education and stressing the guiding principle of healthcare ethics. Legislation reveals the ethical conditions occurring in the healthcare industry. An example is the Health Insurance Portability and Accountability Act of 1996. Education allows healthcare employers to offer training courses to explain ethical issues they may encounter. Penalties can be very severe for non-compliance. A worker may be suspended, fined, lose his medical license or be sued in court. The penalty depends on whether the worker violates his company's ethics policy or ethics legislation. The guiding principle of the industry is the Hippocratic Oath. It caters to the ideal that harm should not be done on another person. Some see euthanasia as merciful rather than harmful as it terminates the other person's experience of terminal or incurable pain. Others see it as harmful or evil because it terminates human life (Thibodeaux).

Career Outlook

The 2008 Bureau of Labor Statistics projected the job growth in this field to grow at an average page from 2008 to 2018 (Scrofano, 2012). It saw laws and regulations as continuing to increase and rendering it more relevant than before. But it also saw competition for this type of jobs as turning intense but for the legal practitioners (Scrofano).

Currently, the position…[continue]

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