3 Compliance Excuses That Will Haunt You

Halloween is just around the corner. So, in light of the spookiest of holidays, one of our copywriters has taken a stab (ha!) at this blog post to add some holiday fun to our expert’s original, and otherwise respectable, thought leadership piece. The normal version will be available immediately following the holiday. Enjoy! And remember, it’s in light of halloween.

In my twenty years of professional work in the healthcare compliance field, I’ve heard some terrifying things when it comes to compliance excuses. Some, just short of, “a goblin ate my homework,” like when we were kids (except maybe replace “goblin,” with “dog,” unless you were raised in the Upside Down). And I understand it to some extent, it’s how many avoid perceived problems. Although, compliance is about prevention, and working together as a team. As a compliance officer, I’m not here to scare anyone or get my coworkers in trouble. Still, some of the excuses I hear, well, they’re pretty horrific. As a compliance professional, I’m sure you’ve heard plenty of scary excuses of your own.

3 Compliance Excuses That Will Haunt You

1. “Let’s just correct the problem moving forward, we don’t really need to go back and return money.”

Wait, come again? Sigh. NO! We get it, nobody likes to give back money. But in the case of overpayments, it’s not your money. You’re giving back money that’s not actually your money. Also, the logic is just unbelievable. It’s like the Headless Horseman showing up in court, “maybe, I’ve slayed a few people, but I promise, no more throwing jack-o-lanterns moving forward.” It’s highly unlikely that the judge is going to say, “Great news! Enjoy your life, pumpkin head.” That guy will get prosecuted, and you might, too.

“Correcting from now on,” is a terrible attitude to have when it comes to overpayments, but I’ve heard this from senior level management leaders. The whole purpose of a compliance program is to prevent or detect and correct noncompliance. This includes billing and payment issues. If your organization has failed to prevent improper billing, then it must return funds that have been identified as overpaid.

Recent enforcement in this area has highlighted the importance of performing due-diligence on past claims or overpayments when an error has been identified. The 60-day overpayment rule requires this to be done promptly or the overpayments could be found to be false claims (i.e., the so-called, “reverse false claims,” provisions).

2. “Nobody is going to break the law. We only hire honest people.”

Every time a serial killer gets caught the neighbors say, “but he was such a nice, charming, guy!” Sure, you might be amazing when it comes to hiring, and you probably haven’t hired any psychopaths, but you still need a compliance program. Also, really great people can make mistakes. The complex healthcare industry is highly regulated and non-compliance may occur because uninformed individuals are focused on patient care or other very important services. Wrongdoing isn’t always conscious. Investing in a compliance program may seem costly, and it can be. But, no doubt, every company and executive that has settled non-compliance issues for millions of dollars wishes they could go back in time to invest just a fraction of that settlement amount into a compliance program and prevention.

3. “We’ve always done it this way and haven’t gotten into trouble.”

Ah, well, continue on my friend. Wait, No, this is a terrible idea. Just because you’re getting away with something, doesn’t mean it’s okay. Vampires have (according to hollywood) always preyed on villagers. Totally doesn’t make it okay to go around hypnotizing the townspeople. As a compliance officer, this is the worst excuse I hear because if your process is non-compliant, and you’ve “always done it this way,” you might be facing some significant payback issues or other ramifications given the longevity of the problem. Don’t wait until it’s too late. The whole thing gives me nightmares.

More Horror Stories, You Say?

Enjoying Compliance horrors? Download our free eBrief, "10 Compliance Horror Stories," for the full list of compliance stories that will horrify you.

Share Your Own Compliance Horror Story

Have you heard your fair share of compliance excuses? We’d love to hear them!

Put your stories in the comments section below (anonymously if you choose, doesn’t need to be related to halloween) and have some fun with your fellow compliance officers. At the end of the year, we’ll be compiling our favorite stories for a hilarious and informative compliance guide.