[Podcast] Post-COVID-19 Compliance and Value

The delicate art of the paper trail: Most compliance officers know it well. Because when the OIG starts sniffing around, negotiations begin for a corporate integrity agreement, or when there is an acquisition or a merger, the documentation proving an effort to maintain compliance (or lack thereof) can make or break it all. In our most recent episode of Compliance Conversations with host CJ Wolf MD, Wolf sat down with Nick Merkin JD to talk about value, proof, and living in a post-COVID-19 compliance world.

“And instead of the compliance function being just a cost for a healthcare organization, I think this will hopefully be gratifying to hear from a lot of your listeners who might be compliance officers, but it is also really a way to increase your value.” Said, Merkin.

Nick Merkin is the Chief Executive Officer of Compliagent. He serves as a fractional or interim compliance officer for organizations experiencing rapid growth, enforcement challenges, or in the process of merger and acquisition. Nick also advises healthcare organizations in connection with the creation and implementation of their compliance programs and infrastructure.

“Compliance officers are seen as the police force in the organization, and I think that’s never what we want to hear. [But] it really is part of the role, and sometimes I’ve told people, “Hey, you squeeze the bad guy, throw me under the bus, say that this is coming from the compliance officer.” Having somebody like that can be really valuable to an organization. But when compliance works, I think it’s when we do our job best by being collaborative.”

Listen to our most recent episode of “Compliance Conversations: Living in a Post-COVID-19 Compliance World” with CJ Wolf MD and Nick Merkin JD on your daily commute to learn:

• • How a compliance program (and proof of efforts) can increase your value.
  • The importance of a detailed compliance efforts paper trail.
  • A glimpse into post-COVID-19 compliance challenges.
    
    

Episode Transcript

CJ: Welcome everybody to another episode of Compliance Conversations. I am CJ Wolf with Healthicity, and today I have a good colleague and friend Nick Merkin with us. Welcome Nick.

Nick: Hey thanks CJ, thanks for having me on.

CJ: You know Nick, I appreciate you coming back on. I was looking through our past podcasts, and you were like one of our very first guests when we started this over five or six years ago. Something crazy like that.

Nick: Wow, was it really that long ago? I didn’t even know that podcasts were invented that long ago.

CJ: I know. Yeah, I think it was almost five years ago and I think you were episode number five. I’m so glad that you’re willing to come back and talk to us some more.

Nick: Alright, well, thanks again for having me on and yeah, I’m happy to talk.

CJ: You know, Nick, we usually like to have our guests introduce themselves a little bit, tell us how you got involved in compliance, maybe give a little bit of your background and then we’ll jump into more specific questions about our topic today.

Question: We’d love to hear a little bit about you and what you’re doing?

Nick: Sure, in terms of my background, I’m really a healthcare lawyer by background. I started off my career more on the litigation side, defending government investigations and different lawsuits for healthcare organizations. Around the time, maybe we’re getting around 10, 11 years ago, around the time the Affordable Care Act started rolling out. We recognized a partner, and I recognized a need for sort of more proactive compliance program building. We were seeing clients come to us and saying there are more affirmative requirements to build out organizational compliance plans and have compliance infrastructure and really engage in the process of compliance that has really evolved and matured over the last ten years or so. We saw this as an opportunity and formed a consulting firm. We included in that firm a lot of different kinds of healthcare professionals, people with facility management experience, a number of nurses and clinicians, and we’ve grown a lot.

A lot of what we do today is work enroll which is like a fractional or interim compliance officer for organizations. One thing that is interesting to me is that when we first started doing this, five, six, seven, eight years ago, a lot of the work we did was a result of enforcement. We’d get a call from a colleague of mine who was defending some kind of compliance investigation or action against a healthcare provider, and they would say, “Ok, as a part of our negotiation, we’re negotiating a CIA (Corporate Integrity Agreement), a Corporate Integrity Agreement, or we’re going to sit down with the Department of Justice and try to negotiate a settlement; and one thing we’d try to show them is that we’re really proactively recognizing that there is some kind of deficiency here and we’re getting our compliance program together. We’ve got our policies and procedures in place. We’re starting an education and training regimen over the course of the year. We’re starting internal audits and monitoring, and we have a hotline set up now.” All sorts of things like that.

That was good work, but what is interesting to me, and in a way really gratifying, is what I see in the compliance world from a lot of our incoming clients. I’m getting calls from bankers, from venture capital funds, from private equity groups, or even just facility owners, different kinds of facility owners, be they a hospital, it could be addiction treatment, it could be skilled nursing, it could be things like autism and audiology. They’re saying, “Hey, I just talked to my banker and we’re either looking to be acquired, or we’re looking to acquire other organizations, and my banker says we need to lay this paper trail of compliance, can you help us with that? We have a one-year time horizon, or a two-year time horizon, or a three-year time horizon.”   And instead of the compliance function being just a cost for a healthcare organization, I think this will hopefully to be gratifying to hear by a lot of your listeners who might be compliance officers, but it is also really a way to increase your value. Because during due diligence, what the lawyers or the bankers or whomever, is going to be looking for is let me look at your incident log from the past couple of years. Have you had any government investigations and how did you deal with them? Have you had HIPPA breaches, how did you address them? Are there lingering liabilities that we may have to account for in the transaction, or that might even make us walk away from the transaction? If we see a balance sheet with revenue, is that righteous revenue, so to speak? Is that revenue coming from potential kickback violations, or Stark Law violations, or something like that? Or even False Claims Act violations? Or is that clean revenue, for lack of a better word, that has really come from quality delivery of healthcare? And that has made my day to day life, both from a perspective of new clients coming it, but also in terms of the work that we do, a lot more fun and really a feeling that, hey we are a part of the team, and compliance is not only something like an insurance policy or a way to mitigate risk, which it is, and that is certainly important, but it is also a way to increase value. I think that is very fulfilling for those of us in the compliance field.

CJ: You know I’m glad you brought that up. I have seen that, and I think you’re spot on that historically it was more reaction. Someone is getting investigated, DOJ (Department of Justice), or OIG (Office of Inspector General), and now it’s more of, “we need to get our house in order and make sure we’re clean and good.” And I’ve even seen that as well. It is an interesting kind of transition that has been happening. I think that’s really interesting.

Question: Tell us, the firm’s name that you lead is Compliagent. Is that right?

Nick: That’s right. To say a little bit about it: as I mentioned we really have a mix of different kinds of healthcare experience that can be brought to bear on compliance problems, compliance challenges, building out and maintaining compliance programs for organizations. I think that’s one of the great things about working in Compliagent is that I’m interacting with people who really have expertise in areas that I don’t. Like I mentioned, I’m a lawyer by background and I’m not a clinician, but I can walk across the hall or pick up the phone and talk to you some of our nurses with combined decades of real, in the trenches healthcare experience. Which is very different than my background, and by the same token I can talk to somebody who has managed a healthcare facility, or someone like me who has been on the other side, who has been in a courtroom defending. Bringing those kinds of perspectives to bear can lead to really robust work in terms of building compliance infrastructure and compliance programs.

CJ: You know, you and I were throwing around some ideas on what to talk about today and we kind of landed on talking about this post-COVID healthcare world. We have all lived through something that I don’t think any of have lived through before. Lots of things have changed in healthcare. New services are being offered more frequently, things like telehealth and those sorts of things. But we thought it would be kind of fun for our listeners to kind of go back and forth a little bit and talk about what are some of these risks, emerging compliance risks as they relate to, I know we might not technically be post-COVID, the public health emergency has been extended a little bit longer, but I think we’re all kind of ready to put it behind us whether that happens or not.

Question: As far as new compliance things, what are some of those initial thoughts that you have for a post-COVID healthcare compliance world?

Nick: Well, taking a step back, I think the pandemic revealed a lot of weaknesses and deficiencies in our healthcare system that give rise to compliance challenges. To give a couple of examples, first of all even a payment and reimbursement challenge. We have, as we all know, a primarily employer-based health care system. There are government payors like Medicare and Medicaid, certainly, but most Americans get their healthcare coverage through work. If you talk to people in just about any other country about that idea, they would look at like you like that’s weird. “Why should your job have something to do with whether or not you have healthcare, or what kind of health care, or what doctor I can go to?” And there’s historical reasons for that that are kind of beyond the scope of this discussion.

But reimbursement challenges, like people doing things like telemedicine. By necessity, thinking about behavioral health or mental health issues, a lot of that moved online very quickly. And can you get reimbursed for that? What constitutes a patient encounter? How does that work? It might be over the telephone, or it might be over some kind of platform? There’s PHI (Protected Health Information), protected health information, going back and forth during that conversation. How do I make sure that’s protected when I may be sitting in my basement, and my patient might be sitting hundreds of miles away and driving in her car, or something like that?

What happens, relatedly, what happens when we have workforce challenges during the pandemic, as we saw? A lot of people tested positives, healthcare workers tested positive, and couldn’t come to work. So, number one, when are we justified in saying that “Well, if I’m licensed in State A, am I allowed to practice in State B?” What about in an emergency situation when somebody really needs care? Maybe I can even physically get there but I’m not licensed there? Should we start thinking proactively about making those allowances?

We talked a bit about data. If I am treating someone and I’m not their usual healthcare provider, because maybe because their usual healthcare provider is sick and I’m brought in on an emergency basis, how do we make sure that the data is accessible? That I can treat the patient effectively if I’m a healthcare provider? We want it protected, but I think one of the challenges that we see in compliance, and I’m sure that many people listening can relate to this, is like you’re sort of stuck between a push and pull. We want to protect our data, but if we build our walls too high that really can make it really challenging to be accessible. There are things that may be outside the scope of compliance, like just the public health response. What do we do with different state systems, and different county systems, and even different city systems? And I think we learned a lot that streamlining that, and coordinating that, is really important. So, I think that some of those things we’re going to see changed. I think there were a lot of successes, too, I don’t mean to be too down on the health care system. I still believe the United States has got the best health care system in the world, but I think we always want to do better, and some of that falls on us as people in the compliance world to address.

CJ: You know one thing I was thinking about with the public health emergencies, somethings were because there was this immediate need for telehealth and other avenues for communicating and accessing care. Some of those really strict requirements for telehealth that existed before the pandemic were loosened a little bit during this public health emergency. But at some point, we don’t know exactly when, that declaration of a public health emergency is going to end and some of those requirements are going to be strengthened again, and the “loosenings” will have to be tightened again. Those horses that were let out of the barn you’re going to have to try to get those back into the barn. And we’ve lived a couple years now with kind of these loosened regulations, to some extent, for HIPPA, OCR (Office for Civil Rights) had their loosening a little bit, and EMS. So, one thing is that is going to have to be brought back in and tightened.

Question: Have you thought about that at all, or do you agree with it?

Nick: Yeah, and there’s a lot of political lobbying going on. I think there’s a lot of public sentiment for loosening those kinds of restrictions, particularly as it relates to telehealth, even beyond the pandemic. Like, I live in a big city, I live in LA, so for me, or many people who live near me, to get to a sophisticated healthcare provider with a real specialist is really easy. I live like ten minutes from Cedar-Sinai, ten minutes from UCLA, and probably a million providers in between. But if you’re living in a more rural area where, for example, taking an eye exam, or bringing my child to an eye exam, might mean that she needs to be taken out of school for an entire day. What’s the price of gas now, $6-7 a gallon? I may have to drive 200 miles to see an eye specialist and take a day off of work myself. You’re talking about hundreds and hundreds of dollars of resources getting burned to do that. I think there’s a lot of public sentiment that some of those things can be made more efficient.

But I’ll defend the other side as well. I think there’s more opportunities for fraud and abuse, to bring it home to the compliance world a little bit, that require us in the field to make adjustments in our compliance programming. Like, for example, you’ve got care delivered remotely so it’s easier for things like identity fraud, or easier to establish a fake doctor patient relationship and bill that. There are marketing issues, right? If I’m dealing with a patient pool that might not be just within driving distance of my office. Now if I can do telemedicine and I can practice across state lines, I can be in Miami Beach and treat a patient in Portland, Oregon. How do I market that? So that’s a very different kind of mass media digital marketing and with that comes temptation for overutilization, unnecessary procedures, unnecessary medical supplies. We’re seeing a big rise in, I think, from an efficiency perspective and a cost perspective, mail order pharmacies. Drug diversion has always been an issue in places like hospitals and clinics. How do you address drug diversion issues when things are going through the mail? That loosening in our ability to deliver care in a different way, which is good, in general, I think, if you run the statistics for quality of care.

That loosening is going to create more compliance challenges. If I am the compliance officer for my health system, maybe it’s my skilled nursing facility, or it’s my hospital, I have to think about it. There’s still liability there, right? I have to think and make sure that I’m adjusting the focus. I may have to adjust policies; I may have to… Nobody knows. In most cases, health care providers are not that sensitive to the differences that might be in an in-person patient encounter versus a remote patient encounter, right? So, things like consent, things like consent to record, and making the patient aware that there are limitations to practice when you’re doing something remotely. All of that, you have to make sure that your clinicians are getting that training so that mistakes aren’t made. Because again, the liability could come back to you. Auditing, monitoring, things like that, the examples that we just talked about. How is your marketing? How are your marketers marketing when they now know that to be successful marketers their geographical reach has to be much broader? Are they saying things that are potentially impermissible or that imply things that they shouldn’t imply? Are they potentially getting patients referrals from the source, or with some kind of manner that could be deemed improper? All those kinds of things are made more acute by some of the good things that are arose during COVID.  CJ: While you were talking about those principles, two cases came into my mind that I had read recently. DOJ type of settlements. One was a huge one a few months back when they have every year, they kind of have their national broad take-down type of things.   You mentioned kind of bad actors, people who wake up in the morning wanting to do bad things and wanting to cheat the system, have new ways to do it. And one of those cases that was interesting to me, and you kind of mentioned it, was it medically necessary that certain orthotics, that certain DME, durable medical equipment, were those being ordered when there was no… Because a physician usually has to certify, or somebody has to certify saying that this product, this orthotic, this DME equipment is medically necessary. And so, one of the big cases was fraud in that arena where essentially docs were just taking kickbacks to kind of sign stuff that they were never really making individual determinations for the medical necessity of those. That to me falls a little bit more into this fraud category, right? Where people are trying to create a system where they are cheating, and they are trying to get monies.

The other one that came up that I thought was interesting, and I guess this is also potentially fraud, I don’t know all the details I just read the press release. It was a medical practice in Florida, and they were a pain management practice. And this was during COVID. Remember early in COVID when a lot of elective procedures were canceled? So, this medical practice that is pain management, they were doing procedures to manage people’s pain, but they weren’t emergent, right? So, they were things that could be postponed. The governor of Florida said, “look, all elective procedures are postponed for this time period.” And this particular practice, it was alleged that they went to telehealth, and previous to the pandemic they were really only seeing their patients once a month, and during the time when they could not do these elective procedures, they upped their volume to seeing patients every two weeks. And it was alleged that why was that suddenly medically necessary? I guess there may have been some paper trail suggesting that they were doing this to make up for the lost revenue of their elective procedures and so they turned to telehealth. And they have followed all the regulations of documenting the telehealth visits, etc., but if it wasn’t medically necessary to begin with was that really appropriate? And were they doing it to kind of pad their revenue that they were losing from the canceled elective procedures?

So those two things were kind of interesting.

Question: You may be aware of those already, and maybe that’s what you had in mind when you were talking about this?

Nick: Well, I’ll tell you the first one that you mentioned about ordering supplies. One of the things that happened, as all of us probably remember, was there was a pretty severe supply chain issues in health care during the pandemic. Most famously for PPE, personal protective equipment, and things like gloves or whatever, but even medications. I could see a situation, if I’m remembering correctly, I think things like insulin, there were times when it was not as easy it was before the pandemic to get insulin. And obviously if you’re someone who is diabetic and needs insulin then that’s pretty severe. And you could see a situation where, with good intention somebody doubles a prescription. You know what I’m saying? A healthcare provider says I’m worried about this patient not being able to get their insulin and over orders as a way of combatting supply chain issues. But then looking at that another way, that might be over utilization. So, I think we have to think that through a little bit. A lot of health care, probably over the last ten years, and I’m far from an expert, I’m sort of like healthcare management consulting side of things, but I know that having inventory is very, very expensive. And a lot of the thinking was, “let’s keep as low of inventory as possible because it’s really easy to get delivered in 24 hours’ notice, 48 hours’ notice,” and that wound up being something of a challenge during COVID when there were supply chain issues. And I think there still are to a certain extent today. So maybe some of that thinking has to change.

The second thing you mentioned, maybe this a little more attenuated from what was happening in that pain management clinic case. But I think, both because of technology, and good technological innovations that allow care that used to require an acute care research hospital, not so many years later can be done by a plugin on your smart phone by a home health nurse, or something like that. And that’s good because in the long run decreases the cost of care and allows people to remain not institutionalized for longer in their life, which I think is a good thing. Especially as our population skews older and older over the next few decades. But I think we’re going to see a shift to more outpatient services, and more of it has been for people to come into healthcare facilities, and more of a demand to make a lot of things outpatient. And that raises its own set of compliance challenges. Scope of practice issues, and monitoring data appropriately, and even the use of non-physicians, or allied healthcare professionals as they’re often called. I think some of this is just being driven by the cost of care and trying to decrease that, which is an understandable goal. But I think that more and more allied health care professionals are being empowered in different states to do things that five years ago, or 10 years ago, could only be done by a physician, and could only really be done in somewhere like an operating theater, or with a lot of multi-million-dollar equipment surrounding them. What is the standard of care in that kind of situation? Like we don’t necessarily have case law on that yet. All sorts of those questions.

CJ: Just from your point, yes that it reduces cost of care that sort of thing. And then you get lazy people like me who just like it for convenience. Before the pandemic I had never personally done a telehealth visit, and then during the pandemic I have multiple. And I’m like, this is the way to go because I don’t want to get into my car and go drive. You were much more thoughtful on your explanation; you were thinking about people who couldn’t afford it. I was just thinking of myself lazily. I could get this done in the next half hour, I don’t have to waste an hour to go and an hour to come back. So, I think some of this is, too, driven just by convenience. Like we live on our phones, we do banking, we pay bills, we look at our kids’ grades. Whatever we do we do on a phone now, and I think healthcare is going to go there. I think the marketplace, and the patients, are going to demand more of that as well, as our lives in general become more tied to, for better or worse, tied to using these technologies.  Nick: Yeah, definitely. I think this may be a little more removed from COVID, but I think we see in a couple of other veins in the last couple of years. And you mentioned some of the federal government task forces, and there are a number of them that work through DOJ, or OCR, or Department of Health and Human Services, and there are state ones as well, especially in big states like California and Texas. I think we’re seeing a trend towards greater criminalization of misconduct. I see more and more in what I’m reading. And like you I read those DOJ announcements and subscribe to probably more than necessary number of emails, and blogs, and things like that. And I think we’re seeing a real uptick on the criminalization side. And some of this is just driven by… I think there’s a lot of righteous, populist outrage towards healthcare fraud. It’s pretty bipartisan, there’s not a heck of a lot of things that are bipartisan in this country anymore. But I think just about both sides of the aisle can get behind the government not wanting to write a check for fraud, waste, and abuse. Activities that constitute fraud, waste, and abuse and it comes out of our tax dollars.

I think we’re also seeing, even on the civil side, a real explosion of whistle blower claims, and a real growth in that plaintiff’s bar. Some of it might just be that there is more data available, I think there’s a perception that those cases are easier to pursue than they might have been in the past. Things that when I was a younger lawyer would have taken months and months of combing through bankers’ boxes with documents can now, you can get something electronically, you can run different searches, there’s a whole field of data science that didn’t exist not so log ago. And detecting, and proving, these cases of fraud, waste, and abuse, and false claims and things like that, is getting easier, and our system makes it not only that but profitable to pursue. I talked about in the beginning of our conversation that I was happy to see a lot of compliance being driven by mergers and acquisitions, and things that I guess that are, for lack of a better term, making people money. But there is still plenty going on in terms of acuity of enforcement. One of the major rolls of the compliance department and a compliance officer in an organization is to try to remain vigilant to that within their own organization and to be able to defend and show a paper trail of good faith efforts to prevent that.

CJ: You and I reconnected a few months ago at a national healthcare conference. I don’t know which all of the speakers you listened to, but there were a couple that I listened to from the government that we're talking about just that. The data analytics and how that they’re really using that more and more, of course just because you found an outlier doesn’t mean there’s a fraud. But it sure does sift through a lot of the rest of the haystack to find those needles where there is wrongdoing. I think of Christi Grimm, who is the inspector general now, she spoke about that, and there were some others that kind of spoke about that data analytics as a key tool that they’re using. The other thing you mentioned was this criminalization. So, one other hat that I wear is that I teach at my alma mater. The medical school where I graduated from, they have a master’s degree in patient safety leadership. As faculty we did a webinar recently about a nurse, who was convicted in - I don’t know if you’re familiar with this case - in Tennessee. She made an honest mistake, I guess maybe I’m simplifying things a bit, but gave a patient the wrong medication, that patient ended up dying. And medication errors happen all over the place and they’re tragic, but do they rise to the level of a criminal activity? The prosecutors in that state went after her and she was found guilty of a crime. Fortunately, the judge, the sentence, and I’m showing my bias, and I’m not sure we should criminalize that sort of activity, it kind of dampers, puts a damper on patient safety efforts, where you need transparency and people to admit mistakes and those sorts of things. So that was kind of interesting to me, but I know that may be a little bit off topic. You mentioned criminalization, and I know you have this legal background, and it’s interesting.

Question: Are prosecutors, do you see them as going after these types of things and making them crimes to make examples? Do you have any thoughts on that?

Nick: I mean, first of all I definitely would never ascribe bad intentions to a prosecutor or any one in an enforcement role. I think the work they do is certainly important. Like I said a couple minutes ago, I do think that we have the best healthcare system is the world, and one of the reasons that is true is that there is a higher sense of accountability than there is in other places. But to be fair, that accountability can create challenges for a provider, whether you’re an individual doctor or a provider organization.

I don’t want to say this in a cynical way, but I have a friend who was a former assistant US attorney now working in the private sector. I had lunch with her not that long ago, and we were sort of talking about how things work when you’re in a government prosecutors office, and she told me, “look, Nick” - she worked for the DOJ, the US Attorney’s Office, it’s probably the largest law firm in the world if you think in the terms of numbers. But it’s not necessarily the most funded on a case-by-case basis law firm in the world - And she said, “I walk into my office, and I have a stack a yard high of files that I might look into, and I’ve got one investigator that can do only so many hours a week of investigation. And the way I get promoted is by wins, by settlements, by things like that.”  In the same way that if you’re a plaintiff’s attorney or a contingency attorney, the way that you’re successful is by settlements and wins as well. In a way that the structure is the same.

But one of the things she told me, which I think is a really good lesson for those of us in the compliance world, she’s like, “How do I decide what’s going to be an easy win? Because what I don’t want is a win that takes me two years of full-time devotion. And maybe I win that case, but I can’t afford it, I won’t get promoted, I won’t get whatever, I can’t afford to spend thousands and thousands of hours on a single case. What I look for is chaos.” And this really resonated with me working in the compliance space. She said if my investigator goes in somewhere and maybe we have a little bit of a whiff of there’s some billing impropriety going on, but we don’t ask the direction question first. Ask a question of, who is your compliance officer, asking a random person, who is your compliance officer? Or, hey could you show me your policies on, I don’t know, something in particular, can you show me..? if the answer that I get is deer in headlights, like “oh, well, I’m not really sure where to find that… here’s some policies, you know, I think some of them are old, I’m not sure where the updated ones are, but there is somebody who does know but she’s on vacation this week, you should come back next week.” If that is your answer, she’s like, “Well, then I know to dig in. That’s a place where there’s chaos. And a place where there is chaos, I am going to be able to find something to use as leverage for a quick settlement.” By the same token, if the questions I ask are easily answered, can you show me a list of your HIPPA incidents, in the last two years can you show me your plans of correction on this issue, and somebody just types a few buttons on the terminal, would you like that electronic form, or should I hit print? Boom, boom, boom, boom, here’s your stack. Then I know it’s not worth my time. Not because that means someone is perfect and I couldn’t find something if I really looked, but that’s going to be someone with their ducks in a row. That’s someone who is going to be able to come up with a defense to anything that I could bring. So, I walk across the street. Or my investigator walks across the street.

I like to tell that story to the organizations that I work with, because people often ask the question of like, “why does this little issue that seems like dotting your I’s and crossing your T’s really matter? That’s not a big deal.” And the reason that is it’s almost like the Broken Windows Theory. If you remember back in the early Giuliani days, he had this policing theory if you take a neighborhood and you clean up the graffiti, and you clean up the garbage, and you cite people for broken windows, and stuff like that, then you’ll prevent the bigger crimes down the line. You make it into a better neighborhood. It’s almost like that same theory. If you’re careful enough to dot your I’s and cross your T’s, and sweat the small stuff, I guess as the expression goes, then that’s probably going to come back to you. Both in terms of the story that I just told, if there’s an investigator, but also just a culture of compliance. Where people realize that this isn’t an organization that cuts corners, we do things right. If we say you’ve got to complete your online HIPPA training by June first, you do it by June first. We don’t have fifty percent of the organization not doing it, and then nobody follows up on them, and then there’s a HIPPA breach, and the investigator asks for the training records, and you’re like, “well most people did but,” “no, actually not the people who were involved in this breech it turns out.” And I’ve seen that. I’ve seen that time and time again. Wow, that’s a really bad fact. That you did HIPPA training but the people who were really involved in this breech didn’t do it. And nobody even followed up with them as to why they didn’t complete their training. Even though you might have paid a million dollars to some online education provider. So yes, those are examples of the areas that I think that people should focus on.

CJ: That’s a really good insight, and I’m glad you mentioned that the work that the prosecutors do is very valuable, and by no means are they, yeah, I think you’re spot on. I hope I wasn’t disparaging them because the work they do is essential. And, of course, all of these things are very case specific, and everyone has, as you mentioned, timelines, and priorities, that they have to work through and there are decisions that have to be made. So that’s really an awesome insight.   We’re kind of getting close to the end of our time together. It always flies by. I want to give you, though, a moment if you have any last-minute thoughts. But also, how could people reach you, your website, or whatever you feel is the best way to show the work that you do.

Question: Do you have any last-minute thoughts? And how could people reach you?

Nick: Well, in terms of how people can reach us, as you mentioned, CJ, our consulting firm is Compliagent, and you can find our website at www.compliagent.com. My name is Nick Merkin, again, and my email address is just my first initial and last name, so N like Nancy, M-E-R-K-I-N @ compliagent.com. Feel free to reach out. I’m always happy to connect with people, and answers questions if people have them, and see if there’s ways that we can be helpful as an organization to you.   In terms of just closing thoughts: I would just like to say that a lot of times, compliance officers are seen as the police force in the organization, and I think that's never the hat I want to wear. It really is part of the role, and sometimes it is, and sometimes I’ve told people, “Hey you squeeze the bad guy, throw me under the bus, say that this is coming from the compliance officer, something like that.” And that can be really valuable to an organization to have somebody like that. But when compliance works, I think it’s when we do our job best by being collaborative. What I like to tell people he work you’re doing, and this is particularly when I’m talking to the health care providers and the health care professionals; your work is what is important here, not mine. You’re serving a vulnerable population, and you’re serving an important population and delivering great quality of care. And my job isn’t to create roadblocks and hurdles and hindrances for you to do that. My job is to when you have questions and you figure out how you get to a clinical goal, an operational goal, to serve patients better, or to fulfill the mission the vision, values of the healthcare facility, my job is to help you find a way to do that in a compliant way. Be there for you when you have questions, have concerns, and even something like the compliance hotline. I like to tell people I don't even want to call it that, that should be a compliance questions line. It’s not there solely; even though admittedly, sometimes it is there for someone to raise something that needs to be raised, maybe anonymously, and something that needs to be investigated; but 90% of the calls to that line or the emails, or the communications, with that kind of function, should be asking questions. Like, “Hey Nick, can you weigh in on this? We’ve seen this challenge in our department, we’ve seen this challenge with patient intake, and we’ven this challenge in billing. Can we meet about it because you may have some ideas on the right way to do this?” And I think that’s where, we, as compliance professionals, do really good work. And really add value in the ways that I’ve been talking about in the past.

CJ: I love that, Nick. That’s part of the reason why I’ve loved my career in compliances. I’ve felt like I came from a clinical background, but left that, and felt that if I could help the docs and the hospitals, and the people focus on what their mission is. Which is what you said, it’s to take care of patients and to take care of people, that’s really the mission. We want to make sure they do that without shackles on, right? Do it compliantly without a lot of roadblocks. It’s like we’re aiding them, we’re helping them in achieving their true mission and I love that. Thank you for reminding us of the importance of that.

Nick: Well, thank you again for having me.

CJ: Thanks, Nick, so much. It’s always a pleasure to speak to you, I love your insights. You put things in such a good way, you’ve painted a nice picture about where compliance is today, where it came from a little bit, where it is today, and where it might be going. We thank you so much, and we thank all of our listeners for listening and hope you’ll listen again to our next episode. Until then, be safe, and thanks everybody.

Nick: Thank you, have a great day.