Compliance Perspectives

Andrew McBride, Founder and CEO of Integrity Bridge and an expert in ethics and compliance, dives into the transformative potential of AI for compliance programs. He highlights five practical use cases: AI as an Interpreter for translating and summarizing documents, as a Drafter to refine policies and create training scenarios, helping as a Data Analyst to connect training with outcomes, and serving as an Investigator to flag issues in data. McBride emphasizes the need for tailored AI applications and mindful management of AI-generated information.

Kristy Grant-Hart, an author and compliance expert, dives into the pitfalls of poorly designed due diligence questionnaires. She emphasizes the importance of asking targeted questions that genuinely inform decision-making, rather than overwhelming with unnecessary detail. Kristy shares insights on who should contribute to these questionnaires and discusses key risk areas like bribery and privacy. Her rule of thumb? If the answer won't alter your decision, don't ask the question. Discover how to streamline due diligence for more effective outcomes.

Vera Cherepanova, Executive Director of the nonprofit Boards of the Future, sheds light on the crucial intersection of board governance and compliance. She reveals that many boards underestimate culture as a core risk, falling short of their responsibilities in today's regulated environment. Discussion reveals how events are forcing boards to engage deeply with compliance issues, especially in light of supply chain challenges and regionalization. Vera advocates for greater inclusion of compliance experts on boards to enhance ethical decision-making and navigate non-financial risks effectively.

By Adam Turteltaub With a rising focus on value-based care, and a new program seeking to make the approach mandatory, we spoke with Ed White (LinkedIn), Partner at Nelson Mullins. Previous efforts to move toward value-based models, such as Accountable Care Organizations (ACOs), faced significant barriers due to regulatory frameworks like the Stark Law and Anti-Kickback Statute. These laws were designed to prevent financial incentives from influencing medical decisions, but they also limited the ability of hospitals and physicians to collaborate in ways necessary for effective value-based care implementation. Recognizing these constraints, CMS and the Office of Inspector General (OIG) collaborated in 2020 to issue new regulations aimed at facilitating the transition to value-based care. The next step in the transition is the new Transforming Episode Accountability Model or TEAM program, which will become mandatory in 2026. This program includes 740 hospitals across the country and targets five specific surgical procedures. Participating hospitals must coordinate care with a range of providers—including specialists, primary care physicians, labs, durable medical equipment (DME) providers, hospice agencies, and others. The TEAM program is designed to last for five years, during which time hospitals are responsible for ensuring that patients are connected to appropriate post-discharge care, including follow-up with primary care providers. The goal is to reduce complications, avoid emergency room readmissions, and promote better health outcomes—all while keeping costs below a CMS-established target price. To drive efficiency, the TEAM program introduces three financial risk “tracks”: Upside-only track – Hospitals can earn shared savings if costs come in below the target price. Moderate risk (upside/downside) track – Hospitals can either earn savings or incur penalties depending on performance. Full-risk track – This track will offer both greater risks and rewards. According to industry consultants, two-thirds of participating hospitals are expected to lose money in the early phases of the TEAM program. Hospitals must rethink their compliance, care coordination, and partnership strategies in the wake of these changes. Listen in to learn more about what this all means for your compliance program both today and in the future.

By Adam Turteltaub Imagine that it’s time to move on from compliance to another role, either by choice or being voluntold.  Does what you learned in compliance help? Absolutely, according to Kortney Nordrum, Vice President and Senior Corporate Counsel at Deluxe.  Amongst other benefits, it taught her how to break down large issues into more manageable pieces, better identify and manage risks and help deals close. That isn’t to say the transition has come without challenges.  She has had to learn to trust others to run compliance and also to be less risk averse. Listen in to learn more about how your compliance skills can help if your career ever takes you to another profession.

Garth Jordan, the newly appointed CEO of SCCE & HCCA, brings a rich background in association management. He shares his excitement for building trustworthy organizations and the opportunities for growth in membership and global presence. Garth emphasizes his unique perspective on product development and strategy, aiming to leverage his operational experience to enhance the association's offerings. He also discusses his plans to rapidly immerse himself in the compliance sector by cultivating an empathy-focused understanding, rather than just technical expertise.

Barbara-Ann Boehler, Senior Director of the Program on Corporate Compliance and Ethics at Fordham University, shares her passion for experiential learning in compliance training. She highlights the surprising connection between baking cupcakes and effective training, illustrating how hands-on activities can make lessons more memorable. Barbara-Ann discusses engaging simulations, including a cybersecurity exercise and a fun frosting test, emphasizing the importance of communication in policy drafting. Her interactive approach prompts lasting discussions and deeper understanding.

Kim Jablonski, Chief Compliance & Ethics Officer at Bristol Myers Squibb, sheds light on the complexities of compliance leadership in rapidly changing times. She emphasizes the importance of a data-driven approach and the need for leaders to communicate integrity as a core value. Kim advocates for collaboration across teams, highlighting that understanding the business landscape is vital. Notably, she reminds us that we all have 'obstructed view seats,' urging leaders to recognize diverse perspectives when navigating compliance challenges.

Join Colin May, a Professor of Forensic Studies and Criminal Justice at Stevenson University, as he delves into the alarming rise of fraud in non-emergency medical transportation. He discusses various schemes like billing for unprovided services and overcharging for tolls. Colin stresses the importance of training frontline employees to spot irregularities and highlights the potential of technology in pre-trip screenings to enhance oversight. Tune in to discover how providers can safeguard their services and patients against these fraudulent practices.

By Adam Turteltaub Things are a bit out of balance when it comes to Business Associates (BAs) in healthcare.  Organizations invest a great deal of time and resources in vetting these third parties to make sure that they will safely handle data from the covered entity.  But, when the relationship ends, those same organizations may overlook the risks to their data post-separation. The problem is complex because different BAs will fall under different regulations and use data differently.  Some may process but not retain data.  Others may have terabytes of your data to return or destroy immediately.  For others, there may be a law or regulation requiring them to hold onto that data for several years. The compliance team, explains Marti Arvin (LinkedIn), Vice President, Chief Compliance and privacy Officer at Erlanger Health System, needs to ensure it is part of the process whenever a BA relationship is coming to an end.    At that point, it’s time to reach out to the BA to ensure there is a plan in place for how data will be handled, and to begin documenting the process.  This helps in case there is an incident later. Listen in to learn more about what you can and should be doing to ensure that the close-out process is as healthy as it should be.