Compliance Perspectives

By Adam Turteltaub Despite being a Civil War era statute, the False Claims Act (FCA) always has something new going on.  To find out what’s hot these days, we spoke with Joshua Drew (LinkedIn), a former federal prosecutor and chief compliance officer and currently a Member at Miller & Chevalier. Lately, he explains, there has been a steady stream of activity. May:  The Civil Rights Fraud Initiative was announced by the administration and proposes to use the FCA against any federal funding recipient that it believes are operating DEI initiatives that violate antidiscrimination laws. July:  A new working group was created between the DOJ and HHS to focus on healthcare and life sciences.  It encouraged whistleblowers to file action in areas such as Medicare Advantage, drug device and biologics pricing and barriers to patient access, amongst others. August:  A trade task force was created to encourage whistleblowing against tariff violators. All of this occurs against a backdrop of activity by the Administration to identify and fight waste, fraud and abuse. Listen in to learn more about where the Administration is focusing and what compliance teams can learn from recent actions.

By Adam Turteltaub The possibilities of AI don’t stop with generative AI such as ChatGPT.  Agentic AI may have more potential for compliance teams, Zahra Timsah, co-founder and CEO of i-GENTIC AI tells us. Unlike generative AI, which is well known for its ability to create content, agentic AI can be used an internal enforcement agent.  Trained properly, she tells us, it can look for a potential violation and stop it.  For example, it can spot personal health information that is about to be transferred and redact the sensitive data automatically. This ability to step in and take action will, she believes, free compliance teams from many routine tasks and allow them to shift their focus to matters that are more complex and fall within the grey area.  It will also help teams speed up the rate in which new laws and regulations turn into effective internal policies. In addition, agentic AI will be able to produce measurable value by demonstrating what it can do to manage risk, improve trust and increase efficiency. Listen in to learn more about agentic AI’s ability to improve your compliance program.

Lewis Eisen, an expert on policy writing and author of RULES, reveals how to revamp policies for better engagement. He critiques the patronizing language that often alienates employees from policies. His approach advocates for simplified, value-driven statements while keeping complex details in separate guides. Eisen discusses common pitfalls in policy-making, emphasizing the importance of neutral tone and positive intent. He believes that aligning policies with organizational values can enhance adherence and connection among employees.

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.