Healthcare businesses — hospitals, medical practices, health insurers, medical device manufacturers, and the like — live in a world of heavy regulation. That regulation comes from the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services.

Specifically, OIG publishes guidelines on how healthcare companies should structure and operate their compliance programs. The agency then follows up with audits to see how well companies are achieving their compliance program goals, and can impose monetary penalties or direct companies to undertake extensive compliance program improvements if their programs fail to meet expectations.

All that preamble brings us to a simple reality: healthcare companies cannot achieve OIG compliance in any practical sense without the help of technology. The demands are too exhaustive for manual processes; something (probably numerous things) will go overlooked.

This post explores how compliance software technology can help you, and the capabilities that the solution you choose should encompass. Then you can get on with the business of effective OIG compliance.

Understanding What ‘Compliance Technology’ Is

The formal definition of “compliance technology” is rather straightforward. It is software specially designed to help your business comply with OIG regulations, reduce the risk of fraud, and maintain operational efficiency.

Exactly how compliance technology achieves those objectives will vary from one company to the next, and one software tool to the next; but all compliance technology should have several basic features:

• Automatic regulatory updates, since OIG guidance can change often.
• Audit trails, to provide the evidence that auditors will want to see for proof that your compliance program meets expectations.
• Alerts for potential violations, so that the compliance team and other employees can intercept those violations before they become serious.
• Educational materials for employees, so that your workforce knows what’s expected of it and what to do.

The compliance technology you use should fit within the rest of your organization’s “technology stack,” pulling together relevant data from across the enterprise so you understand what your compliance risks are and where your compliance program efforts need help.

Those insights, in turn, can help compliance officers run the compliance program more efficiently and effectively, and help you weave a strong culture of compliance throughout your whole business.

Examples of How Compliance Technology Helps

The overall goal of compliance technology is to help compliance programs run more efficiently — to move away from manual processes that consume more time and money, and that run a higher risk of error.

In practice, that would lead to real-world benefits such as:

• Streamlined, automated tracking of adherence to OIG rules, so that you can identify any departures from those rules more quickly and clearly.
• More automated and streamlined risk assessments, such as identifying gaps in your internal controls that introduce compliance risk.
• Tracking mitigation work, by assigning remediation tasks to specific people and confirming whether that work is or isn’t done by required deadlines. This both creates an audit trail that you can provide to auditors, and helps you to identify clogs in your workflow (that is, people not executing tasks on time) so you can escalate as necessary to get remediation done.

Those are only three of many ways that compliance software technology can help your organization. The key point is that by moving away from manual processes (such as tracking data by spreadsheet and chasing down information via email), compliance technology helps you identify and address discrepancies more quickly, all while generating the audit trails you need for faster (read: cheaper) audits.

Advantages of Using OIG Compliance SOFTWARE Technology

The advantages of using OIG compliance software technology come in many forms, but broadly speaking those advantages are all about gains in efficiency and accuracy. More specifically, we can say that compliance technology…

• Reduces the chance of error, since employees will need to do less manual entry of data. That, in turn, decreases the risk of compliance violations (and ensuing investigations and monetary penalties).
• Drives more operational efficiency, thanks to more automated workflows. That means faster risk assessments, speedier remediation, and easier production of evidence for auditors.
• Leads to better reporting, because your compliance solution will pull the latest, most accurate, and most comprehensive data for those reports. So you, the compliance officer, will be better informed and can have more productive conversations with management, the board, or regulators about the organization’s overall compliance posture.

Moreover, remember that as you automate manual compliance processes, you will free up employees’ time to focus on other, more valuable tasks. For example, the compliance team could spend more time on difficult investigations or designing better controls. Operations teams could focus more on patient care, sales, or research and development. In other words, the efficiency gains you reap from OIG compliance software technology also lead to higher productivity throughout the whole organization.

Key Features for Compliance Technology

When evaluating potential compliance vendors (and there are plenty out there!), you’ll always need to consider issues such as cost, the vendor’s reputation, its familiarity with your specific niche in the healthcare world, and other questions about the vendor as a business.

You also need to study the specific features of the technology, to make sure it fits your needs. Again, we can identify a few fundamental capabilities that all compliance technology should be able to deliver:

• A user-friendly interface, with automatic updates, customizable reports, and secure data protection measures; so that your employees can use the technology to its fullest extent.
• Real-time data analysis and integration with other systems, so you as the compliance leader can get current, complete reports about the company’s compliance risks and the state of your compliance program.
• An ability to customize the software to match organization-specific needs, especially as your business expands, adopts new enterprise technology, or merges with other businesses.

Prepare to Face (and Overcome) Challenges

The single biggest challenge you’re likely to face when implementing compliance technology is resistance to change. That resistance could come from senior management (“why are we spending money to do this?”), operations teams (“why are we doing this at all?”), or both.

To overcome those objections, compliance officers need to define and articulate a compelling use case for your technology solution. Yes, investing in technology costs money in the short-term, but it can also save money in the long term and drive more business growth thanks to employees focusing on more value-added tasks. Think long and carefully about what those benefits are, and how to quantify them in practical, dollars-and-cents terms. The better you can articulate the benefits of using compliance technology, the more easily you’ll overcome this obstacle.

Other more practical obstacles include a lack of technical expertise, high setup costs, and employee difficulty understanding how to use the new tool. All of those are real challenges, not to be taken lightly. Overcome them by working with your chosen vendor to plan the technical implementation, financing, and training of your compliance technology carefully.

One effective strategy here is to begin with a pilot program, to identify the challenges your organization might face and to let everyone understand how the technology can help them. For example, you begin with an automated screening tool for, say, a three-month trial period. Track the costs, manpower challenges, and performance metrics. If the tool works as intended, you can then scale up to larger technology projects that tackle other tasks.

Conclusion: Compliance Technology Is Here to Stay

Compliance technology is already a formidable advantage to help achieve — and maintain — OIG compliance. Moreover, advances in artificial intelligence, data analytics, and automation will make compliance technology even better in the future. The question isn’t whether you should invest in compliance technology, but when; the longer you wait, the more your manual compliance processes will keep clogging the system and allowing compliance risk to slip by undetected.

That, in the final analysis, is the benefit of compliance technology: it gives you more confidence that your compliance program is working with maximum efficiency and effectiveness. And those gains, in turn, will give your organization a competitive edge as you provide better care to more people, all while navigating a complex regulatory environment.

SIDEBAR: The Compliance Technology Family

A “full suite” of compliance technology will encompass several tools that, ideally, work in a seamless fashion to keep your compliance program moving forward. Those tools are…

• Regulatory change management tools, to help you stay current with the latest changes to healthcare regulations at the federal and state level. No more searching online, or paying consultants an expensive hourly fee to do the same; a regulatory change management database will automatically capture updates so you always have the latest, correct information handy.
• Internal reporting hotlines, so that your employees and third parties can report potential compliance violations to you. Your hotline should be easy to use, where employees can submit reports in multiple formats (online, phone, email, or even text messages) and in the multiple languages that your workforce might speak. The hotline should also be able to accept anonymous reports and offer some way to let you keep communicating with employees (even those reporting anonymously).
• Case management tools, so that you can investigate and manage reports of compliance violations with a consistent, uniform level of rigor. For example, the tool should allow you to append evidence and interview notes to the original complaint, and automatically alert the proper investigative teams as new information arrives.
• Training materials to help employees and third parties understand their compliance duties. The training should be relevant to each employee group (for example, accounting employees need different anti-bribery training than the sales team) and the tool should provide rich analytics to help you understand the effectiveness of the training, completion rates, and so forth.
• Vendor due diligence tools, to help you onboard new vendors quickly and consistently. The tool should be able to perform background checks, flag past litigation or regulatory infractions, and classify vendors by risk category so you know which ones need close supervision and which ones need to be shown the door.
• Exclusion screening tools, which are a subset of vendor due diligence tools. Exclusion screening tools will automatically screen employees, business partners, and other third parties against OIG’s lists of excluded providers (the LEIE databases) so you can avoid those problematic third parties before hiring them.