Blog Post

Internal Reviews Are Not Independent Compliance Effectiveness Evaluations

Richard P. Kusserow | May 2022

Key Points:

  • Results from the 2022 Health Care Compliance Benchmark Survey
  • Internal reviews don’t provide credible evidence to outside authorities
  • Compliance Officers cannot independently audit their own program
  • Nearly half of respondents reported never having an independent evaluation
  • A checklist review is a process leading to outputs, not outcome
  • Effectiveness leads to outcome, not output

Independent compliance program evaluations are growing in importance and are reinforced repeatedly by the OIG and DOJ as critical to evidencing program effectiveness. Results from the 2022 Health Care Compliance Benchmark Survey, developed and analyzed by Strategic Management, found that evidencing compliance program effectiveness was among the top challenges and priorities for Compliance Offices this year. Nearly half of respondents reported they have never had an independent evaluation of their compliance program. Noteworthy is that about one-quarter of respondents reported the intention of having such an evaluation this year. 

Four out of ten respondents reported developing metrics to evidence Compliance Program effectiveness, although metrics relate to output, not outcome, whereas effectiveness relates to outcome of processes, not the output of the process. Metrics can be useful for ongoing monitoring but do not provide credible evidence of the program’s effectiveness. The fact is that Compliance Officers cannot independently evaluate or audit their programs. The results of any such efforts would not be considered credible by outside authorities, such as the OIG and DOJ.  

Independent evaluations should be performed by experts who by definition are outside of the organization. Such reviews should focus on program results, not metrics related to process. The importance of having evaluations conducted by outside experts has been stressed repeatedly by the OIG Compliance Program Guidance documents, without which there would be little consideration given to mitigation of penalties. The Department of Justice’s June 2020 “Evaluation of Corporate Compliance Programs” guidance also highlights the importance of “effective evaluation measures” to determine if the compliance program is a “paper program” or one that is fully “implemented, reviewed, and revised, as appropriate, in an effective manner.” Regular, rigorous, and consistent independent review of compliance programs is now expected. All this supports the need for periodic independent evaluations of the compliance program.

Click here for information about the 2022 survey.

For more information on Compliance Program Effectiveness Evaluations, contact Richard Kusserow ([email protected]).

About the Author

Richard P. Kusserow established Strategic Management Services, LLC, after retiring from being the DHHS Inspector General, and has assisted over 2,000 health care organizations and entities in developing, implementing and assessing compliance programs.

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