The Department of Health and Human Services (HHS) Office of Inspector General (OIG) is mandated by law to provide a semiannual report to Congress that summarizes its activities. This report includes a section on the OIG Hotline (1-800-HHS-TIPS), which is available to individuals to report fraud, waste, or abuse in HHS programs. The OIG considers its hotline as a significant avenue of intelligence. The report underscores the notion that many “whistleblowers” contact the OIG directly, rather than filing qui tam actions with the Department of Justice (DOJ). During the second half of 2017 alone, the OIG Hotline received and then evaluated 58,510 hotline contacts to determine whether the issue rose to the complaint level and whether it fell within the OIG’s jurisdiction. The OIG determined that 13,781 of those contacts warranted investigation. After evaluation, the OIG referred 10,888 for action, finding that the remaining claims either lacked a basis for further action or lacked evidence of any HHS violations.
The OIG received the contacts that were ultimately referred for action through various channels. There were 5,815 of these cases that came through the telephone hotline, with another 3,966 obtained via the OIG website. Letters and faxes accounted for another 1,107 cases. The OIG forwarded approximately one-third of the complaints to its field offices for follow-up and slightly less than half to the Centers for Medicare and Medicaid Services (CMS), with the remaining complaints referred to other HHS operating divisions and other federal agencies. The OIG expected recoveries of $9.9 million stemming directly from hotline complaints during the reporting period.
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Jillian Concepcion has assisted many clients with their hotline operations through the Compliance Resource Center (CRC). She notes that having an effective hotline program is a must for any successful compliance program; yet, many organizations maintain ineffective hotlines. The failure to promote an effective hotline operation may be a grave error that drives complainants externally to the DOJ, the OIG, litigation attorneys, the media, etc. Receiving and resolving issues internally is the right approach and can benefit the organization in multiple ways. Failing to do so can result in potential liabilities, headaches, and serious remedial work. Maintaining a positive compliance culture in which employees feel comfortable reporting problems, concerns, and perceived wrongdoing will encourage internal reporting instead of external “whistleblowing.”
- Develop and implement written guidelines relating to the hotline operation that should provide information on (a) hotline operations, (b) the duty to report, (c) non-retaliation, (d) anonymity, (e) confidentiality, and (f) investigations of complaints, among others;
- Include information about the hotline in the Employee Handbook and Code of Conduct;
- Promote a culture that encourages employees to raise concerns and report perceived problems;
- Maintain a confidential recordkeeping system to review employment history for employees who have raised concerns or reported problems;
- Place posters on the employee bulletin boards advertising availability and use of the hotline;
- Ensure that the hotline number and its availability is included in new employee orientation;
- Consider including the hotline information on fliers, screensavers, or other widely used or disseminated items;
- Include information about the hotline on the company intranet;
- Use an organization newsletter to promote the hotline; and
- Take extra care to avoid any actions that might be interpreted as retaliatory.
Strategic Management Services
Strategic Management Services, along with Compliance Resource Center, have years of experience reviewing and monitoring compliance programs, as well as providing tools, like hotline services, to support healthcare compliance needs. If you have questions about the effectiveness of your compliance program or any other compliance concerns, contact us online or get in touch with an expert at (703) 683-9600.