Saying Goodbye

You may have secret weapons in your home care company. People who will be totally honest with you. People who will tell you everything no one wants you to know, who will tattle on the people in your organization who may be putting you in danger and who will offer suggestions about how to fix your company’s problems.

Who are these people, these sources of knowledge and truth? The answer: the employees who are leaving your company, those who quit and those who are fired.

Every smart home care company should look for ways to get honest feedback about its compliance activities and its internal operations. Feedback that relates to new or growing problems is particularly important, and particularly difficult to obtain.

Your employees are often the best source for this information. Unfortunately, they often are uncomfortable coming forward. Sometimes this is because they don’t feel it is their place to talk about a problem. Sometimes it is because the problem is new and they think it might fix itself, or they are unsure if it will grow to be a problem important enough to discuss. Sometimes they wait because a supervisor said, “Let’s wait and see,” or whatever.

Personnel who are leaving your organization, however, will not usually let any of these disincentives keep them from talking. An exit interview that seeks this information can provide substantial and varied benefits.

An exit interview means a meeting with a departing employee to discuss transitional issues like work transfers, severance packages and the like, and perhaps more. A formal meeting prior to departure is usually preferred, although impromptu sessions, telephone conferences and post-departure meetings are not uncommon.

Your secret agenda for effective exit interviews is to seek information from departing employees about how they believe they have been treated, whether they are aware of any discrimination or harassment, and whether they are aware of violations of company procedures or reimbursement rules, etc. In addition, in an exit interview, a company can assess the employee’s honest perspective on its ethics, attitude, level of regulatory compliance and the dysfunctional parts of its compliance program, etc.

Also, one key benefit of this interview is to identify whether the employee may potentially become a whistleblower or, at the very least, a detractor of the organization. Sometimes by giving the departing employee an opportunity to vent, you can diffuse his or her anger. Regardless, you will learn much you need to know.

A departing employee’s perspective certainly can be biased. But someone with no vested interest in avoiding conflict or being diplomatic will often reveal information not otherwise known to company executives. An exit interview may be particularly helpful to identify inappropriate behavior patterns by management, such as laziness, cover-ups or harassment.

Typically, the human resources manager/director/officer conducts this meeting. However, this facilitator should be prepared to steer the discussion to the company’s compliance officer if the employee begins to identify specific compliance concerns. Of course, the exit interview should welcome information about problems or recommendations that go beyond reimbursement and fraud issues.

So, having spent a number of recent columns discussing the care and feeding of whistleblowers, what conclusions may we draw? I suggest that there are three lessons to be learned.

First, whistleblowers fuel the government’s enforcement activities. In fiscal 2006, whistleblowers brought the federal government $1.3 billion in settlements and judgments. Not only do whistleblowers typically generate more than half of the government’s anti-fraud revenues, their information alerts the feds to issues to be addressed in their enforcement work plans.

Second, any company has the ability to create whistleblowers. The ingredients for this recipe include:

• hypocrisy, by implementing compliance protocols that are then ignored or applied selectively;
• dismissiveness and disrespect for personnel who wish to ask questions or identify potential problems;
• a disorganized or non-existent reporting mechanism that allows personnel to tell you about concerns;
• failure to communicate with personnel after they alert you to concerns; and
• failure to reward employees for their efforts with acknowledgement, thanks and, perhaps, tangible benefits.

Third, potential whistleblowers can often be defused. A signed waiver may lead disgruntled personnel to conclude that the severance package is preferable to whistleblowing.

Any HME provider will need a vibrant, loyal workforce in order to thrive in the years ahead. When that loyalty turns sour, it can lead to serious trouble. When nurtured, the passion that fuels most whistleblowing can instead be used for the company’s continued growth and success.

Neil Caesar is president of the Health Law Center (Neil B. Caesar Law Associates, PA), a national health law practice in Greenville, S.C. He also is a principal with Caesar Cohen Ltd., which offers compliance training, outsourcing and consulting and the author of the Home Care Compliance Answer Book. He can be reached by e-mail at [email protected] or by telephone at 864/676-9075.