“I really nailed my bosses at work today,” Lynda Lyer bragged to her friends after her shift at Dewitrite Homecare Supply Co. “My supervisor is always on my tail for mistakes. So I called my company hotline number and said that my boss told me to put down the wrong billing information. Now, not only will he get in trouble, but if they try to go after me, I'll claim that they are discriminating against me because I blew the whistle on them!”
On the other side of town, Marvin Malicious boasts to his drinking buddy. “That brown-noser Gary Goodness has bugged me for too long, so I called my company hotline and told them that Gary was stealing supplies from the warehouse. I even planted some nebulizers in his office. Best of all, I remain anonymous since I used the hotline!”
In our exploration of effective reporting methods, we must pause briefly to consider that special breed of employee, the “jerk.” Unfortunately, personnel may be motivated to use your HME's reporting mechanisms inappropriately. As with Lynda Lyer, a substandard employee might use the reporting structure to put on the cloak of a whistleblower. Others, like Marvin Malicious, may view the reporting structure as a means to get even with fellow employees, whether the alleged offenses are real or imagined.
Does Dewitrite Homecare have any recourse against Lynda and Marvin? Yes — to an extent.
Every home care company must make clear that personnel will be subject to severe discipline if they exploit the company's reporting systems to spread false rumors. However, companies must be quite careful when enforcing this rule.
Discipline should only be imposed when there is substantial evidence of false information, fabrication and so forth. Otherwise, sincere employees who report inaccurate information could be subject to unfair discipline.
None of this, however, means that you should accept bad behavior. Just make sure that the evidence supports the consequences that follow.
Overall, home care providers must accept a certain amount of improperly motivated reporting as an unavoidable consequence of the reporting mechanism itself. Some mechanisms, such as hotlines, make malicious activity more difficult. Even anonymity can be put in place using a tracking system so that the employee is anonymous but still identifiable. If there are repeated false allegations, the employee can then be tracked, and the company can take direct steps to curtail the inappropriate hotline use.
Finally, let's meet Charlie Coldcall, a marketing representative trying to improve his sales figures.
“Hello, Hotline? I think someone in my company targeted potential customers by calling everybody on the roster at a nearby senior center. Is this the kind of thing they are allowed to do under the Medicare rules?” Charlie resists giving his name because “first I want to know the Medicare rules about unsolicited calls.”
“Sir, I can't advise you about Medicare's rules. You will have to talk to your compliance officer or counsel.”
“Wait a minute!” Charlie objects. “Why should this be a compliance problem?”
Charlie illustrates one other danger of reporting systems, that of the employee who tests the waters. This staffer typically utilizes the system to inquire whether some activity of an alleged colleague is in line with company policy.
These reports should be taken seriously, even where the staffer declines to give his name. Investigate whether the actions discussed in the “hypothetical” inquiry have actually taken place. Even where there is no evidence of wrongdoing, alert your compliance team.
Even though your reporting system must tolerate inappropriate behavior, it is still one of the cornerstones of an effective compliance system. Nurture it well, encourage its use repeatedly and reward those who use it appropriately with thanks, praise and respect. You will be rewarded with increased compliance and increased profits — the kind you don't have to pay back to the government two years later with interest and penalties.
Materials in this article have been prepared by the Health Law Center for general informational purposes only. This information does not constitute legal advice. You should not act, or refrain from acting, based upon any information in this presentation. Neither our presentation of such information nor your receipt of it creates nor will create an attorney-client relationship.
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@example.com or by telephone at 864/676-9075.
The ROPE Ladder
Rung 1: Articulate the way you want things to run, and note how they run now. Then, tweak your systems as necessary to comply with “The Rules.”
Rung 2: Teach your operating systems to your employees.
Rung 3: Implement a clear and simple method for dealing with problems — identify them, report them, investigate them and fix them.
Rung 4: Give your compliance staff resources to help them keep up-to-date with internal and external changes that may sometimes require you to refine your operating systems.
Rung 5: Monitor your operating systems to make sure they continue to run as you intended.