Hospital Compliance Issues

Physician-industry interaction, in the form of consulting, teaching and clinical trials, repeatedly helps patients by improving the practice of medicine. But quite a few people have a different perception of such collaboration. They see collaboration as potential conflicts of interest, conflicts that enrich companies and physicians. These perceptions have led to laws like Stark and Anti-Kickback … and new rules like Sunshine.

For years, industry has been paying billions of dollars in settlement fees. Similarly, hospitals have suffered millions in defense and compliance costs. Why? Often hospitals don’t have the required information (due to out-of-date and inaccurate data.) Many physicians are not properly trained in related compliance requirements. Few physicians have adequate legal and accounting support; as a result, they cannot prove whether they are being paid at fair market value.

Outstanding physicians have been investigated by Congress, HHS Office of General Counsel, US and state Attorneys General and the IRS. Their careers have been ruined by guilt by investigation, leaving them disappointed at their hospitals for not adequately defending them. No wonder physician-industry interactions dropped 50% over five years.

Existing regulations, new NIH rules and Open Payments have created a need for hospitals to pay significant attention to insuring that the outside activities of their physicians comply with numerous requirements.