Articles on Compliance Strategies

Featured Health Business Daily Story September 18, 2008

'Staged' Calls to Compliance Hotlines Can Help Separate Effective Operators From Bad Performers

Reprinted from REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues.

When the hotline operator answered the phone, he got an earful from a tearful employee of the County of Orange Health Care Agency (HCA) in California. The employee reported that her boss had thrown out all kinds of confidential patient information in the regular trash instead of shredding it. And her boss had threatened to cancel the caller's vacation if she breathed a word of her actions to anyone. But it was both a HIPAA violation and a breach of HCA's non-retaliation policy, and the employee just couldn't let it slide. "Someone higher up than me needs to stop her," the employee said.

So the hotline operator, who works for HCA's hotline vendor, wrote up a report detailing the employee's allegations and sent it to HCA's compliance officer. It was just another call among many that he handled day in, day out. Little did the hotline operator know that the complaint was a fake, a scenario crafted by HCA's chief compliance officer, Jeffrey Nagel, Ph.D., and his team, as part of its audit of hotline effectiveness.

Staging hotline calls, says Nagel, is perhaps the only way that he really knows whether his hotline vendor does a good job answering calls, taking down information reported by callers, writing reports and forwarding the information to HCA's compliance office, as required. He stages three calls a year and shares the results with the hotline vendor, which Nagel declined to identify. Compliance committee members volunteer to place the fake calls to ensure hotline operators don't recognize any voices.

When staged calls are placed, Nagel evaluates the hotline operators for how accurately they capture the caller's complaints. "We request [that] hotline operators try to take down verbatim as much as possible what is said to them and to clarify it if it doesn't make sense," he says. He also checks to see whether the report is assigned a unique call-back number, which is used by the caller to identify the issue that he or she reported in order to receive feedback about the investigation. "We follow [the staged call] right to the end," he says. "We even verify that the operator reads the exact feedback provided by the compliance program to the hotline vendor at the conclusion of our 'investigation.'"

Watching how its vendor handles fake calls is one step of HCA's four-part process for evaluating the effectiveness of its hotline's operation, Nagel says. The process consists of (1) a review of compliance statistical-analysis reports provided by the vendor for hotline calls received during the review period; (2) a review of communication tools used to advertise the hotline, to assess effectiveness of the tools; (3) a review of the compliance survey responses related to hotline usage; and (4) staged test calls to the hotline service by compliance committee volunteers to assess the professionalism of the operators, the accuracy of the reports used to transmit the information obtained by the hotline service and the adherence of the contractor to the agreed-upon statement of work.

Staged Call Uncovers Bad Operator

Though Nagel is happy with the overall performance of HCA's hotline vendor, the company did have one rude, unhelpful hotline operator. Her poor performance was exposed by a staged call, he explains, which led to the vendor firing her. It turned out that it was not the first time she had behaved badly, he adds.

Here's what happened, according to Nagel:

An HCA employee called the hotline to report a timecard issue. It involved miscoding time spent on nongrant-related activities to a federal grant to maximize the amount HCA could collect. "This would be considered a serious compliance issue by most compliance professionals," Nagel says. (It didn't really occur, of course, because it was a staged call.)

But the operator refused to take down the information. "Instead, the operator read a canned statement indicating that [the employee] had a human resources issue and to call human resources." The chief compliance officer says the hotline caller (who volunteered to be part of the staged call) "found the experience to be confusing and thought that she had made a mistake because she was not assigned a reference number for the call."

Nagel shared the experience with the hotline vendor. "I am actually very pleased with our vendor, and they were very responsive to our feedback about this particular call," he says.

HCA also staged a call this year about time abuse. A compliance committee member placed a call to the hotline to report this fake problem: "Linda Lovely is going home early four to five days a week. I heard her laughing about this job being a joke. She tells Ned Neverland, her supervisor, that she has appointments for training and leaves by 12:00 almost every day. Several people have heard her talk about the county being so stupid because she gets paid full time but never has to do any work. She brags that she will never get caught because Ned did the same thing before he got promoted to supervisor."

HCA has also placed staged calls about licensing issues, credentialing, abusive managers and employee theft, among other things. "You can make up just about any issue you want," says Nagel. "The important thing is to have the scenario written out so you can compare what you receive back from the hotline to what was read to them."

The process of staging calls has also led to some insights about the way to make the reporting process more effective. "I want to encourage [employees] to bring things up internally, so I changed the script [used by hotline operators when they answer calls] so they don't become whistle-blowers," Nagel says. "It was a bit stilted. We made it more friendly."

Also, he says, he encouraged the hotline operators to try to extract more details from callers when they are vague about their complaints. Operators are encouraged to ask the five "Ws" — who, what, when, where and why — and to say things like, "It's not clear what you mean." Otherwise, there is not enough information to investigate. Then the caller thinks nothing is being done and feels alienated and ignored when the reality is that the caller didn't provide enough details to trigger an investigation.

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