This blog post excerpts an article written by Bill Sacks, former Vice President of COI Management at HCCS, A HealthStream Company.
Examples of Conflicts of Interest
Conflicts of interest can range from the most simple and obvious to extraordinarily complex, as a few examples can demonstrate. One meeting planner was found to be regularly sending business to a restaurant owned by her husband while neglecting to disclose the relationship as required. In another case, a department manager hired her husband, who was subsequently paid significant overtime, all while maintaining a full time job outside the university. In a particularly egregious example, a salaried Chief Compliance Officer contracted with an outside firm—where she was the only employee—to provide compliance services normally provided by the CCO. These were clear conflicts, some of which amounted to outright fraud.
Situations Ranging from Simple to Complex
Other situations can be far more complex. One former CCO recounted a story of a clinical staff member who developed a software solution in cardiology, retaining ownership with approval from leadership. Under that arrangement no royalty payments were received from the healthcare institution. Shortly thereafter, the product was picked up by a third party distributor, resulting in a “spider web” of ownership, financial, and management issues that needed to be untangled.
While some providers demonstrate total commitment to disclosure, and seek to avoid even an appearance of conflict (an example being “I think I accidentally accepted a sandwich from Merck!”), others will “forget” or claim ignorance of disclosure requirements. In those cases, compliance officers can employ various tools to assess the accuracy of disclosures. The open payments database may be the most well-known resource, but savvy compliance officers will periodically Google the names of their most prominent physicians to identify relationships from press releases, conference agendas, etc.
Look for Unusual Prescribing Patterns
Electronic medical records can identify unusual prescribing patterns tied to pharma company payments. Information from the purchasing department will identify the specific medical devices used in orthopedics, cardiology and other departments, and help an auditor to determine whether there are questionable financial relationships with specific device manufacturers.
Inject Common Sense
As stated earlier, well defined policies and procedures can provide a template for improved understanding and compliance with conflicts of interest policies. But even the best designed policies and rules cannot anticipate every possible situation. One compliance officer from horse country recounted a conversation with one of her physicians, who complained that there was no specific rule prohibiting the action he had been called to task on. She told him: “There is no rule that says not to bring your horse to work, but… DON’T bring your horse to work!”
This article also includes:
- Leadership Can Set the Tone for COI Compliance
- Use Surveys and Questionnaires, Supplemented by the Open Payments Database and Google to Identify COI Issues
- Unexpected Signs of a Healthcare COI
Download the article here.