Follow the OIG’s Lead and Use Analytics to Power Your Compliance Efforts

Labs need to use the power of data to make compliance programs more focused, efficient and successful. Take a lesson from the Office of Inspector General. An OIG podcast features an interview with Caryl Brzymialkiewicz, the Chief Data Officer for the HHS Office of Inspector General, who explains the value of data analytics to the agency’s investigation and enforcement efforts. What laboratories can learn from this is not just that the government is using data to ferret out fraud and abuse and false claims but that data can help laboratories find compliance issues within the lab before the government does. And, compliance officers can also use data analytics to support compliance budgets and requests for resources.

Brzymialkiewicz explained that the Chief Data Office, which was initiated a year ago, uses data to help the OIG reveal compliance hotspots, conduct peer comparisons to spot providers who are outliers and identify trends, and draw connections between providers. Labs can likewise use data to identify trends in test ordering and billing, analyze claims denials, monitor relationships with referral sources, compare billing to those of other labs and set benchmarks. Anomalies spotted in the analytics can spot not only operational or revenue issues but potential compliance concerns.

The information revealed through analytics also helps the OIG internally as well to inform decision makers when setting priorities and allocating resources and staffing. “[I]f we need additional resources, we’re standing on some very solid ground in terms of our logic of what we need when we go back and ask people for additional money,” added Brzymialkiewicz.

Lab compliance professionals can similarly use data analytics about compliance efforts and challenges to support requests to the c-suite, board or senior management for more compliance resources or to justify existing compliance budgets.

(A version of this article appeared in the June issue of G2 Compliance Advisor).