Do What the OIG Does: Use Analytics to Address Compliance Efforts and Resources

Labs need to use the power of data to make your compliance program more focused, efficient and successful. Take a lesson from the Office of Inspector General. An OIG podcast posted this month 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 their own operations before the government does. And, compliance officers can also use data analytics to support their compliance budgets and requests for resources.

Brzymialkiewicz explained that the Chief Data Office, which was initiated a year ago, is focused on “how do we help the OIG become even more effective and efficient in what it’s doing— which includes improving our access to data”—by determining what datasets are needed and how to ensure high quality data. That’s a function laboratories can emulate as well.

The work of the Chief Data Office allows the OIG to plot data geographically to reveal compliance hotspots, to conduct peer comparisons to spot providers who are outliers and identify trends, and to draw connections between providers. The information revealed through analytics also helps the agency internally as well to inform decision makers when setting priorities and allocating resources and staffing. “[T]hen if 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.

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 identify not only operational or revenue issues but potential compliance concerns. Lab compliance professionals can also use data analytics about their 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.