Compliance Experts Research Articles

An initiative to improve mortality index in gynecologic oncology.

256 Background: The mortality index (MI) is a quality metric that measures the ratio of actual mortality to expected mortality among inpatients. Expected mortality is a probability calculation based on patient risks and comorbidities. A MI of < 1.0 represents that fewer patients die while admitted to the hospital than expected. Methods: We formed a multidisciplinary team that included Gynecologic Oncology (GO), Health Information Management, Clinical Informatics, Revenue Operations, Coding and Institutional Compliance experts. Our aim was to decrease the GO MI by 10% within a year. Quality Improvement Assessment Board approval was obtained. GO clinical providers were educated on proper documentation of patient comorbidities and severity of illness. Audits of the documentation were performed by the multidisciplinary team. GO patients perceived at high-risk of inpatient mortality were identified for additional review. All GO inpatient deaths were reviewed at the monthly GO Morbidity and Mortality conference and opportunities for avoidance of inpatient death were discussed. Plan-Do-Study-Act (PDSA) cycles were repeated with adjustments made to the review and education processes. Baseline (BL) 8/2017-7/2018 and interim post-intervention (PI) 11/2018-2/2019 outcomes were compared using the Mann Whitney U test. Results: The BL median number of inpatient deaths per month was 2 (range 0-7), with a median expected mortality of 2.96 (range 1.46-5.11), and a median MI of 0.84 (range 0-1.37). The PI median number of inpatient deaths per month was 2.5 (range 2-5), with a median expected mortality of 4.24 (range 3.77-5.06), and a median MI of 0.56 (range 0.53-1.27). The number of inpatient deaths per month was similar between groups (2 vs 2.5; p = 0.49) but the expected mortality increased from to 2.96 to 4.24 (p = 0.03). MI decreased by 33% between BL and PI (0.84 vs 0.56). Conclusions: Inpatient mortality is an important quality metric. Accurate measurement of expected mortality is critical and requires proper documentation. This can be improved through education, review and frequent assessment by PDSA cycles. Our preliminary results show improvement in accurate documentation and measurement of expected mortality resulting in a decrease in MI.

Insider trading – unsolved issues

PurposeThis paper aims to show that, despite the development of prevention mechanisms for banks, undetected insider trading remains highly feasible. It, thereby, highlights that the current anti-insider-trading mechanisms, on which previous literature has extensively focused, can be easily circumvented.Design/methodology/approachA two-step research process was employed. First, informal interviews were conducted with illegal financial services providers. Second, 50 compliance experts and law enforcement officers were formally interviewed. Responses from both sets of interviewees were subjected to quantitative content analysis to yield empirical findings.FindingsConcrete and specific methods of insider trading and limiting the risks of being prosecuted were reported by interviewees. They suggested that the use of strawmen and offshore banks greatly facilitate insider trading.Research limitations/implicationsThe perspectives of the 100 interviewees have not been quantitatively tested.Practical implicationsSuggestions on how to more effectively combat insider trading are provided for financial institutions and compliance officers.Originality/valueAlthough the empirical findings are based on conditions in Europe, the results have potential global application.

Financing of terrorism through the banking system

PurposeThe purpose of this paper is to illustrate that it remains feasible for terrorists to use the banking system to transfer funds to finance their activities.Design/methodology/approachBased upon a qualitative content analysis of 15 informal interviews with financiers of terrorism and 15 formal interviews with compliance experts and law enforcement officers, concrete methods of financing terrorism through the banking system can be described.FindingsEven though banks have implemented strict control mechanisms, they often do not give the same attention to terrorism financing as they do to money laundering. Recently, refugees and “tourists” may have been involved in terrorism financing. When it comes to transferring larger amounts of money, terrorists do not necessarily act in their own name, but rather hire “straw men”. Some terrorists have proceeded to set up real companies in Turkey. Terrorists can explain why funds need to be transferred from Europe to Turkey through “charitable contributions”. Transfers of large amounts of money can also be facilitated by lawsuits.Research limitations/implicationsThe findings are based on semi-standardized interviews limited to the perspectives of the 30 interviewees.Practical implicationsThe identification of gaps in current terrorism-financing prevention mechanisms provides both compliance officers and legislators with valuable insights.Originality/valueWhilst the existing literature focuses on understanding the channels terrorists can use to finance their activities and on developing prevention mechanisms, this paper emphasizes that terrorists can still use the banking system to accomplish their goals. This paper illustrates ways terrorists can transfer funds through banks.

Incentive systems in anti-bribery whistleblowing

PurposeWhile existing literature focusses on the causes and negative consequences of corruption, this paper illustrates the potential use of whistleblowing incentives to combat bribery in multinational corporations. The purpose of the present study is to highlight that anti-bribery mechanisms, which have already been successfully applied in the public sector, may also be deployed in multinational organisations.Design/methodology/approachA two-step qualitative research process was used. Informal interviews were conducted with 35 corrupt public officials, followed by formal interviews with 35 compliance experts and law enforcement officers. During the interviews, the advantages and disadvantages of whistleblowing incentives in multinational corporations were discussed. The interviewees’ responses were subjected to content analysis.FindingsThe principal finding was that rewarding employees with significant monetary bonuses may help to increase anti-bribery whistleblowing. However, such bonus payments should be made in only major cases of bribery to safeguard multinational corporations, company cultures and trust among employees.Research limitations/implicationsThe findings convey the perspectives of the 70 interviewees based in Austria, Germany, Liechtenstein and Switzerland.Practical implicationsThe paper offers suggestions to multinational corporations on how to effectively combat corruption and other forms of white-collar crime.Originality/valueWhile the empirical findings are based on a European sample, the results may be applied globally.

Compliance as a service: Utilising the power of the cloud

The importance and changing nature of financial regulation requires special attention to a variety of domains: law, financial instruments and technology. Historically, technological innovation in the financial sector has developed asymmetrically by favouring outperformance and revenue generation to the detriment of ensuring regulatory obligations were complied with in a robust, demonstrable yet cost-effective way. This paper explores advancements in compliance-related technology brought on by the increased use of cloud software, data standardisation and a new application of the software as a service (SaaS) model: compliance as a service (CaaS). It includes an analysis of how utilising the network effects provided by cloud technology improves compliance outcomes. This new model of regulatory compliance lowers the risk of errors in legal interpretation, facilitates industrywide collaboration among a community of compliance professionals and brings important insights from practice to bear on often abstract legal reasoning. The unique combination of high-touch service by compliance experts and an ability to both discuss and learn from peers avoids the pitfalls of the traditional outsourcing model and naturally creates an industry standard. In this model, participants gain knowledge while reducing costs through a high level of automation and with assurance that regulatory change is integrated at speed.

Financing terrorism through hawala banking in Switzerland

PurposeThis paper aims to illustrate the feasibility of circumventing the Swiss financial sector’s compliance mechanisms by financing terrorism through hawala networks.Design/methodology/approachBased upon a qualitative content analysis of 15 informal interviews with providers of illegal financial services and 15 formal interviews with compliance experts and law enforcement officers, the general suitability of hawala networks for the financing of terrorism was assessed and concrete methods of doing so were better understood. In addition, it is shown how terrorists can limit their risks in using the services of hawala bankers.FindingsHawala banking in Switzerland is extraordinarily useful for the financing of terrorism.Research limitations/implicationsThe findings are based on semi-standardized interviews limited to the perspectives of the 30 interviewees.Practical implicationsLaw enforcement and intelligence agencies must be provided with additional tools, such as a broader scope of allowable activity for undercover police officers and the possibility of secretly conducting remote online searches of electronic devices. While this article focuses on Switzerland, its findings could be applied on a global level.Originality/valueWhile the existing literature focuses on understanding the channels terrorists can use to finance their activities and on developing prevention mechanisms, this paper describes exactly how terrorism can be financed through hawala networks in Switzerland.

Emergency Information Forms for Children With Medical Complexity: A Qualitative Study.

Children with medical complexity (CMC) are at risk for poor outcomes during medical emergencies. Emergency information forms (EIFs) provide essential medical information for CMC during emergencies; however, they are not widely used. We sought to identify factors related to optimal care for CMC to inform development of EIFs for CMC. We interviewed 26 stakeholders, including parents of CMC, healthcare providers, health information technology, and privacy compliance experts. We inquired about barriers and facilitators to emergency care of CMC, as well as the desired content, structure, ownership, and maintenance of an EIF. Audio recordings were transcribed and analyzed inductively for common themes using thematic analysis techniques. Providers identified problems with documentation and poor caregiver understanding as major barriers to care. Parents reported poor provider understanding of their child's condition as a barrier. All groups reported that summary documents facilitate quality care. Recommended content included demographic/contact information, medical history, medications, allergies, advance directives, information about the patient's disease, and an action plan for anticipated emergencies. Twenty-three participants indicated a preference for electronic EIFs; 19 preferred a Web-based EIF that syncs with the medical record, with paper or portable electronic copies. Although 13 participants thought that EIFs should be patient owned to ensure availability during emergencies, 19 expected medical providers to create and update EIFs. Stakeholders interviewed reported a preference for Web-based, sync-capable EIFs with portable copies. Emergency information forms could be maintained by providers but owned by patients to optimize emergency care and align with the concept of the medical home.

The Hidden Power of Compliance

Although corporate wrongdoing can reach an immense scale with disastrous ramifications, holding boards accountable has long been perceived as elusive. Under both state fiduciary duty law and federal securities doctrine, directors and officers are liable only if they were aware of corporate failures or reckless in ignoring them. Since providing evidence of awareness or recklessness is exceedingly hard, corporate law scholars have long seen these requirements as raising an almost impenetrable shield over the board. Instead, we demonstrate that the evidentiary path to boards’ state of mind is nowadays more open than it has ever been before, due to the revolutionary growth of compliance departments in recent years. Corporate law literature has largely dismissed compliance as ineffective, fearing that in-house monitors would be too weak or too loyal to constrain corporate wrongdoing. Contrary to this conventional wisdom, we argue that legal and compliance experts’ reports and recommendations, especially if ignored at the time they were made, often expose the board to liability once misconduct is revealed. To support our argument, we turn to parallel case law developments in Delaware fiduciary duty law and federal securities doctrine in the last ten years. We show that, in order to better delineate board liability, state and federal rulings have raised the evidentiary standards, demanding concrete proof that directors were aware of ongoing violations or had received sufficient red flags. In response, courts turn time and again to internal reports by legal and compliance personnel, which are well-suited to offer the requisite evidence. We offer a systematic analysis of Delaware jurisprudence in the last ten years since the landmark Stone v. Ritter ruling, which shows how instrumental legal and compliance personnel are in guiding the board through the multi-pronged requirements of its monitoring duties. We trace similar developments in federal securities class actions under Rule 10b-5. Finally, we discuss a small but growing body of law which imposes personal liability on legal and compliance personnel if they fail to alert the board about ongoing misconduct or gaps in its oversight systems. The threat of personal liability further cements the position of these officers vis-a-vis the board. To show how these developments transformed the legal treatment of massive corporate wrongdoing in practice, we study four recent high-stakes corporate debacles: the Wells Fargo fake accounts scandal, the Yahoo cybersecurity breach, the General Motors ignition switch scandal, and the Washington Mutual mortgage meltdown. Our case studies illustrate that the choices legal and compliance officers make when communicating with the board end up determining its liability. Chief legal and compliance officers, we conclude, have become the leading corporate actors in ensuring sound risk management and ethical leadership for companies.

How are Small Banks Faring Under Dodd-Frank?

This paper presents the results of the Mercatus Center’s Small Bank Survey, which include responses from approximately 200 banks across 41 states with less than $10 billion in assets each, serving mostly rural and small metropolitan markets. The initial analysis suggests that Dodd-Frank significantly affects small banks and their customers. A large majority of respondents viewed Dodd-Frank as more burdensome than the Bank Secrecy Act, and the participating banks reported substantially increased compliance costs in the wake of new regulations. These costs include hiring new compliance personnel, increased reliance on outside compliance experts, additional resources allocated to compliance, and more time spent by noncompliance employees on compliance. The increased regulatory burdens have led small banks to reconsider their product and service offerings, including considering whether to stop providing residential mortgages. Many small bank customers, who will have difficulty locating convenient alternatives, will feel the indirect effects of Dodd-Frank.

The role of rules-based compliance systems in the new EU regulatory landscape

Purpose – The purpose of this paper is to understand how institutional changes to the European Union regulatory landscape may affect corresponding institutionalized operational practices within financial organizations. Design/methodology/approach – The study adopts an Investment Management System as its case and investigates different implementations of this system within eight financial organizations, predominantly focused on investment banking and asset management activities within capital markets. At the systems vendor site, senior systems consultants and client relationship managers were interviewed. Within the financial organizations, compliance, risk and systems experts were interviewed. Findings – The study empirically tests modes of institutional change. Displacement and Layering were found to be the most prevalent modes. However, the study highlights how the outcomes of Displacement and Drift may be similar in effect as both modes may cause compliance gaps. The research highlights how changes in regulations may create gaps in systems and processes which, in the short term, need to be plugged by manual processes. Practical implications – Vendors abilities to manage institutional change caused by Drift, Displacement, Layering and Conversion and their ability to efficiently and quickly translate institutional variables into structured systems has the power to ease the pain and cost of compliance as well as reducing the risk of breeches by reducing the need for interim manual systems. Originality/value – The study makes a contribution by applying recent theoretical concepts of institutional change to the topic of regulatory change uses this analysis to provide insight into the effects of this new environment.

SOA-enabled compliance management: instrumenting, assessing, and analyzing service-based business processes

Facilitating compliance management, that is, assisting a company's management in conforming to laws, regulations, standards, contracts, and policies, is a hot but non-trivial task. The service-oriented architecture (SOA) has evolved traditional, manual business practices into modern, service-based IT practices that ease part of the problem: the systematic definition and execution of business processes. This, in turn, facilitates the online monitoring of system behaviors and the enforcement of allowed behaviors--all ingredients that can be used to assist compliance management on the fly during process execution. In this paper, instead of focusing on monitoring and runtime enforcement of rules or constraints, we strive for an alternative approach to compliance management in SOAs that aims at assessing and improving compliance. We propose two ingredients: (i) a model and tool to design compliant service-based processes and to instrument them in order to generate evidence of how they are executed and (ii) a reporting and analysis suite to create awareness of a company's compliance state and to enable understanding why and where compliance violations have occurred. Together, these ingredients result in an approach that is close to how the real stakeholders--compliance experts and auditors--actually assess the state of compliance in practice and that is less intrusive than enforcing compliance.

An iterative approach to synthesize business process templates from compliance rules

Companies have to adhere to compliance requirements. The compliance analysis of business operations is typically a joint effort of business experts and compliance experts. Those experts need to create a common understanding of business processes to effectively conduct compliance management. In this paper, we present a technique that aims at supporting this process. We argue that process templates generated out of compliance requirements provide a basis for negotiation among business and compliance experts. We introduce a semi-automated and iterative approach to the synthesis of such process templates from compliance requirements expressed in Linear Temporal Logic (LTL). We show how generic constraints related to business process execution are incorporated and present criteria that point at underspecification. Further, we outline how such underspecification may be resolved to iteratively build up a complete specification. For the synthesis, we leverage existing work on process mining and process restructuring. However, our approach is not limited to the control-flow perspective, but also considers direct and indirect data-flow dependencies. Finally, we elaborate on the application of the derived process templates and present an implementation of our approach.

Understanding pharmacy department billing and the charge master

Every hospital develops a charge master, also called a charge description master (CDM). Although CDM designs differ among hospitals, they generally include similar types of data: general ledger number, product description, billing units, Healthcare Common Procedure Coding System (HCPCS) codes, revenue codes, and pricing information. Functioning as the line-item detail for all hospital billing and compliance, a CDM is the central billing mechanism for all supplies, procedures, services and drugs. Because of the complexity of the charging and billing processes, it is vital that pharmacy directors and managers understand the various resources available to assist them in making intelligent decisions regarding their practices. The first and most important resources are the hospital leaders and other individuals at the facility who are responsible for charging activities. Consequently, pharmacy directors and managers must establish a proactive working relationship with executive leadership and the finance department, especially the chief financial officer (CFO). Within an institution, the CFO provides critical guidance regarding CDM organizational goals and legal requirements. Pharmacy managers should also collaborate with compliance experts, coding and billing personnel, and accounting and business office personnel, who often are the best resources for learning about the CDM processes and regulations.

Fundamentals of Clinical Trials

The randomized clinical trial has become a significant career focus for an eclectic group of professionals, which includes physicians, epidemiologists, statisticians, computer specialists, compliance experts, nurse coordinators, and others. A society for clinical trials has evolved, which now has about 1500 members and publishes a quarterly journal. Courses in clinical trials are widely available, and several books have appeared to summarize the considerable practical experience and burgeoning methodological literature. Friedman and his collaborators brought out one of the first of these in 1981, which they have now updated. It is a well-written little book, which can be read in a day or so but could equally well serve as the basis for a semester course. The basic concepts underlying clinical trials are easily grasped, so most of the subject matter is accessible to the statistically unsophisticated reader. The authors have organized the book around a series of fundamental points, which