An integral approach to compliance.

ABSTRACT

Financial managers of managed care organizations should structure their compliance plans to conform with requirements shaped by forces such as judicial decisions and extralegal standards for managed care operations, in addition to state and Federal laws and regulations. In addition to researching the law and training employees, an integral compliance plan should include monitoring organizational systems that can encourage or impede compliance, measuring employees' motivation to adhere to compliance standards, and modifying corporate culture to support compliance goals. Managed care organizations should empower compliance officers with a broad range of tools to assess and improve compliance efforts, or risk having organizational decisions examined externally through the lens of an onerous, dynamic system of laws and judicial decisions.