Professional Practice, Leadership, and Ethics
Compliance is a system, not a slogan
Expect questions on the elements of an effective compliance program: written policies and procedures, a designated compliance officer and committee, training and education, open lines of communication, internal monitoring and auditing, consistent enforcement and discipline, and prompt response with corrective action. Understand the laws that make it matter: the False Claims Act, including qui tam relators and treble damages; the Anti-Kickback Statute, which is intent-based and covers remuneration for referrals; the physician self-referral law, which is strict liability for designated health services; and the HIPAA privacy and security rules.
Leadership questions test whether you can separate the person from the process: fair enforcement, documented decisions, escalation, and no retaliation against someone who reports a concern.
Traps
- Routine waiver of copays or deductibles for all patients; this can be treated as remuneration and raises Anti-Kickback and False Claims exposure.
- Productivity bonuses tied directly to billing volume or code levels without quality and compliance guardrails.
- Free or discounted services to physicians or facilities that refer patients.
- Sharing passwords or letting a colleague use your credentials.
- 'Everybody in this specialty bills it that way'; custom is not a legal defense.
- Retaliating, even subtly, against a staff member who raised an issue.
Rule of thumb
If a workaround only makes sense because no one is watching, it is a compliance question. Escalate in writing and document the answer.
Worked example: A practice proposes waiving 20 percent copays for all new patients to attract business. The correct response is to recognize the pattern rather than negotiate a discount: routine waivers for insured patients can implicate the Anti-Kickback Statute and the False Claims Act. A case-by-case hardship determination with documented financial need is a different thing from a standing policy.