Kusserow on Compliance: Human Resources Management Compliance Jurisdiction

By Richard Kusserow, former HHS Inspector General and CEO of Compliance Resource Center.  Reprinted from Wolters Kluwer‘s Kusserow on Compliance Blog

The great majority of internal investigations arise from complaints filed with the human resources management office (HRM) or through the compliance office hotline. Both functions have their own jurisdiction for dealing with sensitive issues, and this can raise tension and conflict if not addressed properly. HRM has a mission to assist employees in a host of ways, ranging from salaries and benefits to working conditions. It is therefore not surprising that the department is a front-line recipient of questions, concerns, complaints, and allegations related to the workplace. For all practical purposes, the primary responsibility for investigating and resolving personnel-related issues, including unfair labor practices, discrimination and harassment, lies with HRM.

Specific rules must be followed when conducting such investigations and the federal agency providing guidance and oversight is not the HHS Office of Inspector General (OIG) or the Department of Justice (DOJ), but the Equal Employment Opportunity Commission (EEOC). Furthermore, in some states, individuals conducting these types of investigations must undergo a designated number of hours of specialized training on the laws and rules governing employees in the workplace.

The sources of workplace complaints are varied, but their emergence is all but inevitable. With that in mind, it is important to have a clearly communicated and consistently applied policy detailing the specific procedure for reporting complaints. Many organizations encourage employees to utilize the “traditional” chain of command approach to reporting and resolution, while others have established more progressive open door communication policies to encourage unrestricted communication. Direct reporting to HRM is also an option for employees.  Allowing employees to report issues via an employee hotline, generally managed by the compliance officer, is yet another mechanism of reporting.  With most hotline calls have issues that fall under HRM primary jurisdiction, it requires careful coordination to guard against a matter falling between the cracks. This does not necessarily create a bright line of authority between the two functions, as many concerns raised may cross the line from being personnel issues to being compliance issues. It is essential that the compliance office and HRM maintain open communications and establish reciprocal reporting obligations for the purpose of ensuring the appropriate department is apprised of issues that are its primary concern. They must be able to coordinate investigative and resolution activity to avoid unnecessary duplication of efforts.

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All of these reporting approaches provide a stream of information that can result in the need for internal inquiry or investigation. It is very important to note that, in order to have an effective reporting program that employees will actually utilize, it must be coupled with a clearly stated anti-retaliation policy. Employees must know that retaliation or attempted retaliation in response to lodging a complaint or invoking the complaint process is strictly prohibited by the organization. In August of 2016, the EEOC issued “Enforcement Guidance on Retaliation and Related Issues”, the EEOC’s first comprehensive review of retaliation since 1998. This was in direct response to the fact that retaliation is now the most frequently alleged basis of discrimination that EEOC receives.

The compliance officer focuses much attention on the Anti-Kickback Statute, Stark Laws, False Claims Act, and other fraud laws with considerable attention given to the OIG, DOJ, and state Medicaid Fraud Control Units. By contrast, the laws that most often occupy HRM interest include Title VII of the Civil Rights Act 1964; the Age Discrimination in Employment Act; the Americans with Disabilities Act; the Family and Medical Leave Act; the Fair Labor Standards Act; the Uniform Services Employment/Reemployment Rights Act; the Employee Retirement Security Act’s governing compensation and benefit plans; and the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) for employer-sponsored health benefits, among others.  The government agencies that oversee these areas are the U.S. Department of Labor, the Equal Employment Opportunity Commission (EEOC), and a variety of state agencies.  Violations can result in serious penalties.

Regarding matters that HRM must investigate and resolve, one area long overshadows (numerically) compliance matters raised to the compliance officer to handle: discrimination and unlawful harassment. Complaints to the federal EEOC and state counterparts number over 100,000 annually.  Many other complaints are received by HRM that never go so far as to be reported to outside authorities.   To meet the challenge of avoiding such complaints, HRM must implement a variety of compliance policies and train everyone on them.  These activities are familiar to compliance officers, who must do the same within their risk areas. However, in the case of some of the HRM-related laws …

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