When the Good Go Bad

Written by: Sam Jones

Have you ever seen the show Designated Survivor? If you haven’t, here’s a quick premise: During the State of the Union, a cabinet member is chosen as the “Designated Survivor” for the worst-case scenario. As you may have an idea, Tom Kirkman, the US Housing and Urban Development Secretary, is chosen as the “Designated Survivor,” and the worst-case scenario ends up happening: The Capitol is blown up, the entire Congress, President, Vice President, and other top leaders die in the terrorist attack. Now it is left up to Tom Kirkman to rebuild the country and find those responsible.

The show went on for three seasons before getting canceled. Over those three seasons, Kirkman is seen as this morally upright individual who always does the right thing, no matter the political implications. You love him and think, “I wish we had more leaders like him!” Now, this show has been over since 2019, but I’ll still say SPOILER ALERT: At the end of season three, you begin to see this example of a leader with upstanding morals let the power take hold, and he begins his descent into becoming just like all the other politicians—power-hungry and corrupt.

What does this show, and Tom Kirkman have to do with compliance? It’s a reminder that just because you have someone in charge of compliance, it doesn’t mean they are immune to breaking the law, whether on purpose or not. We recently saw a clear example of this from the DOJ at the beginning of June.

Steven King, the Chief Compliance Officer for the pharmacy holding company, fraudulently billed Medicare for over $50 million for dispensing lidocaine and diabetic testing supplies that Medicare beneficiaries did not need or want. A1C Holdings LLC, which had pharmacies in multiple states, was operated by King and the co-conspirators. To achieve their goal, A1C would secure prescriptions and refills for these pharmacies, even though it was medically unnecessary, violating Medicare and pharmacy benefit manager rules.

King and others would enroll brick and mortar retail locations for their mail processes to evade rigorous oversight. They would ship refills for medications with high reimbursement, all doing so without patient consent while moving these patients among their pharmacies without their knowledge as well. The group ensured Medicare was billed for these profitable medications and supplies. As the press release said, “As chief compliance officer, King was in a unique position to prevent and report the fraudulent scheme, but he used his position to defraud Medicare instead.” He was convicted of conspiracy to commit health care fraud and wire fraud and now faces a maximum penalty of 20 years in prison.

It is important to put the right person as the head of your compliance program in your organization. But it is also important to make sure compliance is part of the organization-wide culture so that everyone can be in check and power or knowledge doesn’t lie in the hands of one individual. It doesn’t mean that corruption will happen if you don’t, but you are taking away more temptations. Pick the right people, build a team to support them, but also keep them in compliance as well. This will help make sure your team is doing the right thing, the right way, at the right time.

Most business leaders get frustrated when employees don’t do the right thing.  You shouldn’t have to convince people to do what is right.  MCA builds a compliance program and a culture where employees do the right thing, the right way, at the right time so you can focus on taking care of the people you serve.

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Midwest Compliance Associates

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