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DPH compliance office reports whistleblower complaints, privacy breaches and $1.8M voluntary repayments
Summary
The Department of Public Health's Office of Compliance and Privacy Affairs reported 74 whistleblower complaints in FY16-17 (22 substantiated), 16 reportable privacy breaches and roughly $1.8 million in voluntary repayments to Medi-Cal/Medicare; commissioners asked for year-over-year comparisons and noted planned staff expansion.
Maggie Rykowski, chief integrity officer and director of the Office of Compliance and Privacy Affairs (OCPA), told the Health Commission that OCPA operates a 24/7 whistleblower hotline and received 74 complaints in fiscal year 2016-17. The office closed 42 investigations, substantiated 22 claims and had others that remained complex or required coordination with other departments.
Rykowski outlined OCPA's three core components: compliance, privacy and data sharing. She said the office plans to fill four vacant positions (bringing staffing closer to 25 FTE) and recently added a data-sharing officer to oversee legally authorized exchanges intended to improve patient care.
On privacy, Rykowski said the department recorded 16 reportable breaches in FY16-17 (five at Zuckerberg San Francisco General, one at Laguna Honda and 10 elsewhere in the department); anticipated penalties for those breaches were approximately $750,000 for that year. She said OCPA and the department are focusing on access controls and expect the upcoming electronic health record (EHR) system to improve controlled access and reduce unauthorized disclosures.
On compliance and improper payments, Rykowski said internal audits and reviews prompted voluntary repayments of approximately $1.8 million to Medi-Cal and Medicare. She added external auditors recovered close to $4 million in identified improper payments during the year. Commissioners asked for year-over-year comparisons and more robust outcome metrics; Commissioner Karschmer requested that future presentations include comparative data so the commission can see trends.
The commission discussed whistleblower processes and the threshold of specificity needed to investigate anonymous tips; Rykowski said OCPA conducts thorough follow-ups and will investigate anonymous claims where possible. Commissioners thanked the office for its work and noted training and committee oversight opportunities as OCPA builds its staff and operations.
Next steps: OCPA will return with follow-up comparisons and additional metrics in future reports and will continue work on EHR-related access controls and breach mitigation.
