June Gibbs Brown Reflects on Her Legacy as Health and Human Services Inspector General

This time last year we were deep in preparation for our annual Healthcare Best Compliance Practices Forum. Every year at the Forum, the Health Ethics Trust (a division of the Council of Ethical Organizations) selects a fellow of the Trust in recognition of their significant contribution to health care integrity and compliance. We had just approached Ms. June Gibbs Brown to see if she was willing to accept this honor, and we were awaiting her reply. It was the feeling of Trust staff, the Steering Committee and many of our members that few were as worthy of this award than Ms. Brown. Much to our delight she accepted the fellowship and appeared at the Forum to receive the honor. Shortly after this she kindly agreed to be interviewed and talk about her legacy as Health and Human Services Inspector General. Ms. Brown had only just retired at this time and the following account of the interview captures her thoughts and reflections about her experiences shaping health care compliance. We believe this interview provides important insights into the history and philosophy of one of the most influential figures in health care compliance to date.

Foreword by Mark Pastin

This is one of the most important interviews we have published in The Pastin Report. Until her retirement from the position of Inspector General of the United States Department of Health and Human Services, June Gibbs Brown was the first and final authority on compliance in health care. I have tracked Ms. Brown's career in an odd sort of sychronized dance over my own career in ethics and compliance. I have not always agreed with her, but I have always respected and learned from her. I have worked on the "outside" as an academic, consultant and finally as an organization executive, trying to preach the gospel of ethics and compliance. Ms. Brown was on the "inside" meting out punishment to wrong doers. But that is not really fair to the facts, for Ms. Brown was not the usual item for an Inspector General. She has served as an educator every bit as much as she has served as an enforcer.

I first learned of Ms. Brown when I was a business academic with an active consulting practice. I was working with a lot of defense contractors, and Ms. Brown became the Inspector General for the Department of Defense just as scandals were scalding the industry. So many times I would find that she had ordered a contractor to do something that the consultants had been ineffectually recommending for years. At other times, I would see what she had ordered in one context and try to extend it to new environments. Copying Ms. Brown is a very good way to look bright.

That is not the end of it. There were some bold and brilliant strokes. Rather than trying to clean up the defense industry bit by bit, Ms. Brown influenced the behavior of broad segments by urging compliance provisions in DFARs (Defense Federal Acquisition Requirements), creating a powerful voluntary disclosure program, encouraging the sharing of compliance resources industry wide - while giving enforcement attention to the outliers. In large part through Ms. Brown's efforts, the defense industry today is very, very clean.

In the late 1980s, there was a mandate to establish sentencing guidelines for organizations convicted of crimes. A lot of hard work by a lot of people went into the Sentencing Guidelines for Organizational Crime, but it is no exaggeration to say that none of the resulting seven elements surprised anyone in the defense industry. Without much credit, Ms. Brown had influenced the corporate cultures of decent companies nationwide and, now, globally.

And then came healthcare. When Ms. Brown was appointed Inspector General of the Department of Health and Human Services, little note was taken by the healthcare compliance community. There was none. No one predicted that compliance would become as much a part of the fabric of healthcare organizations as it had become among defense contractors. Bit by bit, settlement by settlement, corporate integrity agreement by corporate integrity agreement, things changed. Ms. Brown created the world of today's healthcare compliance officers. As with defense contractors, Ms. Brown emphasized the compliance carrot as much as the dollars and collars stick.

In 2000, the Steering Committee for the Health Care Best Compliance Practices Forum selected Ms. Brown for the highest honor bestowed by the Health Ethics Trust. Ms. Brown was named as a Fellow of the Trust at the 2001 Forum. I was surprised that a committee composed mainly of compliance officers and healthcare executives selected Ms. Brown. Fellows selected in the past were always compliance officers. That the industry chose its top enforcement official for this honor is unprecedented – and just right.

Ms. Brown was kind enough to sit down over this past summer with Caitlin O'Brien, a senior vice president with the Council, and share thoughts. Ms. Brown's willingness to do this reflects her deep commitment to education as the cornerstone of compliance. We are pleased to offer the following excerpts from this interview.

Mark Pastin, Publisher, can be reached at councile@aol.com

Please note that quotes attributed to Ms. Brown are reconstructed from notes, tape and memories and edited to fit the context. We have tried to be as accurate as possible but accept responsibility for any errors that remain.

The material in this area is proprietary and protected by copyright registration to the Council of Ethical Organizations. Reproduction or dissemination-by any means-including photocopying and transmittal by FAX-is a violation of federal copyright law (17 USC 101 et seq) punishable by fines of up to $100,000 per violation. Violators will be prosecuted. Do not copy, quote, duplicate electronically or by any means disseminate without specific written permission.

The material in this area is proprietary and protected by copyright registration to the Council of Ethical Organizations. Reproduction or dissemination-by any means-including photocopying and transmittal by FAX-is a violation of federal copyright law (17 USC 101 et seq) punishable by fines of up to $100,000 per violation. Violators will be prosecuted. Do not copy, quote, duplicate electronically or by any means disseminate without specific written permission.