The Importance of Healthcare Compliance Programs

The Importance of Healthcare Compliance Programs

Published: July 26th, 2017

Compliance and ethics are not just legal requirements in healthcare; they are also critical components to safe, quality patient care.  Regardless, the size or specialty of the practice or facility, all medical organizations face healthcare compliance concerns.

What is healthcare compliance?

Healthcare compliance is the continuous process of abiding by legal, ethical, and professional standards applicable to a healthcare organization or medical practice. Healthcare compliance requires the effective development of processes, policies, and procedures to define appropriate conduct, educate staff, and monitor adherence to these guidelines. Healthcare compliance encompasses many areas including patient care, reimbursement, billing, managed care, OSHA, and HIPAA privacy and security.

What is the purpose of compliance programs?

The purpose of compliance programs is to promote organizational adherence to applicable federal and state law, and private payer healthcare requirements. An effective compliance program can help protect practices against fraud, abuse, waste, and other potential liability areas. Compliance programs designed to establish an organizational culture that promotes prevention, detection, and resolution of conduct that does not conform to the law or the organization’s ethical and business policies. A compliance program should articulate and demonstrate the organization's commitment to adherence of the law and ethical standards.

Under the Affordable Care Act, medical practices are required to establish compliance programs as a condition of enrollment in the Medicare program. Consequently, many commercial health carriers are now requiring providers to have a compliance plan as a condition of participation.

7 Healthcare Compliance Program Tips

  1. Implement written policies, procedures and standards of conduct.
  2. Designate a compliance officer and compliance committee.
  3. Conduct effective training and education.
  4. Establish effective and open lines of communication.
  5. Conduct internal monitoring and auditing.
  6. Enforce standards through well-publicized disciplinary guidelines.
  7. Respond to detected offenses and take corrective action promptly. (1)

5 Tips for Creating a Culture of Compliance

  1. Make compliance plans a priority.
  2. Understand fraud and abuse risk areas.
  3. Manage your financial relationships. 
  4. Just because your competitor is doing something doesn’t mean you can or should. Call 1-800-HHS-TIPS to report suspect practices.
  5. When in doubt, ask for help. (1)