What Is Healthcare Compliance?

With the ever-evolving amount of regulation for healthcare organizations and providers, a large organization or provider requires a dedicated team to focus on healthcare compliance. To ensure that your medical practice follows all the rules, regulations, and laws related to healthcare practices, a compliance program can help. Compliance programs are effective tools that help healthcare organizations maintain compliance. All members of a health care organization should receive training on fraud and abuse laws, as well as the health care compliance program. Effective training and education can be achieved by offering regular compliance training, making training and education part of the job requirements, and staying abreast of compliance issues and trends.

Each of these government agencies issues rules and regulations that interpret the laws that those agencies must implement. The purpose of the Office of Inspector General of the Department of Health and Human Services is to combat fraud, waste and abuse in healthcare. The OIG conducts most of the health care research and has the authority to impose civil monetary penalties and exclude providers from federally funded health care programs.

In addition, written policies, procedures, and standards of conduct enhance the mission and purpose of the health care organization. The avalanche of laws, rules, regulations, and standards that Healthcare Compliance apply to healthcare organizations and caregivers is disheartening. Many people view the Internal Revenue Service code as an overwhelming mass of laws, rules, and regulations that are too complex.

One way healthcare organizations can reduce fraud, waste, and abuse liability is through an effective health care compliance program. Because compliance programs can’t be designed for different types of organizations, the OIG allows you to create a program that meets your unique needs. However, it is advisable for any healthcare organization to pay special attention to the seven fundamental elements of the OIG of an effective health care compliance program.

Health care compliance can be defined as the ongoing process of meeting or exceeding the legal, ethical, and professional standards applicable to a particular healthcare organization or provider. The Office of Inspector General of the Department of Health and Human Services has helped define health care compliance through its compliance guidelines. A culture of compliance promotes the prevention, detection, and resolution of cases of behavior that do not comply with government laws, requirements for public and private health care programs, and ethical and business policies. The scope of compliance extends to many areas, including patient care, billing, reimbursement, managed care contracting, research standards, OSHA, Joint Commission standards, and HIPAA privacy and security, to name a few. The biggest challenge for healthcare organizations and their compliance officers is to keep track of all the requirements and regulations, which are very numerous.

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