Healthcare Compliance

Compliance in healthcare can cover a wide variety of practices and observe internal and external rules. But most healthcare compliance issues relate to patient safety, the privacy of patient information, and billing practices.
Healthcare Compliance

What is Healthcare Compliance?

In a highly regulated, high-risk industry like healthcare, compliance is especially important.

Healthcare compliance is the process of following rules, regulations, and laws that relate to healthcare practices.

Compliance in healthcare can cover a wide variety of practices and observe internal and external rules. But most healthcare compliance issues relate to patient safety, the privacy of patient information, and billing practices.

 

There are many different aspects of healthcare compliance, governed by a variety of federal and state agencies.

Changing laws and regulations can make it difficult for organizations to keep up with healthcare compliance. And laws differ between states and local governments. Every healthcare organization should take time to examine the different laws that apply to their organization.

However, here are some of the governing bodies and federal regulations that govern healthcare compliance:

The Social Security Act governs funding and requirements for Medicare, Medicaid, CMS, and more

HIPAA and the HITECH Act protect patient privacy, requiring healthcare organizations to implement measures to keep patient records secure.

The False Claims Act makes it illegal to file a false claim for funds from a federal program.

The Patient Protection and Affordable Care Act implemented new requirements for insurance, Medicaid, and more.

The Drug Enforcement Administration and the Food and Drug Administration regulate the creation and distribution of medication.

The Department of Health and Human Services and the Office of the Inspector General help protect against fraud.

Healthcare Compliance

Why is Healthcare Compliance Important?

Every healthcare organization must have some level of compliance in order to operate effectively.

Compliance keeps operations running smoothly and makes sure everyone follows proper procedures and understands expectations.

But compliance in healthcare comes with even higher stakes than in other industries. If a clinician or non-clinician does not follow proper procedure, they can end up injuring a patient or another staff member.

Ultimately, healthcare compliance is about providing safe, high-quality patient care. Complying with industry standards and regulations helps healthcare organizations continue to improve the quality of care.

Healthcare organizations are also held to strict standards, regulations, and laws from the federal and state levels. Violations of these laws can result in lawsuits, hefty fines, or the loss of licenses.

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