Healthcare Regulatory Compliance

As a former healthcare professional and business owner I understand the difficulty of handling both the clinical and administrative responsibilities at the same time. My firm offers affordable and accessible consultation for your solo and small group practices to ensure that your office has standard operating procedures that remain compliant with changing regulations. 

What Is Healthcare Compliance?

Healthcare compliance is the ongoing process of meeting, or exceeding the legal, ethical, and professional standards applicable to a particular healthcare organization or provider. Healthcare compliance requires healthcare organizations and providers to develop effective processes, policies, and procedures to define appropriate conduct, train the organization’s staff, and then monitor the adherence to the processes, policies, and procedures. Healthcare compliance covers numerous areas including, but not limited to, patient care, billing, reimbursement, managed care contracting, OSHA, Joint Commission on Accreditation of Healthcare Organizations, and HIPAA privacy and security to name a few.

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) is focused on protecting the federal healthcare programs from fraud, abuse and waste. The OIG has published some of the most comprehensive guidance for healthcare organizations on the elements of an effective healthcare compliance program. According to the OIG, an effective healthcare compliance program must, at the very least, address the following seven areas:

1. The development, distribution and implementation of written standards of conduct and written policies and procedures that describe and further the organization’s commitment to meeting and exceeding the legal and ethical standards applicable to the organization;
2. The designation of a chief compliance officer and other appropriate committees and individuals that are responsible for operating and monitoring the compliance program and who report directly to the organization’s chief executive officer and the governing body;
3. The development and delivery of effective employee education and training programs;
4. The development and maintenance of effective lines of communication that allow individuals to report compliance concerns without retaliation, including the ability to anonymously report concerns and complaints;
5. The development and implementation of a process to respond to complaints that includes the imposition of appropriate corrective action including discipline of employees when required;
6. The use of internal monitoring and audits to measure compliance and address known deficiencies; and
7. Responding appropriately and quickly to detected offenses and implementing corrective action.

The OIG’s compliance guidance is focused on eliminating fraud, abuse and waste. The OIG’s guidance is useful, but an effective healthcare compliance program must also address the other regulatory compliance areas applicable to the healthcare organization or provider.

Every healthcare organization and provider deals with confidential health information. Consequently, every healthcare organization and provider will also need to include compliance with the Health Insurance Portability and Accountability Act (HIPAA) as part of its compliance program. The HHS Office of Civil Rights (OCR) is charged with implementing and enforcing the HIPAA privacy and security rules, and it has provided volumes of guidance on compliance with those rules.

So how will you meet the ongoing process of meeting, or exceeding all the legal, ethical, and professional standards applicable to you or your practice? As the regulations applicable to the healthcare organization are constantly changing you need a trusted attorney who understands the complexities of healthcare and the laws related to keep you compliant. 

In addition to being a former healthcare professional, I am certified in Healthcare Compliance by the nationally recognized HealthCare Compliance Board.  Contact The Law Offices of Namrita Notani today to get more information about the compliance programs structured to be implemented by solo and small group healthcare practitioners.