What are Some Compliance Laws in Healthcare?

Dave Clifton
Medical professional with overlay of software icons

Compliance laws in healthcare are critical to ensure the ethical and legal operation of healthcare organizations, protect patient rights, and maintain the quality of care. Understanding the nuances of these complex regulations can be daunting. In this blog, we’ll discuss what are some compliance laws in healthcare.

What is Healthcare Compliance?

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. It ensures that healthcare organizations and professionals adhere to guidelines that protect patient safety, maintain data privacy, and uphold the integrity of medical practices. Compliance is essential for operating within the legal framework, providing high-quality care, and maintaining the trust of patients and the community​.

Key Compliance Laws in the U.S.

Health Insurance Portability and Accountability Act (HIPAA): HIPAA is one of the most well-known healthcare compliance laws. It governs the privacy and security of patients’ health information. Healthcare providers and organizations must protect patients’ sensitive data and ensure its confidentiality.

Patient Protection and Affordable Care Act (ACA): The ACA, also known as Obamacare, contains provisions related to healthcare compliance, such as the requirement for healthcare organizations to establish compliance programs and report financial relationships.

Anti-Kickback Statute: This law prohibits healthcare providers from offering, paying, soliciting, or receiving any remuneration in exchange for referrals of healthcare services or products that are reimbursed by federal healthcare programs like Medicare and Medicaid.

Stark Law: The Stark Law prohibits physicians from referring patients to receive designated health services that are payable by Medicare or Medicaid from entities in which the physician has a financial relationship, unless an exception applies.

False Claims Act (FCA): The FCA imposes penalties on individuals or entities that submit false or fraudulent claims for payment to government healthcare programs. It encourages whistleblowers to report fraud and abuse.

Healthcare Fraud and Abuse Control Program (HCFAC): This program aims to detect, investigate, and prevent healthcare fraud and abuse. It involves collaboration between federal and state agencies to combat fraudulent activities.

Emergency Medical Treatment and Labor Act (EMTALA): EMTALA requires hospitals to provide emergency medical treatment to all individuals, regardless of their ability to pay, when they seek care in an emergency room.

Medicare and Medicaid Conditions of Participation (CoPs): These are a set of standards that healthcare providers must meet to participate in the Medicare and Medicaid programs. They cover various aspects of patient care and facility operations.

Drug Enforcement Administration (DEA) Regulations: These regulations govern the prescribing, dispensing, and handling of controlled substances, such as opioids, to prevent abuse and diversion.

Occupational Safety and Health Administration (OSHA) Regulations: OSHA regulations ensure the safety and health of healthcare workers and patients within healthcare facilities.

State-Specific Laws: In addition to federal laws, healthcare providers must also comply with state-specific healthcare laws and regulations that may vary from state to state.

Health Information Technology for Economic and Clinical Health (HITECH) Act: HITECH promotes the adoption and meaningful use of electronic health records (EHRs) while also enhancing the penalties for HIPAA violations.

Ensure Your Compliance Program Evolves With the Industry

Gone are the days of packed filing cabinets, spreadsheet tracking, and manual exclusions monitoring. Today’s compliance professionals are relying on software and its automation to complete tasks more efficiently. From requesting PSV documents to tracking compliance training and monitoring for exclusions, everything can now be done in one cloud-based compliance platform. If you’re ready to take your healthcare organization’s compliance to the next level, consider MedTrainer.


See how MedTrainer can streamline your compliance.