What Is Healthcare Compliance? Plus Why It’s Important

Melissa Whetzel
Doctor holding tablet with patient and nurse in background

In today’s intricate healthcare landscape, compliance can mean a lot of different things, which might leave you wondering, “What is healthcare compliance?” 

At its core, healthcare compliance is adherence to the vast array of regulatory and procedural standards that protect patients and ensure the highest standard of care. As healthcare evolves, so do these standards, which increases challenges for healthcare organizations.

In this blog post, we will explain healthcare compliance, shine light on its significance, and share best practices within the industry.

Who Governs Healthcare Compliance?

There are a number of regulatory agencies who have a role in ensuring healthcare organizations are operating in a safe and compliant manner. These are just few examples:

Occupational Health and Safety Administration (OSHA): Supports the overall health and safety of workers by reducing the risk of injury, illness, death, suffering, and financial hardship.

Office of Inspector General (OIG): Prevents fraud, waste, and abuse within the department’s vast array of Department of Health and Human Services (HHS) initiatives.

Centers for Medicare and Medicaid (CMS): Evaluates providers’ adherence to state/federal regulations and guidelines at both the individual and organizational levels. 

Office for Civil Rights (OCR): Provides oversight of the safe and ethical handling of patient data and privacy. This agency enforces HIPAA rules.

Health Resources and Services Administration (HRSA): Provides equitable health care to the nation’s highest-need communities through funding to community health centers and federally-qualified health centers.

Why Is Healthcare Compliance Important?

Healthcare compliance commits an organization to excellence in patient care, ethical conduct, and the overall integrity of the healthcare system. It’s why employees will choose to work at a facility and why patients will trust your organization.

Ensuring Safety and High-Quality Care

Regulatory standards are set in place to ensure that every patient receives consistent, high-quality care regardless of where or from whom they receive it. These standards address various aspects of healthcare, from the administration of medications to surgical procedures and beyond. Non-compliance doesn’t merely risk financial or legal repercussions; it directly impacts patients.

Protecting Patient Privacy and Data

With the proliferation of electronic health records and digital patient data, patient privacy has never been more crucial. By following regulations like the Health Insurance Portability and Accountability Act (HIPAA), compliance teams can safeguard sensitive patient information from breaches, unauthorized access, or misuse. 

Reducing Fraud and Abuse in Healthcare

By ensuring accurate, transparent billing practices and reducing the potential for fraud or abuse, compliance helps in streamlining the financial aspects of healthcare. This not only protects institutions and practitioners from costly penalties but also ensures that patients are charged fairly and transparently for their care.

The Role of Healthcare Compliance Teams

Healthcare compliance teams set the tone for ethical conduct, fostering an environment where quality care and patient rights are paramount. They navigate the complex web of rules, from patient safety standards to billing practices, ensuring everything aligns perfectly.

In most healthcare organizations, a compliance officer takes responsibility for ensuring all employees are trained and actively monitoring and assessing practices within their organization. If they spot potential issues, they dive in to investigate. After a thorough analysis, their findings can lead to policy changes, further training, or, in some cases, disciplinary action. 

Best Practices To Ensure You Are Compliant

Maintaining healthcare compliance is crucial not only to avoid legal ramifications but also to ensure the safety, quality, and efficiency of patient care. Here are some best practices for healthcare organizations and providers to ensure consistent compliance:

Stay Updated on Regulatory Changes

There are many federal and state agencies governing healthcare operations and there are even more regulations that are frequently updated. By subscribing to agency newsletters, watching webinars, and maintaining a network of compliance professionals, you can stay up to date on the changes and communicate them with all your employees. 

Use Training as a Tool

Nearly every regulatory agency requires training for staff. Training is also a common way to take action after an incident or violation. Understanding and staying up to date on the requirements, having a standard process, and automated completion tracking will keep things easy. A learning management system (LMS) can really help.

Maintain Clear Policies and Procedures

Developing, documenting, and disseminating clear compliance policies and procedures will ensure staff know what is expected and provide a guide to follow. Be sure to regularly review and update these policies according to regulations and track staff acknowledgement, verifying that they have reviewed the policies.

Conduct Regular Audits

By regularly reviewing your organization’s compliance and billing, you can detect any discrepancies or areas of concern. Periodically using external auditors for a review will offer an unbiased perspective.

Implement Technology Solutions

Using compliance management software will streamline the workload for the compliance team and also simplify training and compliance for all staff. When employees can complete required courses online in their own time and submit incident reports electronically, it is easier for them to stay up to date and compliant.

Open Lines of Communication

Create an environment where staff feel comfortable raising concerns or reporting potential compliance issues. Share regulatory updates frequently so employees are not taken by surprise. 

Be Ready for the Future of Healthcare Compliance

Healthcare compliance isn’t just a set of rules or bureaucratic red tape; it’s the backbone of a trustworthy and efficient healthcare system. As the healthcare landscape continues to evolve, so will compliance measures, reinforcing their pivotal role in shaping a brighter, safer future for both providers and patients alike. 

Technology is sure to play a critical role in the future of healthcare compliance. Governance and protection will be a big part, but introducing automation and efficiency to the role of the compliance officer will also be critical.


See how MedTrainer can streamline your compliance.