Reporting Healthcare Non-Compliance Is Non-Negotiable

Brian Williams, MHA, MBA

Failing to report healthcare non-compliance is a lot like failing to tell your parents you got sent to the principal’s office. At some point, everyone is going to find out and it’s going to be much worse than if you had just confessed in the beginning. In this blog, we’ll outline why reporting healthcare non-compliance is non-negotiable and how software platforms make it easier to stay in compliance with the myriad regulations that govern good 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​.

Non-compliance refers to a situation in which a patient or healthcare provider does not adhere to the recommended or prescribed medical treatment, therapies, or healthcare guidelines. When a healthcare provider or organization fails to report healthcare non-compliance, several potential consequences can occur, depending on the nature and severity of the non-compliance, as well as applicable laws and regulations. 

What Happens When You Fail to Report Healthcare Non-Compliance?

The consequences of non-compliance in healthcare can be severe, affecting not just the financial stability of an organization but also its reputation and the quality of patient care. An investigation for compliance violations may occur long after it occurred (in some cases years!).

Non-compliance can lead to significant fines, legal battles, and the loss of license or accreditation. Moreover, it can erode patient trust, which is crucial for the long-term success of any healthcare provider. 

The OIG notes that when sentencing is imposed by the Department of Justice, they may take into consideration when the non-compliance was discovered, how it was discovered (or reported), and the actions that were taken (documented) once it was known, and what was done to prevent further non-compliance.

Sometimes major mistakes are made that were an error or non-intentional action.  Unfortunately, a lack of knowledge does not release the organization of their compliance liabilities. The OIG encourages “self-reporting” as a way to minimize fines and avoid civil actions.

Possible Consequences of Failing To Report Non-Compliance

Even though you’ll hopefully never be in this situation, let’s take a look at what happens when you fail to report non-compliance.

  • Legal Penalties: Healthcare non-compliance can result in legal penalties, including fines, civil lawsuits, or criminal charges, depending on the severity of the violation. For example, healthcare fraud or intentional non-compliance with regulations can lead to criminal charges.
  • Loss of Accreditation: Healthcare facilities who have achieved accreditation may lose all that hard work, which can have significant financial and reputational consequences.
  • Civil Lawsuits: Patients or other affected parties may file civil lawsuits against healthcare providers or organizations if non-compliance leads to harm or damages. Failure to report non-compliance can be used against the provider or organization in such lawsuits.
  • Regulatory Actions: Regulatory agencies, such as the Centers for Medicare & Medicaid Services (CMS) in the United States, have the authority to take actions against healthcare providers or organizations that are not in compliance with regulations. These actions can include fines, sanctions, or even revocation of licenses or certifications.
  • Reputation Damage: Non-compliance can lead to significant reputation damage for healthcare providers and organizations. Negative publicity and loss of trust from patients and the community can be long-lasting and detrimental.
  • Increased Oversight: Regulatory agencies may increase their oversight and monitoring of healthcare providers or organizations that have a history of non-compliance. This can result in additional reporting requirements and audits.
  • Corrective Action Plans: In some cases, regulatory agencies may require healthcare providers or organizations to develop and implement corrective action plans to address non-compliance issues. Failure to report non-compliance can hinder the resolution of these issues.
  • Impact on Funding: Non-compliance with regulations can impact a healthcare organization’s eligibility for government funding, reimbursement, or grants. Failure to report non-compliance may result in financial losses.
  • Loss of Professional Licenses: Healthcare professionals, such as doctors, nurses, and pharmacists, can face disciplinary actions, including the suspension or revocation of their professional licenses, if they are found to be non-compliant and fail to report it.

Using Technology to Remain Compliant 

With the technology available today, it is easier than ever to identify non-compliance. Online incident reporting software offers an easy way for employees to anonymously report concerns and as an administrator, you can identify patterns or trends to proactively address issues. The OIG suggests that organization provide incentives to staff to increase internal reporting and avoid lengthy investigations.

There are so many details required when it comes to maintaining provider credentialing, it can be easy to fall out of compliance. Automated exclusions monitoring and license verification ensure you’re aware anytime something is awry. Plus, keeping all provider documentation online offers an easy way for both admins and providers to access.

MedTrainer’s comprehensive suite of tools and resources offers valuable support to healthcare organizations, ultimately contributing to improved compliance and patient care. By systematically addressing compliance risks, healthcare organizations can foster a culture of accountability and ensure the delivery of ethical, safe, and high-quality healthcare services.