What is Non-Compliance in Healthcare?

Melissa Whetzel
Hands typing on computer with alert icon overlay to portray how to write an incident report

Non-compliance in healthcare refers to the failure of healthcare providers, institutions, or individuals to adhere to the laws, regulations, and standards established to protect patient welfare, maintain data security, and ensure the efficient and ethical delivery of healthcare services. In this blog, we will outline what is non-compliance in healthcare, highlight various non-compliance activities, and explore how healthcare compliance software plays a crucial role in combating non-compliance.

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 Healthcare Activities

Non-compliance in healthcare can manifest in numerous ways. It jeopardizes patient health, and can seriously harm the legal standing and reputation of healthcare institutions. Here are some common non-compliance activities:

  • Failure to Maintain HIPAA Compliance: The Health Insurance Portability and Accountability Act (HIPAA) sets strict guidelines for safeguarding patient health information. Non-compliance in this area includes unauthorized access to patient records, inadequate data encryption, and improper disposal of medical records.
  • Medical Billing Fraud: Some healthcare providers engage in fraudulent billing practices, such as upcoding (charging for more expensive services than provided) or unbundling (billing separately for services that should be bundled together). These actions can lead to financial losses for patients and payers. Significant fines also can be levied by the Office of Inspector General (OIG) for overbilling Medicare and Medicaid.
  • Inadequate Infection Control: Failure to maintain proper infection control measures can result in healthcare-associated infections, which can be life-threatening. Non-compliance includes improper hand hygiene, inadequate sterilization of medical equipment, and poor sanitation practices.
  • Failure to Obtain Informed Consent: Before performing any medical procedure, healthcare providers must obtain informed consent from patients or their legal guardians. Non-compliance in this area involves performing procedures without proper consent, failing to adequately explain risks and benefits, or obtaining consent under duress.
  • Pharmaceutical Compliance Issues: Non-compliance with pharmaceutical regulations can lead to medication errors, counterfeit drugs, and compromised patient safety. It includes issues such as improper storage of medications, dispensing errors, and unethical pharmaceutical marketing practices.

How Software Combats Non-Compliance in Healthcare

In many cases, an individual or organization is unknowingly non-compliant. They’ve forgotten to complete or track training, they’ve failed to update a policy, or mitigate risks. Technology can reduce these unintentional lapses, making your organization more compliant. Here are some key ways compliance software helps healthcare organizations mitigate non-compliance:

  • Streamlined Training and Education: Online learning management systems offer a vast library of healthcare compliance courses, allowing healthcare professionals to stay updated on the latest regulations and best practices. This ensures that staff members are well-informed and equipped to avoid compliance pitfalls.
  • Document & Policy Management: End-to-end document management software gives organizations one place to centralize and securely organize important compliance documents, policies, and procedures. With built-in electronic signature functionality, acknowledgements have never been easier!
  • Automated Reminders: Rely on automated alerts and notifications to complete training requirements, sign documents, and make policy updates. This proactive approach helps prevent lapses in compliance.
  • Credentialing Workflows: Streamlining credentialing documentation can ensure you’re ready for a surveyor. Choose credentialing software that enables you to send a secure link to a provider to upload documents and set expiration dates so you receive 90, 60, 30, 10, and 5 day reminders for recredentialing and license expiration.
  • Tracking and Reporting: The platform offers robust tracking and reporting capabilities, enabling healthcare organizations to monitor compliance progress, identify areas of improvement, and generate comprehensive reports for audits and inspections.
  • HIPAA Compliance Solutions: MedTrainer provides dedicated HIPAA compliance solutions to help healthcare organizations protect patient data and avoid costly HIPAA violations. This includes training modules and tools for secure data management.

MedTrainer: Your All-in-One Compliance Software Solution

MedTrainer offers a comprehensive platform with education, credentialing, and compliance documentation all together. It’s easy to ensure policy adherence, employee training, incident reporting, enrollment, privileging, and more. With a user-friendly interface and automated features, MedTrainer empowers healthcare compliance teams to keep their programs current, efficient, and well-documented.


See how MedTrainer can streamline your compliance.