Why Do Healthcare Facilities Use Corporate Compliance Programs?

Amanda Martin, MSN, FNP-C
doctor and professionals in hospital talking

A corporate compliance program in healthcare is a comprehensive set of policies, procedures, and practices that healthcare organizations establish and maintain to ensure that they operate compliant with all applicable laws, regulations, and ethical standards. These programs help to promote lawful and ethical conduct within healthcare organizations and minimize the risk of legal violations, such as fraud, abuse, and other unethical behaviors.

Why do healthcare facilities use corporate compliance programs? We’ll answer that question in this blog along with assessments of a good corporate compliance process.

What is Corporate Compliance in Healthcare?

Corporate compliance ensures that healthcare organizations operate within the boundaries of state and federal regulations. It’s more than just a legal necessity; it help to safeguard patient rights, ensure their privacy, and maintain the integrity and quality of care they receive. When healthcare providers prioritize compliance standards, they foster trust with patients and avoid potential legal repercussions.

Why Healthcare Corporate Compliance is Critical

Healthcare facilities use corporate compliance programs for several important reasons:

  • Reduce Risk-related Costs: Potential costs can arise from a variety of compliance risks including operational, legal, clinical, and financial. Corporate compliance can help to reduce these potential costs by helping companies uphold compliance standards.
  • Ensure Legal and Regulatory Compliance: This helps healthcare facilities stay in compliance with federal, state, and accreditation regulations, including laws like the Health Insurance Portability and Accountability Act (HIPAA).
  • Improve Quality of Care: Include protocols, policies, and guidelines to maintain and improve the quality of patient care. Housing these and having them readily accessible helps healthcare providers adhere to best practices and standards, and in turn, enhances patient outcomes and safety.
  • Prevent Fraud and Abuse: Helps avoid improper billing and monitors for potential fraudulent or waste activities. Many compliance programs offer customized audit reports for organizations to help them review current compliance.
  • Risk Management: Identify and mitigate legal, financial, and reputational risks.  By identifying these risks early, it can help reduce the likelihood of adverse events and noncompliance.
  • Meet Government Requirements: Some government programs and payers, such as the Centers for Medicare & Medicaid Services (CMS), require healthcare facilities to have compliance programs as a condition for participation.
  • Improved Reputation: Patients are more likely to trust organizations that demonstrate a commitment to ethical and legal conduct.

Components of a Healthcare Corporate Compliance Program?

Healthcare corporate compliance programs differ by organization but most consist of the following components:

  • Written Policies and Procedures: Serve as guidelines for employees and stakeholders.
  • Compliance Officer: Have a designated individual responsible for overseeing the compliance program. This person is often a senior executive or a specially trained professional with expertise in healthcare compliance.
  • Compliance Committee: Key stakeholders from various departments within the organization that assist in the development, implementation, and monitoring of the compliance program.
  • Training and Education: Includes training on laws like HIPAA, anti-kickback, fraud and abuse regulations, and other relevant compliance statutes.
  • Monitoring and Auditing: Monitor for adherence to policies and regulations. Compliance programs help identify areas of non-compliance and areas for improvement through audit reports.
  • Reporting Mechanisms: Hotlines or anonymous reporting systems, for employees and stakeholders to report potential compliance violations without fear of retaliation.
  • Investigation and Response: Procedures to thoroughly investigate reports and take appropriate action, which also includes disciplinary and corrective actions.
  • Risk Assessment: Regularly conducted to identify areas of vulnerability to compliance issues, such as billing irregularities, data security breaches, or regulatory changes.
  • Documentation and Recordkeeping: Training records, audit findings, and corrective actions for demonstrating a commitment to compliance and for legal defense in case of investigations or audits.
  • Communication and Awareness: Helps build a culture of compliance and reinforces the importance of ethical behavior. Many compliance programs offer scheduled email reminders which include course due dates or upcoming licensure expirations.
  • Response to Regulatory Changes: Compliance programs are dynamic and adapt to changes in healthcare laws and regulations. Organizations regularly update their policies and procedures to reflect new requirements.
  • Corporate Culture: Helps to foster a strong culture of compliance within the organization, emphasizing the importance of ethical behavior and adherence to laws and regulations.

Ensure Your Compliance Program Evolves With the Industry

Gone are the days of packed filing cabinets, spreadsheet tracking, and manual exclusions monitoring. Many of today’s compliance professionals are relying on software automation to complete tasks more efficiently. Today, cloud-based compliance platforms offer a wide array of services, ranging from requesting primary source verification (PSV) documents to tracking compliance training and automated exclusions monitoring. If you’re ready to take your healthcare organization’s compliance to the next level, consider MedTrainer.

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See how MedTrainer can streamline your compliance.