What is Healthcare Compliance?
Simply stated, healthcare compliance means a healthcare practice is demonstrating an absolute commitment to the highest standards of ethics and professionalism, and is following the laws and regulations that pertain to the healthcare industry.
For example, every healthcare practice that files claims under Medicare, Medicaid, and/or private insurance must be following healthcare compliance. These are the guidelines that make sure healthcare organizations do not run afoul of the law by committing Medicare fraud and/or Medicaid fraud, and are being reimbursed properly.
Also, healthcare practices must stay in compliance with security and privacy rules contained within Health Insurance Portability and Accountability Act (“HIPAA”), and have a protocol in place if data is breached.
Why Does My Practice Need to Stay in Compliance?
For several reasons. Being in compliance and following a program shows your employees and your community that your practice is committed to honesty, ethical behavior and acting responsibly.
It creates a process by which the organization can identify and prevent criminal and unethical conduct, particularly by encouraging your employees to report problems.
By being better able to identify compliance problems — including Anti-Kickback Statute and Stark Law violations — they can be corrected before they are discovered by the government or reported by a whistleblower.
More importantly, without an effective compliance program in place, should health care fraud be identified within your practice, your culpability can be increased. This can lead to allegations of deliberate ignorance and subsequent investigations.