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Regulatory Compliance

As a result of the ever-growing network of regulations, administrative rules and statutes, which often times seem in conflict with each other, most health care providers are left scratching their heads and wondering if they will ever really be in compliance.

Chapman Law Group shares your concern and your desire to be in compliance. Therefore, we work with you before allegations of non-compliance to help ensure compliance, as well as after to protect your interests and your right to continue to practice medicine. Regulatory compliance is very complex and requires a multi-disciplinary team to assist in reviewing compliance and preparing an appropriate defense to the allegation(s) of non-compliance. Unless you are a large hospital with a full-time team of compliance officers, you cannot be expected to ensure compliance on your own.

Health care regulatory compliance is a scary process for most small health care providers and a daunting task for hospitals and larger health care providers. Ensuring compliance consumes a significant amount of valuable resources. The Center for Medicare and Medicaid Services (CMS) together with Health and Human Services (HHS) seem to be in the exclusive business of writing regulations. CMS websites state, “The various guidance and procedure documents on this website number approximately 37,000, comprising over 7 million pages.” Every health care provider that accepts CMS funding must comply with all applicable regulations. Additionally, each state has its own set of regulations, and all health insurance companies have an equally daunting set of regulations. Of course, complying with theses regulations is just the beginning. Health care providers must also comply with the following:

    • Occupational Safety and Health Administration (OSHA) and state safety regulations
    • State board regulations relating to the delivery of health care
    • State licensing regulations (professional rules/regulations)
    • Facility regulations
    • Labor department rules
    • Drug Enforcement Agency (DEA) rules
    • A host of rules and regulations too numerous to list

CMS tries to communicate the details of each rule to health care providers through “small entity compliance guides” and the “Medicare Learning Network” (MLN). MLN provides educational compliance information for Medicare fee-for-service providers. MLN also aims to solve that problem by providing a variety of training and educational materials that break down Medicare policy into plain language with actionable tips to use in day-to-day work. MLN uses a variety of mechanisms to deliver a planned and coordinated provider education program, such as the Internet, national educational articles, brochures, fact sheets, web-based training courses and videos.

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