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Healthcare compliance program basics

No two compliance programs are exactly the same. There is variability of purpose and scope due to the unique aspects of healthcare services your organization delivers or the products you sell if your organization is a health plan. Additionally, the populations served often create extra complexity and regulatory requirements, which can shape the type of requirements each program is subject to. For example, some organizations have special responsibilities for protected classes of people like children, pregnant women, or adults with special needs, all of which are factors that adjust the key areas of focus of your compliance program and the regulations to which you may be held accountable. ​

Despite great variability, a few core components of healthcare compliance remain the same. It’s important and a regulatory requirement in most healthcare sectors to have a compliance program work plan, often shaped and influenced by the Office of the Inspector General (OIG) key areas of interest. The work plan is vital for creating a uniform way to track, respond to, and report on the top priorities within your compliance program's framework. The work plan provides compliance program visibility to the compliance committee, senior leadership, and, in many cases, the board of directors. It’s one of the core compliance program necessities and often the first accomplishment of a newly developed compliance department. In addition to a core work plan for tracking and monitoring core program activities, a second framework that is vital to have mastered is a consistent way to monitor and report on changing regulations. Without focus and a mechanism for tracking and responding to existing and changing guidance, you may quickly find yourself out of compliance or blindsided by changes that occurred without your knowledge in the event of a regulatory audit. In addition, the rate at which requirements are released and updated is quite staggering, so it’s highly important to ensure you’re receiving, tracking, and pushing out guidance to impacted departments and individuals across your organization on a routine basis. A final consistent aspect of compliance programs is the required focus on prompt responses to detected offenses, a framework often supplemented or supported by an anonymous hotline or software readily accepting the details of an incident of suspected noncompliance. Years ago, the most typically utilized source for receiving reports of noncompliance, whether anonymous or disclosed, was the use of a hotline. This has since been complimented or, in some cases, replaced by an online tool where users can report and document all aspects of the potential noncompliance they’re reporting to a compliance department. HCC has all your basics covered! Please refer to our Solutions to learn more about our solutions to the core essentials of any compliance program.

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