Health care compliance affects every type of health care provider and health care organization from the solo practitioner to the largest global health care conglomerate. Governmental oversight and regulation of health care will never be eliminated entirely. In fact, governmental regulation and oversight will increase, as the government agencies and other third-party payers implement more quality-based requirements.
Health care compliance is the ongoing process of meeting, or exceeding the legal, ethical, and professional standards applicable to a particular health care organization or provider. Health care compliance requires health care organizations and providers to develop effective processes, policies, and procedures to define appropriate conduct, train the organization's staff, and then monitor the adherence to the processes, policies, and procedures. The successful development and implementation of a compliance program acts as a dose of “preventive medicine” for health care providers because it identifies problems before they can grow and negatively impact the organization or practice.
Health care compliance covers a wide variety of areas including, but not limited to, patient care, billing, reimbursement, managed care contracting, OSHA, Joint Commission on Accreditation of Healthcare Organizations, and HIPAA privacy and security to name a few.
It is nearly impossible to exaggerate the complexity of health care compliance and the review process. The avalanche of laws, rules, regulations and standards that apply to health care organizations and health care providers is daunting. Health care organizations and providers are not only required to comply with the Medicare rules and regulations, but they are also required to comply with numerous other federal and state healthcare laws, rules and regulations.
The compliance process can create legal dilemmas that require seasoned judgment from experienced health care counsel. Our firm can help you to develop an effective compliance program to help keep your organization out of trouble. We have been involved in the development and review of compliance programs for a broad spectrum of health care providers for many years.
Contact The Health Law Firm for any assistance in the compliance process.