The Importance Of Compliance Planning

Filled under: Healthcare Compliance on October 2012

Compliance planning is nowadays essential. Compliance planning is mandatory in many industries within the United States and the healthcare system makes no exception from this point of view. All healthcare providers have to build a culture of compliance within their organizations.


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Compliance plans

A compliance plan actually is a set of documents which help guiding an organization according to the government legal requirements. Healthcare providers, mostly behavioral health providers, need such compliance plans, and they should be aware of this fact, even though there still are many healthcare providers that do not have them.

Why are compliance plans needed?

A compliance plan is a guide that healthcare providers can use to secure compliance with the existing laws. These plans promote early detection and reporting of problems, as well as efficient staff communication and training. They should be perfectly integrated in the conduct of an organization.


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A compliance plan will include the following basic elements:

  • Written standards of conduct that determine a clear commitment to compliance, which should be effectively communicated to all employees;
  • Efficient and effective staff training programs;
  • Monitoring systems to detect certain problems;
  • Systems to detect fraud;
  • Efficient staff communication;
  • Disciplinary systems for noncompliance;
  • Appointment of high-level individuals to oversee compliance;
  • Measures to prevent noncompliance recurrence. 

Employees have to know the regulations to compliance to be able to respect them. Training should be received by all workers of the organization. Standard rules of conduct also have to be communicated clearly to all employees. These standards need to reflect strong commitment to legal compliance.


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The existence of an effective compliance plan provides evidence that mistakes have no entered the system. An effective compliance plan will include the following elements:

  • Clear commitment to compliance. Compliance planning is a must to make sure that all employees of an organization understand their obligation to comply with the legal standards.
  • Effective training and education programs. Training and education programs are needed to get everyone in the organization involved in the compliance program implementation.
  • Auditing and monitoring. The monitoring process includes a methodology that facilitates employee reporting of cases involving fraud and abuse.
  • Internal investigation and enforcement. In case inappropriate conduct within the organization is suspected, adequate investigation will be required. Investigation will be followed by disciplinary actions, in case of violations.
  • Communication. Within the organization, communication need to be effective. The procedure to report suspected violations is also part of an efficient communication process.


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Documentation is a key element to compliance planning, as well. Storing accurate documentation is a must for healthcare providers, both when it comes to the operation of compliance and to patient record. Medical records can be used in case noncompliance claims are formulated. The federal government has the authority to investigate all types of claims, no matter if they involve simple mistakes or fraud.

The importance of compliance planning cannot be ignored. Healthcare fraud and abuse remain a high priority for enforcement authorities. This is the main reason why providers should be extra careful when it comes to evaluating their compliance plans, to be sure that there are no risk areas. Nowadays, the requirement for an effective compliance program in healthcare organizations is no longer voluntary, but it actually is mandatory.

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