Things to Know about Healthcare Compliance Programs

Filled under: Healthcare Compliance on September 2012

Healthcare providers in all domains implement compliance programs in order to ensure business practice in accordance with compliance program guidance from the Department of Health and Human Services Office of the Inspector General.

This is a necessary measure due to the increased severity of penalties established by the Health Insurance Portability and Accountability Act of 1996 and the Balanced Budget Act of 1997. Healthcare providers reduce their risk of criminal and civil litigation, thus ensuring ethical business practices through these compliance programs.


The Healthcare Care Compliance Association is a non-profit, individual membership association which provides resources for ethics and compliance professionals in the US. The Association serves more than 7.200 members through its publications, education programs, conferences and professional networking.

The key to a good compliance program is effectiveness. The compliance must be more than a document initially adopted by the governing body and reviewed once a year.

Here are the main requirements for healthcare compliance programs:

  • conducting internal monitoring and auditing;
  • developing and implementing compliance program procedures and policies;
  • designation of a compliance officer or contact person;
  • appropriate training and education to compliance staff;
  • responding appropriately to detected offences and developing corrective action;
  • developing open lines of communication;
  • enforcing disciplinary standards through well-marketed guidelines.

The compliance programs, policies and procedures should cover areas such as:

  • compliance risk areas;
  • hiring practices;
  • healthcare insurance and billing compliance;
  • medical records releases and informed consents;
  • professional courtesy discounts for different compliance programs and services;
  • medical necessity and documentation;
  • confidentiality and patient rights;
  • employee safety, rights and obligations;
  • environmental concerns.

Members of the Health Care Compliance Association offers publications and live training to its members, as well as constant access to a repository of over 3000 electronic documents including white papers and government memorandum.


HCCA has sealed a deal with the OIG in issuing Government industry roundtable reports to fight back against fraud and abuse, as well as driving for quality in long term care. The video below explains how the healthcare compliance department and the other function and depend on each other, in order to provide the best services.

In the late 1990s, OIG began promoting voluntary compliance programs for the healthcare industry. They issued voluntary compliance program guidance in order to assist healthcare entities to further develop effective internal controls that promote adherence to applicable federal and state law. These programs provide important details on specific elements each healthcare entity should consider when developing and implementing an effective compliance program.


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