The Importance of Healthcare Compliance Programs

If you ask most people if healthcare has improved with the Affordable Care Act, those in support will usually respond that it has increased access to care and those not in support will tell you it has failed. A little know fact is that this law was put into place more to decrease health care fraud and increase enforcement efforts so the system could overall improve the quality of care. Fraud and waste have been major problems dating back to the Civil War. 

The critical components to safe, quality patient care begin with the law requiring healthcare providers to detail compliance and ethics programs from the U.S. Sentencing Commission Federal Sentencing Guidelines outlining seven key components:

  • Establish policies, procedures and controls that effectively reduce violations
  • Exercise effective compliance and ethics oversight at the highest levels by individuals (compliance and ethics officers) who have sufficient authority and resources
  • Exercise due diligence to exclude from authority those individuals who have a propensity to violate the law 
  • Communicate with and train employees on compliance and ethics
  • Monitor and audit compliance and ethics programs
  • Ensure consistent enforcement and discipline of those who don’t follow the compliance and ethic program guidelines
  • Respond appropriately to detected offenses and develop corrective action to prevent any future lack of quality of care

What is healthcare compliance? 

Healthcare compliance is the process of abiding to legal, ethical and professional standards within the medical field. It requires effective development of processes, policies and procedures to define appropriate conduct, educate staff, and monitor adherence to these guidelines. The government drives compliance whereas the individual drives ethics, and both are important in any successful organization. 

ERD has been instrumental in designing and implementing healthcare compliance programs throughout Northern Nevada & California. We understand you are busy which is why we are here to help with the seven fundamental elements of an effective compliance program:

  1. Implement written policies, procedures and standards of conduct.
  2. Designate a compliance officer and compliance committee.
  3. Conduct effective training and education.
  4. Establish effective and open lines of communication.
  5. Conduct internal monitoring and auditing.
  6. Enforce standards through well-publicized disciplinary guidelines.
  7. Respond to detected offenses and take corrective action promptly.

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