Setting up a compliance program in healthcare

Key Takeaway:

Organizations that set up a compliance program in healthcare should go by many voluntary regulations from the OIG, apart from those mandated by HIPAA.

Setting up a compliance program in healthcare is about being compliant with standards. This entails having to be compliant with several standards, which cover a wide variety of areas. There are several voluntary and mandatory guidelines from the Office of the Inspector General (OIG), apart from standards from HIPAA. Setting up a compliance program in healthcare meeting HIPAA requirements is set out and mandated by the Patient Protection and Affordable Care Act (PPACA).

Guidelines from the Office of the Inspector General (OIG)

The series of compliance program guidance documents from the OIG are largely voluntary, and are meant for the different sections of the health care industry. These include

  • Hospitals
  • Nursing homes
  • Third-party billers, and
  • Durable medical equipment suppliers.

These guidelines are issued with the intention of motivating healthcare units to develop and use their own internal controls aimed at helping them adhere to regulations, program requirements and statutes. The OIG issues documents, which act as guidelines for setting up a compliance program in healthcare by providing principles.

These need to be adapted when healthcare organizations have to develop their own compliance program that is in tune with their best interests and needs. Another major aim is served in the implementation of these guidelines for setting up a compliance program in healthcare: They help healthcare units to understand the nature of fraud and other risks associated with abuse, when they are setting up a compliance program for their healthcare unit.

HIPAA requirements

Setting up a compliance program in healthcare while being compliant with HIPAA regulations requires a healthcare organization to put in place measures that ensure that health records must:

  • Be confidential,
  • Have integrity, and
  • Must contain individually identifiable health information, which should be made available

Other requirements

When setting up a compliance program in healthcare; organizations need to keep these general practices in mind.

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