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What is a corporate compliance program in healthcare?

August 10, 2021
August 10, 2021

The Investopedia definition for a compliance program is also applicable to a program necessary for corporate compliance—a "set of internal policies and procedures put into place in order to comply with laws, rules, and regulations or to uphold the business's reputation. A compliance team examines the rules set forth by government bodies, creates a compliance program, implements it throughout the company, and enforces adherence to the program." While organizations may be governed by industry specific rules, especially in healthcare, there are some key elements that are largely standard in a corporate compliance program.

Corporate compliance in healthcare

Compliance can be a major headache for healthcare organizations, requiring much time and energy. Compliance programs are mandatory in healthcare; the Affordable Care Act (ACA) Section 6401 states that every "provider of medical or other items or services… shall establish a compliance program as a condition for enrollment in Medicare, Medicaid, or the Children's Health Insurance Program" (CHIP). One thing that sets healthcare compliance apart from that in other industries is the Health Insurance Portability and Accountability Act, known throughout the healthcare world as HIPAA, which governs the privacy of personal health records and was signed into law in 1996. In the years since then, HIPAA has become one of the most widely cited and discussed regulations in healthcare compliance.

7 components of a strong corporate compliance program in healthcare

The Investopedia article linked above lists the 7 components of a strong compliance program for healthcare providers. They are:

  1. Written policies, procedures, and standards of conduct – A compliance program must have clearly defined policies and expectations, that are published and available to all employees.
  2. Compliance program oversight -- A knowledgeable compliance officer or compliance committee must oversee the program and report to the organization's CEO.
  3. Training and education – Healthcare organizations must ensure all employees are familiar and appropriately trained to the compliance program's set of standards. This should include new hires as well as regular refresher training with all current employees.
  4. Opening the lines of communication -- Employees at every level of an organization need to feel they have an open avenue to express their questions or concerns about the compliance program.
  5. Auditing and monitoring – Tools should be implemented in order to measure the effectiveness of the compliance program, ensure adherence to external regulations, and identify compliance risks.
  6. Consistent discipline -- Clear, written policies must apply appropriate disciplinary actions to those who fail to comply with the program's expectations and policies.
  7. Corrective action – If a significant compliance risk or vulnerability is discovered through an audit, compliance breach, or internal review, the compliance committee should take timely, decisive action that will reduce the risk of non-compliance.

The benefits of HealthStream healthcare compliance education courseware

At the heart of HealthStream compliance-focused solutions is the intention to build a strong culture of healthcare compliance. We facilitate our customers' use of training that underscores the duty to report problems and compliance violations and supports a policy of non-retaliation when an issue or concern is reported in good faith. One way to do this is to incentivize staff by making completion of compliance training and attesting to the code of conduct requirements for annual evaluation merit increases. Ultimately, the goal is to create a culture characterized by a sense of shared responsibility for compliance. This kind of environment can be built on a foundation of training that helps employees apply complex laws and regulations to their daily work, with access to organizational policies and procedures for guidance. In addition, healthcare compliance training is much more meaningful when it provides examples of illegal or suspicious behaviors that should be reported.

HealthStream enables customers to avoid costly violations by ensuring their workforce maintains compliance with innovative, comprehensive, and engaging compliance training and education. Our compliance courseware covers essential topics employees need in order to be compliant with federal and state laws and regulations. We make it possible to healthcare organizations to be confident that they have reduced organizational compliance risks.

Learn more about HealthStream solutions focused on improving quality and compliance.