Top Health Compliance Issues

Healthcare compliance is crucial for safeguarding both your business and your patients. You run the risk of security risks, lost revenue, and danger if your practice doesn’t adhere to industry norms and laws. According to the U.S. Department of Health and Human Services Office for Civil Rights, more than 500 healthcare cybersecurity breaches were recorded in the last year that harmed more than 5 million patients.

While facilities online have occasionally handled sensitive information over unprotected servers, especially in the aftermath of the COVID-19 pandemic, the top compliance concerns have virtually not changed over the past three years, with just a modest shift in the issues’ relative importance. Below are listed some of the top issues that need healthcare compliance solutions at the earliest in this regard.

But first, let us look at some basics:

What do we mean by Compliance in Healthcare?

Healthcare is governed and regulated by a number of organizations. These organizations are in charge of formulating the constantly evolving collection of regulations, looking into transgressions, and implementing penalties for non-compliance. Healthcare compliance alludes to this multi-tiered system of checks and balances created to advance healthcare quality and safeguard beneficiaries of Medicare, Medicaid, and other programs from fraud, waste, and abuse.

The continual process of complying with or exceeding the legal, moral, and professional requirements that are specific to a given healthcare institution or provider is known as healthcare compliance. A healthcare compliance officer will be certified in achieving these metrics; as part of their obligation to their employer or contractor, they will make sure that standardized rules are followed to help prevent, identify, and address actions that are inconsistent with the law, corporate policy, or other standards.

Top Healthcare Compliance Issues in 2022

#1 Cyberattacks and Ransomware

The frequency of security breaches in the healthcare industry reached new highs in 2021, with the number of cases recorded growing by roughly 70% and total damages topping $4 billion over the previous year. The FBI continued to issue cybersecurity advisories at this time. A particular vulnerability was discovered in healthcare organizations, particularly during the COVID-19 pandemic.

The purpose of ransomware is to prevent users from accessing a software system or database unless a certain amount of money, or “ransom,” is paid. Unfortunately, as digital technology enters the market, certain service providers have been attacked by ransomware. In no time at all, ransomware and cyberattacks have emerged as one of the most frequent dangers to patient health data.

#2 Value-Based Compensation Agreements

The healthcare industry is embracing the value-based care paradigm everywhere. Determining the value-based pay plans for doctors, which can be challenging, is one of the biggest threats to providers’ compliance with healthcare regulations. Healthcare providers should create value-based reimbursement inventories and determine the desired outcome in order to simplify this procedure. To ensure this seamlessness, suppliers shouldn’t just rely on benchmark data alone.

#3 Due Diligence in Healthcare Transactions

For transactions involving the healthcare industry, it is important to perform adequate due diligence in areas such as medical coding, billing, and documentation issues; HIPAA security; litigation, audits, and investigations; employee relations; risk management; quality metric reporting; and filing/approval requirements for ownership changes.

An annual risk assessment, exclusion checks, conflict of interest reviews, contract reviews, vendor reviews, and other procedures are all part of the due diligence processes for healthcare compliance. Any healthcare practice is well safeguarded by these regulatory inspections of healthcare compliance. Yet, maintaining such best practices is a cause of concern for many.

#4 Data Security with the Advent of Telemedicine

By utilizing telemedicine across state lines, competition is increased, and more resources are made available to patients. However, the doctors’ capacity to offer the required services in other jurisdictions is constrained by these laws, norms, and licensure. Finding technology that is both secure and usable is crucial to maintaining compliance.

Data security is still a significant danger to healthcare compensation, even without ransomware. It is imperative but challenging to ensure that the software your practice employs is secure at all times.

#5 Assessing Claim Accuracy

False claims and whistleblower lawsuits are currently presenting major difficulties for the healthcare sector. Whistleblowers now have more influence as a result of recent reform initiatives. It is now simpler for them to file claims against healthcare organizations because they no longer need to be the original source of the material in such a claim.

As a result of finding patterns of errors in claims filing, which might be termed false claims, government oversight agencies, and their contractors frequently make significant financial demands. Following agreements with referral sources, false claims cases are listed by the DOJ and OIG as their second-highest priority in terms of enforcement.

The Need of the Hour: Upgrade and Update to Reduce Healthcare Compliance Risks

Implementing best practices is crucial to ensuring that your hospital remains compliant with healthcare regulations and that your practice and patients are kept as safe as possible. This is especially important in the ever-changing world of healthcare regulation and given the current technological threats to privacy and security.

To ensure that you never commit compliance mistakes, you need to work with a partner who is totally knowledgeable about all industry regulations. With the right partnership, you can provide your team peace of mind and increase your ability to concentrate on providing high-quality patient care.