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The Truth About Healthcare Regulatory Compliance

medical practice complianceBy: Jeff Cohen

Healthcare regulatory compliance is too damn complicated sounding and scary!  What the heck does it even mean?  Basically it means making sure you’re following about a dozen specific laws, some of which interrelate.  It’s a little like making a cake.  You have to make sure you have flour, eggs, sugar and so on.  And then you have to make sure you put enough in the bowl and bake it at the right temperature.  So what’s so unique re healthcare regulatory compliance?  Healthcare professionals and businesses are inundated by these confusing laws written in legalese, to the point where they go numb.  They lose the ability to focus on them and to take them seriously.  And they hire someone that uses the word “consultant” or “compliance”; and they think they’ve got compliance covered.  But they don’t.  And that’s a big mistake in the healthcare world!

Healthcare is a unique business sector that is immensely regulated due to the vulnerability of patients and the risks associated with the treatment delivered.  Add on to that the fact that the government funds much of the treatment, providing an interest in keeping medical care under tight restriction. Given the advances in medicine and technology, regulations will never shrink.  They will just keep expanding.  Hence Secret #1 (not really a secret):  a healthcare professional who owns and runs a medical practice or any other healthcare business cannot be expected to stay on top of the regulations.

When someone gets in trouble for a HIPAA violation, an HR violation, a Stark, Kickback or Patient Brokering violation, they often say (1) I didn’t know, or (2) I thought my consultant handled this.  Which brings us to Secret #2:  consultants (including lawyers) are super specialized, and hiring one does not mean you’re compliant.  It just means the thing(s) they specialize in are (or should be) in order.

People who actually do engage a professional to help ensure compliance need to understand that the results of their initial audits (or assessments) are NOT confidential unless they’re under the direction of a lawyer or accountant.  Secret #3:  ensure that ALL compliance activities are conducted in the context of the attorney client relationship.  Otherwise, the deficiencies revealed by the internal audit/assessment are discoverable.

Additionally, many business people are daunted by the discomfort of compliance.  That’s understandable, especially if there is a lack of transparency concerning the process or costs.  That’s why both the scope of the audit/assessment and the cost out to be set in advance.  Moreover, any action items identified for correction ought to be itemized, with a specific cost to correct.  Secret #4:  compliance doesn’t have to be difficult or mysterious.  It should be made simple and clear.

Finally, healthcare regulatory compliance is one of the best investments you can make in your business.  Done right, the result of compliance is a more efficient business generating more revenue (that you can be sure is lawfully generated and secure)!