The primary mission of every health care organization is to provide high-quality, cost-effective services to patients, families, members, and their communities. In accomplishing this mission, many organizations view regulatory compliance as a necessary evil federal and state governments impose upon them. Those organizations that operate with high integrity view their compliance obligations as a burden they must bear to protect the world against a few bad apples. The stresses imposed by the current regulatory environment promote a comply-or-see-yourselves-on-the-evening-news mentality and fuel resentment among many senior leaders who regard compliance as an obligation rather than a valuable asset.
Nevertheless, Health & Human Services Office of Inspector General (OIG) and the Department of Justice expect health care organizations to maintain compliance programs, and federal sentencing guidelines reinforce that goal. The quality of an organization’s compliance program can make the difference between a mistake and reckless disregard, which can invite massive fines and criminal prosecution. With the RAC program identifying $10B in payment corrections (overpayments & underpayments) since its inception, reported PHI breaches growing exponentially, and health care reform and fraud prevention, governmental scrutiny will not abate. Whether or not such scrutiny is justifiable, it is here to stay, and there simply is no hiding from it.
If you are to be held responsible for the activities within your enterprise, you should have the insight you need to proactively manage against your regulatory stance. Download the "Investing in Compliance" whitepaper to understand where you should focus resources in order to gain clear, real-time visibility into the risk and compliance stance of your organization, instead of making decisions based on incomplete or inaccurate information.