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Definition of Compliance in Healthcare

Definition of Compliance in Healthcare

The business of healthcare is extraordinarily complex and involves both state and federal guidelines that healthcare professionals must abide by. The action of adhering to the regulations and rules within the healthcare industry is called “compliance,” and medical providers need to ensure that they execute and operate their policies within the confines of the law. Many of the compliance rules pertain to patient and staff safety, patient privacy, and payment practices.

While there are constantly changes in the various laws regarding compliance, every healthcare organization needs to have a department or management members that follow the requirements.  Lack of compliance can result in fines and fees that can potentially shut a healthcare provider down and ignorance of the laws is not an acceptable excuse.

Federal Laws and Organizations Regarding Compliance

Each healthcare organization needs to confirm with their own state guidelines regarding compliance, however, there are blanket federal laws that govern compliance adherence that compliment state laws:

How Is Compliance Managed?

A majority of organizations in the healthcare industry have a department and/or officer that is responsible for compliance. These individuals are educated on both state and federal guidelines and create the required programs necessary to accommodate compliance guidelines. The compliance department works in conjunction with the executive and/or management of an organization to establish documentation, follow through and actions for an effective compliance program.

All staff must be involved in the educational process of compliance so that all regulations, guidelines, and procedures are followed. The compliance officer or department needs to establish a workplace attitude of responsible and ethical behavior as well as educating all employees in understanding the importance of compliance. Open transparency for compliance guidelines and reporting is key to a successful program.


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