Healthcare compliance is the ongoing process of meeting, or exceeding the legal, ethical, and professional standards applicable to a particular healthcare organization or provider. Healthcare compliance requires healthcare organizations and providers to develop effective processes, policies, and procedures to define appropriate conduct, train the organization's staff, and then monitor the adherence to the processes, policies, and procedures. Healthcare compliance covers numerous areas including, but not limited to, patient care, billing, reimbursement, managed care contracting, OSHA, Joint Commission on Accreditation of Healthcare Organizations, and HIPAA privacy and security to name a few.
Healthcare compliance is not a new concept. One of the earliest forms of healthcare compliance was the establishment of minimum standards for surgery facilities by the American College of Surgeons in 1918. Today, the volume of regulations applicable to healthcare organizations and providers requires they have dedicated team members specifically focused on healthcare compliance.
Each of the government agencies that regulate healthcare approaches its regulatory framework based upon its own area of control. For example, the Drug Enforcement Administration (DEA) is charged with enforcing the laws regarding controlled substances. The DEA's healthcare compliance is understandably directed toward ensuring that controlled substances are only used appropriately.