The Ultimate Compliance Checklist for Companies in Healthcare

HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 governs how healthcare organizations handle protected health information (PHI). This set of regulations relates to sharing, collecting, storing, and disposing of health records, patient data, and other sensitive information.

HIPAA compliance requires the following types of measures:

• Physical safeguards: Storage of and access to PHI on paper or in digital media, video surveillance, password protection for computers and other electronic devices, and locks for filing cabinets and other storage facilities.
• Technical security: Network infrastructure protection through firewall, data encryption, authentication measures like usernames and passwords, antiviral software updates, and access logs.
• Policies and procedures: Steps for handling, storing, accessing, and sharing PHI; consequences for non-compliance; and protocols for reporting and responding to breaches.
• Staff training: Topics including employee rights and responsibilities in handling PHI, core policy practices, best practices in ethical behavior, the importance of HIPAA compliance, and identifying and reporting incidents.
• Administrative protections: Organization-wide policies, including designating a compliance officer, appointing a compliance committee, conducting regular risk assessments, making corrective actions in response to incidents, and developing emergency management plans.

OSHA

The Occupational Safety and Health Administration (OSHA) emerged from the 1970 OSHA Act, which requires organizations to implement protocols that maximize worker safety and maintain safe working conditions. Following OSHA standards promotes the health and well-being of employees, patients, visitors, and other stakeholders who enter the facility.

A compliance checklist for companies must incorporate the following OSHA elements:

• Bloodborne pathogens: Preventing contact with and transmission of diseases and infections like HIV and hepatitis B and C.
• Emergency preparedness: Developing and improving contingency plans to protect patients and employees during crisis events, including regular drills, training, emergency communication protocols, and evacuation routes.
• Hazard communication: Awareness of hazardous chemicals and other substances through training, proper labeling, warnings, and communication methods about such hazards.
• Infection control: Routine cleaning and disinfecting of physical areas, promoting proper hygiene, and mandating social isolation during infection outbreaks.
• Personal protective equipment: Eye protection, gloves, respiratory equipment, gowns, and other gear that protects against hazardous exposures.
• Violence prevention: Preventing physical and psychological violence through training, risk assessments, de-escalation strategies, and security measures.

FWA

Fraud, waste, and abuse (FWA) in healthcare primarily refer to the inefficient and inappropriate use of Medicare and Medicaid funds. Under the direction of the U.S. Office of Inspector General (OIG), the Centers for Medicare and Medicaid Services (CMS) oversees the disbursement of federal money and enforces regulations that protect against FWA.

To help compliance officers differentiate acts of fraud, waste, and abuse, the CMS provides these explanations:

• Fraud refers to acting alone or in collaboration to submit a false medical claim for monetary gain (e.g., misrepresenting medical facts or data, billing for patients who don’t show up for appointments, or falsifying records).
• Waste involves intentionally or unintentionally misusing funding (e.g., using incorrect billing codes, prescribing expensive drugs when more affordable ones exist, or submitting redundant paperwork).
• Abuse includes actions directly or passively resulting in avoidable medical expenses (e.g., subjecting patients to unneeded tests or price-gouging on medical supplies or procedures).

Preventing FWA involves employing several policies and procedures, including:

• Developing an organization-wide compliance program under OIG guidance
• Training all staff on understanding, detecting, and reporting FWA
• Ensuring thorough documentation and accurate medical coding
• Invest in resources and services that promote FWA prevention and detection

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With support from Compliancy Group, completing a compliance checklist for companies can save you significant time and effort. Contact us today to see how we can help you achieve your compliance goals and protect your financial security.