Top 8 Compliance Risks in Healthcare for 2024

Last Updated on March 5, 2024

Top 8 Compliance Risks in Healthcare for 2023-2024

From labor shortages to cybersecurity threats, today’s healthcare leaders face a bewildering host of operational challenges. And underlying them all is the need for diligent attention to a series of shifting regulations. But as we exit the pandemic phase and head into 2024, where should leaders focus their attention? In addition, what are the most impactful compliance risks in healthcare for the immediate future?

Understanding Compliance Risks in Healthcare

Ensuring safety and quality of care for patients and residents isn’t just the goal of every individual healthcare organization, but also the priority of the industry as a whole. Moreover, because the stakes are so high, lawmakers have, in recent decades, laid a complex groundwork of regulations to compel organizations to follow specific guidelines and protocols.  

From the False Claims Act to the Patient Safety Rule, the goal of these rules is to detect not just malfeasance, but also honest errors and misunderstandings. Organizations that fail to keep up may face penalties. These range from loss of accreditation by The Joint Commission and other quality assurance organizations to hefty fines and even shutdowns.

On the bright side, staying compliant will give organizations faster, more efficient workflows. That helps keep patients safe and healthy, and workers happy and engaged. It’s also a helpful tool to ensure that organizations receive every dollar of their reimbursement earnings.

The Role of Healthcare Compliance Risk Management

Yes, it’s true that every healthcare organization operates under a unique patchwork of regulations, but there are still a few important areas that every operator should consider.

Most organizations have a compliance officer or even an entire department dedicated to the task. Many of them follow the seven stages of compliance, as defined by the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS):

  • Create and follow written standards and procedures
  • Designate a committee and officer to direct and oversee efforts
  • Conduct training and education
  • Develop effective communication
  • Conduct internal monitoring and audits
  • Enforce standards and address failures
  • Enable prompt response and corrective action

Some experts add risk management as an eighth stage. If compliance is the act of balancing available resources to contain risk, then managing it requires a process for assessing risk via internal audits, then aligning the management of those risks with larger goals and strategy.

Proactive compliance through risk management identifies needs and issues early on, which defines critical focus areas for successful compliance. Additionally, the more that data analytics is used to inform the process, the better the results are likely to be. 

8 Compliance Risks in Healthcare

As we close out 2023 and head into 2024, what are the most important compliance risks in healthcare for employers?

#1: Patient Data Protection and Privacy

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is perhaps the industry’s most famous rule, but it’s far from the only one that concerns itself with protecting data. There’s also the Patient Safety Rule, which has its own confidentiality requirements. And organizations also need to follow any state-level policies in their area, which can cover not just the use of personal data but also the means in which it’s stored, transmitted, and protected.

In the future, look for the requirements of HIPAA to only even more complex. Some groups are calling for it to be strengthened, or supplemented with additional statutes concerning newer technology like machine learning and encrypting data. 

#2: Finance and Price Transparency

Many of the compliance risks in healthcare exist to address false or improper claims, referrals, payments or other “kickbacks.” Navigating the rules around the False Claims Act and implementing greater price transparency can help prevent weighty fines, and even keep staff out of legal jeopardy. Yet according to Crowe LLP, financial and price transparency currently make up just 16% of all audits.

#3: Post-Pandemic Changes

As the industry moves out of the pandemic, some rules are going back to the way they were before. But that doesn’t include all of them, at least not yet. The official Covid-19 public health emergency (PHE) ended in May, 2023, along with the telehealth waiver program. As a result, a significant amount of care delivery now adheres to different rules than when the year began.

Yet some of the pandemic rules carved out for remote care remain in place. The 2023 Appropriations Act extended the lifting of restrictions on telehealth access for many people on Medicare through December 31, 2024. The Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home program will also last through next year.

#4: Technology Compliance

With the growth of healthcare AI, technology is changing healthcare delivery almost in real time. Part of the goal of HIPAA is to help ensure that an organizations’ tech foundation is up to the job of keeping patient data safe. But that’s only the beginning of the compliance obligations of technology.

For instance, the HITECH Act governs the use of healthcare technology with a specific framework to follow to ensure best practices. Doing so will help protect against cyberattacks, ensure business continuity, and enable third-party risk management. It will also help ensure the proper use of biomedical devices, including telehealth hardware and software.

#5: Safety Compliance

From clinical competency to disaster preparedness, patient safety affects most parts of healthcare. Clinical risks like surgical safety and device use requires monitoring and auditing. It also includes protecting employees and visitors against violence and other aspects of security.

The Joint Commission takes patient safety as a top concern. Its Sentinel Event Policy provides employers with important information and guidance to help prevent catastrophic events. The end result is helping boost not only compliance with patient safety rules, but also overall outcomes.

Did You Know: CareerStaff also holds a Gold Seal of Approval® in Joint Commission-Certified healthcare staffing?

#6: Education and Training

Many care providers are required to ensure ongoing staff training in specific ways. For instance, long-term care facilities are required since October 24, 2022 to train staff and contractors on a number of themes central to optimum care. These include topics as diverse as cultural competence, infection control, trauma-informed care and quality communication.

#7: Vendor Management

Healthcare compliance risk management also requires showing control over third-party vendors, suppliers, and subcontractors. Companies can be held responsible whether any of these parties fail or become compromised. So, it’s important to ensure that risk management and compliance efforts extend to each, including full audits, frank monitoring assessments, security checks, and business continuity analysis.  

#8: Labor Management

Finally, compliance risk management means that healthcare employers have certain responsibilities over everyone working for their organization, no matter in what capacity that may be. Especially at a time when flexible staffing requires the use of temp and travel workers, organizations need to ensure compliance with Independent Contractor (IC) and other state rules, including California’s AB5.

Did you know? IC compliance is included when you partner with a leading managed services provider (MSP).

Manage Your Compliance Risks in Healthcare with CareerStaff

Mitigating compliance risks in healthcare takes dedicated resources and serious expertise. For leaders looking to improve their efforts, each of the above areas is an excellent starting point. And, at a time when few organizations can afford the penalties of failure, outside guidance may offer the best path forward.

At CareerStaff Unlimited, we’re proud to help healthcare organizations improve their ability to stay compliant with the rules that matter. From nationwide staffing to workforce management services, our Joint Commission-Certified solutions are tailored to meet the needs of organizations of all sizes. Contact us to today to learn how we can help you mitigate today’s healthcare compliance risks.

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