What Is Compliance in Healthcare? Procedures, Benefits and Advantages

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A compliance officer reviews data.

Compliance is the process of adhering to the rules and regulations that accompany an organization’s standard practices. What is compliance in healthcare? In healthcare pipelines, officers overview discrepancies regarding payment, patient confidentiality and patient welfare. Healthcare compliance is essential for medical providers to operate and execute policy smoothly and within the confines of the law, and oversight positions will always be necessary. By enforcing the quality of security and protecting the sensitive information of patients and colleagues, compliance officers uphold and improve the standards of the healthcare industry. Administrators who become experts in healthcare compliance have an advantage over their peers that can lead to higher salaries and more instrumental roles in their field.

What Is Healthcare Compliance?

Healthcare compliance is an essential component of every medical provider. Within the hierarchy of a practice’s administration, there are typically several individuals whose sole responsibility is to ensure the practice meets all regulations, safeguards patient and worker information, and upholds standards for sharing medical data. The U.S. Department of Health and Human Services (HHS) has created nationwide standards known as the Health Insurance Portability and Accountability Act (HIPAA), and the core facet of healthcare compliance is enforcing this legislation.

Providers face serious penalties when HIPAA protocol is breached. They range from hefty fines to charges and convictions brought by the U.S. Department of Justice. Most penalties are imposed for failure to protect personal patient information. For example, the Centers for Medicare and Medicaid Services (CMMS) highlights a 2018 case in which the laptop of a wireless health provider employee was stolen, thereby compromising the electronic protected health information (ePHI) of 1,391 patients. The provider was forced to pay $2.5 million to the HHS for failing to keep that information secure. In another case highlighted by the CMMS, a thumb drive containing the ePHI of 2,200 patients was stolen, and the subsequent investigation revealed improper risk assessment and management. The investigation also discovered that the provider had no systems in place to notify patients of the breach. This ultimately resulted in a settlement of $150,000 for breaching HIPAA protocol. An online Master of Health Administration (MHA), particularly one with a focus on healthcare compliance, equips professionals with a thorough grasp of the legal ramifications and penalties pertaining to healthcare compliance violations. When looking into advanced degrees, students should consider the advantages that expertise in healthcare compliance can bring.

Healthcare Professionals Who Understand Compliance Can Become Subject Matter Experts

Understanding the language of healthcare compliance can give healthcare professionals a substantial advantage in the field. Individuals who fully grasp the complexities of compliance protocol are poised to become sought-after specialists, and with experience, they may become recognized as experts. The average healthcare worker has little understanding of the intricacies of healthcare compliance, but administrators who specialize and can competently communicate and execute protocols help to ensure quality in the care and protection of patients.

Understanding Healthcare Compliance Helps Administrators Provide Better Care to Patients

Upholding high healthcare compliance standards is one way that hospitals and clinics strive to offer the best patient care. Healthcare providers routinely collect, observe and access patient data. Safeguarding patient information and results as they are collected and shared has become a core component of the healthcare industry. With data loss prevention and high-tech protection strategies suited for the digital age, compliance officers ensure health records are kept private. Protection strategies that prevent the loss of data and secure sensitive information ensure data can be used to shape care decisions without compromising patient privacy.

Compliance-Educated Health Administrators Qualify for Rewarding and High-Paying Careers

Healthcare compliance officers have important roles in the function of every medical institution. Fully understanding and working in accordance with nationwide compliance standards can save a practice millions of dollars in penalties, as well as the priceless value of patient confidence. Careers in healthcare compliance reflect this. According to September 2019 PayScale data, compliance directors earned a median annual income of $100,753. Top medical administrators are fully versed in healthcare compliance, and pursuing that expertise is a reliable way to work toward a leadership position.

Learn How You Can Help Uphold Patient Privacy as a Healthcare Compliance Professional

Healthcare compliance laws and regulations play a vital role in the healthcare industry. Learn how Duquesne University’s online Master of Health Administration and its concentration in Healthcare Compliance and Risk Management can help you navigate the regulations of healthcare compliance and prepare you to fill an important role in a medical facility.



Recommended Readings

Deciding Between an MHA and an MPA: Which One Is Right for You?

How to Become an HR Manager in Healthcare

What Does a Health Administrator Do in a Day?


AAPC, “What Is Healthcare Compliance?”Centers for Medicare and Medicaid Services, “HIPAA Basics for Providers: Privacy, Security and Breach Notification Rules”Digital Guardian, “Healthcare Security: Understanding HIPAA Compliance and Its Role in Patient Data Protection”

Duquesne University, Online Master of Health AdministrationHHS.gov, Laws and Regulations

PayScale, Average Compliance Director Salary

U.S. Department of Health and Human Services: Office of Inspector General, Compliance