Health Compliance in Hospital and Health Systems

Health Compliance OIG DQI
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Health Compliance OIG DQI
Health compliance is geared towards improving the quality and safety in healthcare service delivery. Health compliance encapsulates a regulatory framework. The said framework is used as a blueprint for enacting health compliance regulations. The healthcare regulatory environment in the U.S continues to evolve. Equally, it also grows more complex. Various aspects of healthcare in the U.S, such as Medicare participation, privacy, confidentiality, security concerns, and approach to health compliance or regulations, present challenging responsibilities for healthcare providers. All these aspects culminate in a broad spectrum of risks that face hospitals and hospitals.
Hospital and Health Systems Compliance Risks
Privacy and confidentiality are issues of concern that pose risks to healthcare systems and hospitals. Some issues surrounding privacy and security of data involve electronic data breaches. Most states have adopted their laws to deal with data breaches. However, the data breach regulations tend to vary amongst states. The variations emanate from an understanding of personal data, approaches to qualifying data breaches, and the extent of penalties imposed on health providers with associated risks that are considered non-compliant with data protection regulations. There are many instances of data security infringements in the U.S, which compromise patients’ privacy rights. A significant number of such violations occur amongst the healthcare providers and their partners that allow some parties access patients’ information as the overall healthcare delivery system increasingly gets digitized (Yaraghi & Gopal, 2018). The 2013 Health Insurance Portability and Accountability Act (HIPAA) boosted business associates’ regulatory oversight and privacy protection demands (Yaraghi & Gopal, 2018). Potential violation of HIPAA poses risks for the healthcare system and healthcare providers.
False claims and whistle bowler suits are other risks that threaten healthcare systems. The False Claims Act prohibits all types of fraud in federally-supported health programs such as Medicaid or Medicare. False Claims Act allows prosecution for acts ...