Why is Healthcare Compliance so Important?

Healthcare compliance is the continuous process of adhering to laws, ethical rules, and professional norms on the part of a healthcare facility. In order to achieve this objective, every healthcare facility must not only have certain policies and procedures in place, but also train and monitor its staff to ensure that these policies and procedures are being followed.


There are two primary reasons why it’s so important to comply with healthcare laws. First, healthcare compliance is designed to ensure that patients stay safe and healthy. Second, penalties may be imposed on healthcare facilities that fail to adhere to healthcare laws, and these penalties can be severe. In the case of HIPAA violations, for example, penalties can include not only hefty fines but even jail time. Although in most cases only financial penalties are imposed for HIPAA violations, the fact that there is a possibility of imprisonment should be enough to convince all healthcare facilities of the importance of developing internal policies and procedures that ensure proper healthcare compliance.

In addition to the prospect of adverse health, financial, and criminal consequences, healthcare compliance is also important because having robust healthcare compliance policies and procedures in place can help healthcare facilities prevent fraud, abuse, waste, and other problems that could give rise to liability or raise costs.


Moreover, under the Affordable Care Act healthcare providers are required to show they have implemented healthcare compliance programs in order to enroll in Medicare. As such, many health insurance companies now require that providers have healthcare compliance policies and procedures in place before agreeing to work with them.


Another reason why healthcare compliance is so important is related to cyber security. Now that healthcare facilities all have computer systems which store sensitive healthcare information even a minor cyber security lapse can have devastating consequences. And there is an ongoing arms race between cyber security specialists and hackers, who are always probing computer systems for vulnerabilities.


Indeed, there has been an alarming increase in the number of ransomware attacks by hackers in recent years, epitomized by the Colonial Pipeline attack in 2021. During this attack a huge oil pipeline system which carries 45% of the East Coast’s oil supply was forced to shut down for 11 days, leading to skyrocketing gas prices, long lines, and panicked buying. The company that was targeted in the attack was forced to pay a ransom of $4.4 million in order to get their pipelines operating again, and although some of that money was eventually recovered the incident served as a wakeup call to companies all over the country about the risks associated with computer systems.


Healthcare facilities certainly aren’t immune to ransomware and other kinds of cyber attacks. In fact, one of the main purposes of HIPAA compliance is to ensure the cyber security of patient healthcare data. HIPAA established national standards for protecting electronically stored patient data—known as “electronic protected healthcare information”—and requires healthcare providers and facilities to implement administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and security of this information. HIPAA also requires healthcare facilities to train their staff on cyber security and undertake yearly risk assessments in order to stave off potential threats to electronic protected healthcare information. Clearpol’s Policies.ai software helps healthcare facilities achieve healthcare compliance and stay on top of the myriad healthcare rules and regulations, including laws at the federal, state, and local level. Healthcare rules and regulations are not only complex, but also change frequently, so it’s crucial to stay informed in order to avoid financial penalties, adverse health consequences, and potential jail time.

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