Healthcare Compliance

Compliance includes following rules, regulations, and laws that relate to the healthcare industry. In an industry like healthcare, it is of utmost importance to make sure you are compliant with all rules, regulations, and laws at all times. Due to the constantly changing regulation and uncertainty in the healthcare industry, many organizations are not even aware of when they are non-compliant. Zetter HealthCare is here to assist you with HIPAA, OSHA, Corporate Compliance, Fraud, Waste & Abuse, and Human Resources compliance.

Healthcare ComplianceWe have partnered with the experts at Healthcare Compliance Pros (HCP) because Zetter HealthCare wants the very best for our clients. Healthcare Compliance Pros is the leading provider of compliance programs and training to the medical community. As a result, our compliance services set your company up for success while ensuring you are compliant with all regulations.


Medicare Fraud, Waste & Abuse

Medicare is a federal health insurance program that people over the age of 65 can take advantage of. Occasionally, those younger than 65 with disabilities may also take advantage of it. Being compliant with Medicare rules and regulations is extremely important. For instance, you do not want to run the risk of being accused of fraud, waste, or abuse.

Medicare fraud by a provider is when providers deceive or mislead Medicare to receive payment when they should not. It can also occur when taking a higher payment from Medicare than needed. This includes billing for services that you never received, billing for more expensive services than needed, falsely telling a patient that Medicare will pay for services, and other forms of deceiving the Medicare system.

Medicare waste means that a provider is over-using services to result in unnecessary costs. For example, charging higher prices than necessary for services or supplies.

Medicare abuse bills unnecessary costs to the Medicare program and encourages providers to perform services on patients that are not medically necessary. Medicare abuse can also include misusing billing codes to increase reimbursement. Generally, if you come face to face with these illegal actions, report them immediately.

Zetter HealthCare ensures your practice’s performance is compliant with all Medicare services.


HIPAA Healthcare Compliance 

HIPAA stands for the Health Insurance Portability and Accountability Act. This act was passed by Congress in 1996 to protect sensitive information about patients’ health without their consent.

All healthcare organizations must comply with HIPAA to protect the privacy, security, and integrity of patients’ health information. Protected health information includes names, addresses, phone numbers, Social Security numbers, medical records, financial information, and photos.

Organizations that must be HIPAA complaint are covered entities and business associates. For example, any organizations that collect, create or transmit protected health information electronically. Covered entities include healthcare providers, healthcare clearinghouses, and health insurance providers.

Business associates are organizations that encounter protected health information on behalf of a covered entity. Common examples are billing companies, practice management firms, third-party consultants, EHR platforms, IT providers, faxing companies, physical storage providers, cloud storage providers, attorneys, accountants, and more.

To be HIPAA compliant, healthcare organizations must comply with the HIPAA security rule. Certain security measures must be taken to ensure patient information is safe and secure. Healthcare companies must also perform self-audits yearly. These audits include assessing Administrative, Technical, and Physical gaps in compliance.

If a breach in security was to occur in your healthcare organization, you must follow the HIPAA Breach Notification Rule. This means that you must notify patients if their information was, or could have been, compromised by a data breach.

HIPAA ensures the privacy of healthcare patients. To make sure that your organization is compliant with all of HIPAA’s rules and regulations, contact Zetter HealthCare.


OSHA Compliance

The Occupational Safety and Health Act, or OSHA, was enacted in 1970. This act was put in place to ensure healthy and safe working conditions for employees. OSHA sets and enforces standards and provides training, outreach, education, and assistance to healthcare organizations.

To be compliant with OSHA, you must follow all regulations set in place. This may include providing personal protective equipment when necessary, creating an emergency action plan, communicating hazards that healthcare employees may encounter, and much more.

For more information about Zetter HealthCare’s online compliance program, click here.

If you need further assistance with healthcare compliance, contact Zetter HealthCare at (717) 691-6768.

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