Compliance monitoring refers to ensuring that healthcare organizations, providers, and suppliers adhere to relevant laws, regulations, and standards that govern the delivery of medical services and the handling of medical information.
This includes monitoring for compliance with privacy laws like HIPAA, quality of care standards, fraud, abuse laws, and reporting requirements. Compliance monitoring aims to promote safe and effective medical care while protecting patients’ rights and safeguarding the confidentiality of medical information.
Let’s explore some current healthcare compliance monitoring trends in 2023:
1. Continued focus on data privacy and security
With a growing number of cyberattacks targeting healthcare organizations, there is heightened emphasis on protecting sensitive medical information. According to the HIPAA Journal, the healthcare industry had the highest percentage increase in weekly cyberattacks of any industry sector, with a rise of 74% from 2021, or an average of 1463 attacks per week. Healthcare became the third most attacked industry globally, behind the government and military. In the United States, healthcare ranked seconds with 1,410 attacks per week, an 86% increase from 2021. Across all industry sectors, cyberattacks in the United States increased by 57% year-over-year.
2. Resurgence of mergers, acquisitions, and consolidations
Healthcare mergers and acquisitions have gained significant traction over the past five years, with the total number of transactions reaching 53 in 2022. This has been driven by the need to reduce expenses, enhance the quality of care, and increase financial stability. For smaller health systems that can no longer operate independently, being acquired by a larger organization has become an increasingly more viable option.
COVID-19 undeniably impacted healthcare M&A activity, but as we move into 2023, M&A will see a resurgence, according to Kaufman Hall, a healthcare consulting firm.
Private equity (PE) firms and their investors have recently encountered heightened pressure from all sides. Government agencies and private entities continually monitor PE firms’ activities, with possible ramifications under the False Claims Act if any misconduct is detected. Increasing attention has been paid to the actions of PE portfolio companies and the investors themselves.
3. Increased government oversight
On December 29, 2022, President Biden signed the Consolidated Appropriations Act, which included different provisions related to Medicaid and CHIP and an extension of Telehealth flexibilities until 2024. This allows Telehealth providers to demonstrate their value and worth to healthcare systems.
A September 2022 OIG report showed that 37 million people utilized Telehealth visits in 2022, a 13-fold increase from the previous year. Nevertheless, there has been an increased focus on handling these services. Fraudulent activities were discovered, such as erroneous billing for more expensive visit levels and duplicate claims, amongst other issues.
The Office of Inspector General’s (OIG) study showed that many programs lacked oversight data. As such, in July 2022, a Special Fraud Alert was issued to providers cautioning them regarding potential frauds associated with Telehealth companies. These frauds often involve incentives for practitioners based on service volume or advertisements encouraging patients to use services at no out-of-pocket cost.
4. Use of technology to enhance compliance monitoring
Technology can automate many aspects of the compliance monitoring process, such as data collection, analysis, and reporting. This can increase the efficiency and accuracy of compliance monitoring, reducing the risk of human error. Technology can also help organizations analyze large amounts of data, which can help identify areas of non-compliance and take corrective action.
5. Emphasis on patient-centered care
A growing emphasis on ensuring compliance monitoring promotes delivering high-quality, patient-centered care. This includes ensuring that medical providers have the necessary information and resources to provide effective treatments and addressing barriers preventing patients from accessing care.
Patients will have more opportunities to receive healthcare in a delivery that is suitable for them. This includes precision medicine, where drugs and treatments are specifically tailored to a group of patients – based on individualized factors like age, genetics, or risk factors, rather than administered on a one-size-fits-all approach.
Final Thoughts
Keeping up to date with trends in healthcare compliance monitoring is essential for several reasons, from protecting patients to staying compliant and maintaining the trust of patients and the public. Consistent monitoring helps ensure that healthcare organizations, providers, and suppliers provide patients safe, effective, and appropriate medical care.
Interested in exploring better ways to improve your compliance monitoring in 2023? Contact us
