Benefits of Outsourced Compliance

For years, healthcare compliance programs were viewed as simply a risk-management practice to avoid regulatory violations and ever-changing healthcare laws. However, the industry is now undergoing a transformation, as compliance programs are not just recommended for improved care delivery and cost-saving management, but required by law. Section 6401 of the Affordable Care Act (ACA) states that a provider of medical services or supplies shall establish a compliance program as a condition of enrollment in Medicare, Medicaid, or the Children’s Health Insurance Program. No compliance program, no enrollment.


Building Blocks of Compliance Programs

The ACA also required that the Secretary of Health and Human Services, in consultation with the Office of the Inspector General (OIG), establish “core elements” for provider and supplier compliance programs, as listed below: 


OIG’s 7 Elements of an Effective Compliance Program

  1. Implementing written policies, procedures, and standards of conduct

  2. Designating a compliance officer and compliance committee

  3. Conducting effective training and education

  4. Developing effective lines of communication

  5. Conducting internal monitoring and auditing

  6. Enforcing standards through well-publicized disciplinary guidelines

  7. Responding promptly to detected offenses and undertaking corrective action


Risks of Internal Compliance Programs

Many organizations have found that by internally sourcing their compliance program, they were basically betting their regulatory viability on one single, likely overworked, individual’s integrity and professionalism, rather than utilizing a highly-credentialed third-party team to conduct their compliance activities. Richard P. Kusserow, former HHS Inspector General, stated that during a government-industry roundtable devoted to compliance, the OIG shared its concerns that among the many risks of internal compliance programs was the tendency for organizations to add the duties of “compliance officer” to the already extensive responsibilities of other staff members, resulting in a compliance officer lacking the time, knowledge, and skills to operate an effective compliance program, thus opening the organization up to the possibility of numerous regulatory violations.


Outsourced Compliance Programs

For most organizations, the only way to guarantee that OIG’s Seven Elements are fulfilled is to employ a team that knows compliance inside-and-out. During the same meeting referenced above, the group determined that the benefits of outsourcing compliance activities included “gaining access to compliance ‘best practices’ by virtue of an independent, broader exposure to the compliance discipline, ongoing verification of internal compliance processes, and the supplementation of limited internal resources.”  


The Centers for Medicare & Medicaid Services (CMS) has advised healthcare organizations, large and small, that outsourced compliance programs offer many key advantages, such as: 

  • Your organization is not paying the bloated cost of a full-time employee and has a reduced cost of recruiting and supporting internal compliance staff;

  • Executive and shareholder confidence and trust;

  • Accurate compliance budgeting and remediation; and

  • Full-support of third-party knowledge, education, training, and guidance.


The business case for outsourcing a compliance program really comes down to three simple points:

  1. Time-Saving: Does not require management hours or payroll hours and outsources all education and orientation of people in compliance positions.

  2. Cost-Effective: Cuts out full-time position of overworked internal “compliance director” and decreases overall risk of fines/damages, with a lower initial investment.

  3. Objectivity: Utilization of independent third-party team of accredited compliance professionals, proving to government agencies that the organization is serious and invested in compliance.


Outsourced compliance programs ensure that your facility is doing everything it can to promote compliance, by placing responsibility in the trusted, and certified, hands of those who know best. If you would like to discuss the further benefits of outsourced compliance, please contact us.


References training/files/Compliance101tips508.pdf