Outsourcing Healthcare Compliance

folded hands outsourcing healthcare compliance

The concept of outsourcing healthcare compliance is a growing option worthy of consideration for a variety of hospitals, outpatient clinics, and other healthcare organizations. At issue is the grappling to comply with regulations, the need to mitigate risks, and the desire to simply do what’s right and in the best interest of the patients being served.

Where large hospitals and clinics may have the resources to hire a full-time employee to manage the program, smaller organizations may not. These organizations often pass the role onto an existing employee who may already have a full workload with other duties and responsibilities. When this happens, focus on the job to be done is diminished, and in doing so, that employee often falters in all areas of concern.


What are the Benefits of Outsourcing Healthcare Compliance?

The benefits of outsourcing healthcare compliance are plentiful but fall predominantly into the following four areas …

  1. The immediate insertion of expert knowledge.
  2. The objectivity that a third party will bring to the organization.
  3. Time savings that otherwise pull current staff away from other responsibilities.
  4. The cost-effectiveness afforded by eliminating a full-time employee.

Below we delve into each of these with a bit more detail.


Expert knowledge You benefit from the full set of knowledge, training, and experience of a third-party consultant. When you hire an expert, you are employing an entire team of people who know healthcare compliance inside and out. They are aware of emerging trends and stay up to date on changing regulations.
Objectivity When you choose accredited individuals to lead up your compliance program, you signal to the government that you are serious about investing in compliance. Additionally, you gain an outside set of eyes to ensure your organization is doing its best to follow procedures and avoid breaches. The potential for conflicting interests is eradicated.
Time savings When you outsource, you turn over all aspects of the program, including employee training and education, to a third party. This saves many employee hours and management time from tedious and time-consuming processes.
Cost-effectiveness By eliminating the need to hire a full-time employee as a compliance manager, you avoid the need to pay for a full-time employee (salary, benefits, onboarding, etc.). Combining that with avoiding possible HIPAA fines from breaches, outsourcing healthcare compliance is a money-saving venture.


Does your hospital have pressing problems and need a quick resolution?  Outsourcing healthcare compliance means beginning work immediately on those compliance issues even by assisting legal counsel, providing training for staff, and developing updated/upgraded policies. To see these benefits in action this case study for the compliance program of a rural hospital may be of interest.


What are the Selection Criteria for Healthcare Compliance Outsourcing?

The selection criteria for healthcare compliance outsourcing should focus on positive references, technology and methodology, communication, and credentials. Whether it’s for a hospital, outpatient clinic, or other healthcare organization, you want to be sure to hire qualified consultants that have the knowledge, skills, and resources to meet your needs.

The table below provides added substance to the recommended criteria.

Positive references What do their clients say about them? An organization that gets the majority of new business from referrals is an organization with satisfied customers.
Technology and methodology Look for consultants that are up to date on the latest technology and methods. An effective consulting firm knows how to combine methodologies that they have perfected over the years with emerging trends of new requirements from changing technologies.
Communication Look for a company that will keep the lines of communication open so that you can stay informed and become active participants in your compliance program.
Credentials What are the credentials and experience of the consultants? Choose a partner that has proven expertise. The Fox Group provides a team of experts with hands-on experience and proven success to assist clients with their unique requirements.


When analyzing your compliance program’s effectiveness, you must consider various steps.  Given the diversity of the healthcare industry, there is no single ‘‘best’’ healthcare compliance program. The OIG recognizes the complexities of the healthcare industry and the differences among various healthcare entities. Some entities are small and may have limited resources to devote to compliance measures; others are affiliated with well-established, large, multi-facility organizations with a widely dispersed workforce and significant resources to devote to compliance. Accordingly, the compliance program guidance issued is not intended to be one-size-fits-all guidance.

When you need proven expertise and performance