Challenges in corporate compliance in healthcare

Due to Medicaid and Medicare fraud in recent years, the Office of Inspector General (OIG) is ramping up enforcement of corporate compliance in healthcare requiring healthcare institutions to perform regular sanction checks of vendors and individuals to ensure that they are not billing for the work of excluded parties.

The ramifications of working with a sanctioned provider can be staggering and can include:

  • Fines of $11,000 per billing incident
  • Treble damages in the millions of dollars
  • Exclusion from federally and state funded healthcare programs
  • Potential criminal damages

Complying with sanction check requirements is a monumental task for healthcare providers requiring them to regularly check multiple sanctions databases and validate provider eligibility – on a continuous basis.

Healthcare organizations that have third parties gaining access to Protected Health Information (PHI) are also challenged by the Health Insurance Portability and Accountability Act (HIPAA) requirement for a HIPAA vulnerability assessment. Most organizations simply do not have the people or financial resources to maintain a continuous, effective program to monitor these healthcare compliance issues.

SureShield Software to mitigate Third Party Compliance Risk

BreachShield

  • Assesses compromised credentials to mitigate breach risk

VendorShield

  • Ensures compliance and reduces the risk of financial penalties

SecurityShield

  • Assesses vulnerability of assets and asset inventory system to respond to security risk

SanctionShield

  • Automates third party sanction checks and exclusions to confirm compliance