The Top Compliance Issues in Healthcare and How an MSP Can Help Facilities Ensure They Meet Regulations

A culture that nurtures and enforces compliance is a necessary condition for healthcare organizations. 

Without compliance regulations and guidelines, facilities would face scrutiny regarding their operations and quality of care. The result would be a catastrophic and system-wide failure to protect the health, safety, and rights of patients and staff. 

Compliance relies on its leaders to create an environment that upholds and enforces it from the top down. In the ever-shifting field of healthcare, any supplemental compliance resources should be exercised to the highest degree. 

In this article, we will discuss the importance of compliance, top compliance issues in healthcare regarding staffing, and how your facility can use healthcare managed service providers as a safety net for contingent staffing compliance. 

Table of Contents

• The Importance of Regulation Compliance in Healthcare
• 6 Examples of Compliance Issues in Healthcare Staffing
• 3 Additional General Healthcare Compliance Issues Facilities Should Be Prepared To Manage
• Trusted Managed Services: Your Source for a Healthcare MSP That Can Help Manage Common Compliance Issues in Healthcare

The Importance of Regulation Compliance in Healthcare

Healthcare compliance regulation refers to the laws and guidelines that govern the healthcare industry.  

A commitment to compliance helps maintain the required Hippocratic principles needed to navigate complex legal frameworks and embrace ethical decision-making. It also promotes a culture where all staff within an organization strive to adhere to regulations that safeguard patient well-being and uphold the facility’s integrity. 

Staffing is one of the pillars of maintaining the necessary standards for regulation compliance in healthcare. Maintaining it relies on a proactive approach involving stringent licensure verification, thorough background checks, and unfaltering obedience to compliance regulations. 

On the legal level, non-compliance to staffing regulations that may potentially create conditions for fraud, waste, and abuse may result in severe legal ramifications, such as:

• Fines
• Civil lawsuits
• Criminal charges
• Loss of accreditation from The Joint Commission or loss of other licenses
• Corrective actions such as shut-down or loss of public funding

The cost of compliance issues in healthcare may also trickle down to the social level of an institution’s inner workings. Loss of morale among staff, deterioration of quality care, reputational damage, and lack of patient trust may also be the result of non-compliance.

6 Examples of Compliance Issues in Healthcare Staffing

In some instances, the healthcare worker shortage has created a crisis where facilities are scrambling to train and onboard staff as quickly as possible. As a result, certain staffing regulations and standards may become in danger of being overlooked or neglected. 

Add the increasing call for a contingent workforce into the mix and now you walk a tight line between a few lost emails and a complete neglect to ensure that a candidate is properly credentialed. 

If you’re already burning through administrative resources like time, money, and manpower to keep your facility warm and running, the last thing you want to do is risk tossing HIPAA or other regulations atop the flames as well. 

Healthcare managed service providers (MSP) help relieve the administrative burden that involves compliance and contingent staff handling. In 2022, travel nurses worked more than 23% of total nursing hours in the average facility. Without a dedicated account manager provided by an MSP, organizations may have a hard time keeping track of contingent nurses while ensuring they are 100% compliant. 

Healthcare MSPs, like Trusted Managed Services, help facilities ensure that all the provided contingent staff and vendors are fully compliant. 

At Trusted Managed Services, we stand as a bulwark for our client’s challenges posed by the staffing shortage and as a safety net against potential contingent staffing compliance issues.

#1: Credentials Verification

Credential verification is a mechanism for validating that the healthcare staff are capable and qualified to work at the facility. It’s a methodical assessment that verifies only the most eligible personnel are engaged in patient care. 

This process requires a meticulous review of credentials such as:

• Educational qualifications
• Training
• Board certifications
• Licenses

A structured credentialing process prevents the admission of rogue healthcare workers with suspicious qualifications. The adverse effects of failing to properly credential staff may add pressure to existing staff and create an environment that fosters poor patient outcomes and dangerous situations.

The healthcare industry has little room for error, so even once healthcare staff has been credentialed, facilities should continually audit them to ensure their performance is up to the organization’s standards and requirements. 

#2: Background Checks

Background checks ensure that a facility is hiring reliable, upstanding applicants who will help preserve the safety of patients and existing employees. 

A background check for compliance should include:

• Criminal background investigations
• Drug screenings
• Confirmation of previous employment
• Employee disqualification checks

Criminal background checks and drug screenings evade negligent employees who may act in bad faith. Employee disqualification checks and previous employment verification prevent a facility from hiring individuals with false credentials or sanctions from participating in certain healthcare programs. 

One study conducted by the U.S. Department of Health and Human Services discovered that 19% of nurse aides accused of employee theft, abuse, or neglect also had one or more convictions on their records.

Out of those nurse aids, roughly half had prior convictions involving theft, and those accused of substantiated abuse or neglect were more than three times disposed to having prior convictions for crimes involving bodily harm. 

#3: Ongoing Education and Training Requirements

Mandatory training ensures that all staff remain compliant, informed, and up to date on the latest guidelines, practices, and techniques necessary for safe and effective care. 

Depending on the facility, position, and state-specific requirements, mandatory training might include programs surrounding:

• Safety: OSHA, infection control, emergency response, etc.
• HIPAA compliance: Privacy, harassment prevention, patient information handling, etc.
• Clinical care: Infection control, fall prevention, wound management, basic life support, etc.
• Communication: Cultural competence, team collaboration, customer service, etc.
• Administrative: Policies and procedures, equipment use, charting, etc.

Training establishes standards that protect staff and employees. Continued education is often encouraged or used to supplement training programs for improved quality of care. 

Some states also require continuing education units for license renewals or licensure by endorsements for RNs, LPNs, and NPs. For example, in New York, all three positions are required to complete coursework and training for infection control at initial licensure and every four years after. 

Documenting and tracking CEUs and training requirements amongst a facility’s many contingent workers sometimes seems like an endless, insurmountable task to administrators who have few resources for tracking this data. 

Trusted Managed Services’s vendor management system allows facility administrators to easily access and manage candidate information to maintain a clear record for CEU and training requirement verification. With our VMS services, your administrators can avoid the headache of waiting for a response from vendors and sorting through correspondence for the right information. 

#4: Labor and Contract Management

Contingent staffing is prolific within the healthcare industry. As the proliferation of travel nurses and per diem nurses increases, so does the risk for healthcare compliance issues like poor labor and contract management. 

Certain travel nursing agencies may categorize nurses as independent contractors. But in truth, rarely are travel nurses truly considered independent contractors in the eyes of the IRS. 

According to IRS regulation, “The general rule is that an individual is an independent contractor if the payer has the right to control or direct only the result of the work and not what will be done and how it will be done.” 

Contracts with contingent workforce must also adhere to federal and state laws such as the Fair Labor Standards Act (FLSA), the Occupational Safety and Health Act (OSHA), and the Health Insurance Portability and Accountability Act (HIPAA) standards, among others.

Without a healthcare MSP, the healthcare organization will be the one under scrutiny if contingent labor contracts do not abide by these state and federal regulations. 

#5: Vendor Compliance 

Vendors, like healthcare organizations, are also expected to follow the same staffing compliance regulations. If vendors fail to adhere to any regulations, the facilities that hire them may also be on the hook for non-compliance. 

Without a healthcare MSP, it is the facility’s responsibility to ensure all contingent staffing vendors:

• Follow federal and state staffing guidelines and laws
• Conduct proper background checks and credentialing verification
• Employ individuals with the appropriate licenses and qualifications

Trusted Managed Services holds all of its vendors accountable for meeting compliance regulations. 

Through a series of assessments, security checks, business continuity analysis, and audits, we intensely vet all vendors so that our clients have access to only the best, most compliant labor resource pools. 

#6: Personnel Documentation 

Proper document management coupled with an effective recordkeeping system is integral to maintaining compliance. It is also mandatory.

For staffing compliance audits, your organization will need to provide:

• Up-to-date personnel files
• Record of employee licenses and certifications
• Documentation of disciplinary actions
• Performance evaluations
• Incident report records

If your healthcare facility is sourcing and managing contingent staff without the help of an MSP, your administrators may need to reach out to multiple vendors to source the necessary documentation. 

This may take time and a lot of emails, which could delay the audit process. If there is anything worse than an audit, it’s a long drawn-out one. Dealing with this could take up valuable time and resources that your administrative staff could use to create a compliant environment where contingent and permanent staff thrive. 

With the help of Trusted Managed Services, all necessary information regarding your contingent labor will be available for easy and prompt access. 

Need to collect documentation for an audit or have questions regarding a contingent worker’s credentials? Simply contact your dedicated Trusted Managed Services account manager. Our services do not require your administrators to chase down vendor representatives or send emails to numerous points of contact. 

3 Additional General Healthcare Compliance Issues Facilities Should Be Prepared To Manage

While healthcare MSPs can add an extra safety net for avoiding contingent staffing compliance issues in healthcare, there are certain aspects of compliance that they are not involved in. 

#1: Patient Privacy

HIPAA protects a patient’s right to medical privacy, meaning health information cannot be used or shared without written permission unless allowed by the law. 

Facilities may experience HIPAA violations that are intentional or unintentional. The law treats the violations the same, regardless. Violations of patient privacy compliance include:

• Impermissible access to patient records
• Mishandling of patient information 
• Improper disposal of records
• Accidental disclosure in conversation

Healthcare organizations can avoid compliance violations related to patient privacy by ensuring that HIPAA-compliant policies and procedures are developed and enforced. Audits may also help administrators catch potential HIPAA risks and HIPAA training may help staff spot and avoid potential violations. 

#2: Cybersecurity

The digitization of healthcare has allowed providers to make groundbreaking changes to patient care and information recording. While these changes have had a profound and lasting impact on the industry, it has also created newer compliance issues in healthcare. 

Data breaches due to ransomware attacks have become increasingly more prevalent, and even worse — they’re growing in severity. 

In 2021, 45.9 million U.S. patient records were breached. In 2022, this number shot up to 51.9 million. However, 2023 broke all previous records, ringing in a total of 133 million patient records exposed, stolen, or impermissibly disclosed. Roughly 79.7% of these data breaches were the result of cybersecurity attacks, 

The average cost of these data breaches is around $10.1 million per incident, mostly due to fines and penalties from HIPAA and HITECH (Health Information Technology for Economic and Clinical Healthcare) violations. 

Organizations can help avoid these compliance issues in healthcare by remaining HIPAA and HITECH compliant, assessing and addressing IT security risks, and taking measures to improve the ways patient data is handled and stored. 

#3: Billing and Coding Practices and Documentation

Billing and coding practices are another emerging feature of the digitization of the healthcare industry. 

Unfortunately, this revolutionary practice also investigates potential compliance issues in healthcare. 

Stringent coding accuracy must be maintained to remain coding and billing compliant. Failure to comply or coding errors may lead to claim denials, delayed reimbursements, or allegations of fraud. 

Healthcare organizations can avoid billing and coding compliance issues by conducting regular coding audits, providing regular coding compliance training, and hiring competent medical coders. 

Trusted Managed Services: Your Source for a Healthcare MSP That Can Help Manage Common Compliance Issues in Healthcare

The landscape of healthcare is continually changing. This shift can cause your facility’s compliance climate to slip, creating an environment where non-compliance thrives and infests other aspects of the operation. 

By utilizing a healthcare MSP to maintain compliance with your contingent staff, your facility can avoid cataclysmic compliance storms that may result in reputational and financial damage.

At Trusted Managed Services, not only will our manager service provider resources help you access talent from a pool of properly credentialed applicants, but we will also assign you a dedicated account manager to oversee the entire compliance process. This individual will be your one point of contact for all of your questions and audits regarding the credentialing, licensing, and verification of your contingent workforce. 

The healthcare system involves a system of multilayered healthcare compliance regulations and laws that may be subject to change. As administrative leaders, your team may have difficulty keeping up to date with current changes while overseeing a large, dispersed contingent staff population. 

MSPs like Trusted Managed Services reduce this scrambling by providing one point of contact that can promptly organize and hand over compliance information regarding contingent staff. This easy compliance measure comes at no cost to the facility and aids an additional safety net for compliance assurance. 

As a Joint Commission-accredited MSP, we are well-versed in compliance standards, laws, and regulations. With our services, you can decrease administrative downtime, supplement your permanent staff with credentialed talent, and avoid prospective fines and penalties for utilizing non-compliant labor. 

With Trusted Managed Services, you do not have to go to great lengths to ensure that your contingent staff are staffing compliant. Request a demo today.