Healthcare Compliance Fundamentals

Check out this practice note from Practical Guidance – Healthcare to understand the seven steps of an effective compliance program, which were first set out in the U.S. Sentencing Commission Guidelines Manual, and later adopted by the U.S. Department of Health and Human Services Office of the Inspector General for use by healthcare organizations. Review how compliance programs can help healthcare organizations detect and prevent fraud and abuse, and how evidence of having an established program can help organizations avoid or mitigate the imposition of fines and regulatory oversight when fraud or abuse is found.

Read now »

Related Content

• Compliance Legal Audit Checklist (Healthcare Organization)
  Rely on this checklist to determine your client’s compliance with state and federal healthcare regulations. Use it to identify potential legal issues facing your client’s organization or when evaluating potential target companies during an acquisition due diligence period.
• Sanctions Checking Policy (Healthcare Organization)
  Download and conform this template to your client’s business. This template provides a form policy and procedure document addressing a healthcare organization's obligation to conduct sanctions (or exclusions) checks of its workforce, as well as those affiliated with the organization (e.g., agents, contractors, and volunteers).
• Healthcare State Law Comparison Tool – Topic: Healthcare Fraud and Abuse Laws
  Compare healthcare fraud and abuse laws across all 50 states and the federal government
  using Practical Guidance’s State Law Comparison Tool (SLCT). Understand how each jurisdiction defines and applies its laws on false claims, kickbacks, and physician self-referrals.

Legal Developments

• Fraud, Waste and Abuse: Spotlight on Ancillary Services
  Learn how managed care companies can minimize risk from providers engaging in fraudulent, abusive, and wasteful healthcare services and billing in two areas likely to garner new or increased attention in the coming months: (1) COVID-19 laboratory testing and (2) durable medical equipment.
• The Next Challenge for Abortion Coverage in Employer Health Plans
  Consult this article to get up to speed on the legality of medication abortion by state and the steps employers can take to prepare for a nationwide restriction on the medication abortion drug Mifepristone, or its removal from the market altogether.

Practical Guidance Updates
Featuring the latest updates from your Practical Guidance account.   

• Legal Developments provide the latest updates and analyses of emerging topics impacting healthcare. Visit the Legal Developments page to see breaking healthcare legal news—notably on the U.S. Supreme Court’s Dobbs decision—and related Practical Guidance content.
• Listen Up! The Practical Guidance and Law360 Podcasts Resource Kit features interviews with industry-leading attorneys on cutting edge issues in the law: NFTs, Cannabis, COVID-19, and more.
• The Practical Guidance Journal (Archived Edition) leads with an article on ransomware issues in the healthcare industry and includes LexisNexis Legal & Professional resources to support the people of Ukraine.
• Check out the new Practical Guidance Author Center! Learn about the 1750+ leading attorney authors contributing to our 22 practice areas and find out how you can Become a Practical Guidance Author.​​​​​​
• Document alerts allow you to stay current on legal developments that affect your practice. Find out how to set up your document alerts.

Experience results today with practical guidance, legal research, and data-driven insights—all in one place.

Experience Lexis+