CASE STUDY: A Comprehensive Healthcare Compliance Program for a Tribal Health Client – Part 2

June 7, 2023

Tribal Healthcare Compliance & Our Client’s Unique Situation

Tribal healthcare compliance refers to the process of ensuring that healthcare organizations serving Native American and Alaska Native communities comply with applicable laws, regulations, and ethical standards.

Tribal healthcare organizations face unique challenges when it comes to compliance. As sovereign nations, tribes have their own laws and regulations that must be followed, in addition to federal and state laws that apply to healthcare organizations in general.

In addition to federal and state laws and regulations, tribal healthcare organizations must also comply with tribal laws and regulations that apply to healthcare operations. Tribal laws may include requirements related to patient rights, data privacy and security and other issues that are unique to tribal communities.

Overall, tribal healthcare compliance is an important component of healthcare operations in Native American and Alaska Native communities, and healthcare organizations serving those communities must remain vigilant to ensure that they are providing high-quality care in a compliant and ethical manner.

 

Our Solution

To ensure compliance, we implemented a comprehensive compliance program that includes policies and procedures, training, and education, reporting and investigation mechanisms, auditing and monitoring, and oversight and accountability measures.

A strong compliance program helped them to minimize risks and ensure that they are meeting their legal and ethical obligations to their patients and communities.

 

Here are some key elements that were included in their tribal healthcare compliance program:

• Tribal laws and regulations: The compliance program included an understanding of tribal laws and regulations that apply to healthcare operations, including those related to privacy, data security, and patient rights.
• Federal and state laws: The compliance program also incorporated federal and state laws that apply to healthcare organizations, such as HIPAA and Stark Law, among others.
• Policies and procedures: Policies and procedures were developed, updated, and implemented that addressed key compliance issues, such as billing and coding, documentation, and quality of care.
• Training and education: Staff received training and an ongoing training and education schedule was created to include compliance issues, with a focus on identifying and reporting potential violations.
• Reporting and investigation: A mechanism was put in place for staff to report potential compliance violations, and a process implemented for investigating and resolving those reports.
• Auditing and monitoring: Regular audits and monitoring will be conducted to identify potential compliance risks and to ensure that policies and procedures are being followed.
• Oversight and accountability: A compliance officer and committee were designated to oversee the compliance program, and accountability measures should be in place for non-compliance.

 

The Tribal healthcare compliance program was tailored to the unique needs and circumstances of their organization.

By incorporating these key elements and following their Compliance Roadmap tribal healthcare organizations like this one can ensure that they are meeting their legal and ethical obligations, protecting patient rights, and minimizing risks.

 

For more information regarding this case study or if you would like to discuss how we can assist with your compliance needs, please contact us at 623.980.8018 or by email at inquiries@johnlynchandassociates.com