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Non-Compliance In Healthcare And Its Consequences

Non-Compliance in medication is referred to the condition in which patients refused to take the medicines and the treatment prescribed by the medical officer. Non-compliance in healthcare means avoiding the rules and regulations of the industry which eventually leads to negative outcomes. nnIt can cost financially as well as ruin the reputation of the system, in a worst-case scenario the organization can face more serious consequences for their non-compliance exercises.nnIn this article, we will discuss some of the consequences of the non-compliant behavior of health care and possible measures to avoid it.n

Consequences of Non-Compliance Behavior

nWhen looking at the health care sector the ultimate goal is to deliver the best services to the patients. To deliver the best services there needs to maintain the standards and follow the rules and regulations of the industry, unfortunately, non-compliance behavior is very common. nnMost of the health care sectors have not even a single staff member who can maintain the industry standards. While it is the responsibility of everyone from the top to the bottom to assure the quality in the system. nnFrequent Non-Compliance behavior can cause several consequences like license cancellation, financial losses, and security breaches, here is an outline of some of the consequences you can face due to Non-compliance. n

1. Impact on Patient Health

nA non-compliant attitude makes your patient suffer a lot, with negligence in providing the service will negatively impact the health of the patient. As a health care worker, your first priority is to give your patients the best services possible. nnWith poor practices and treatment, you may lose the trust of the patients. On the other hand, if you are facing fines and penalties then you may face financial losses which can slow down your revenue cycle and you might not be able to buy some essential equipment and machinery.nnAt the same time, these fines and penalties may also damage the image of the health care sector. So a compliant behavior is very essential for the working of any health care sector. n

2. Fines and Punishments

nNon-compliance may cause serious damages to the revenue cycle of healthcare industries. According to the HIPAA resolution, the violation of any HIPPA rules may cost the health care sector $100 to $500 or in serious cases may cost $1.5 million annually for each violation. So these violations can cost your practices and these financial damages will further slow down your revenue management system. n

3. Security Violations

nPreviously the patient health records are saved on paper, with the advent of new technologies like Electronic health record systems, the data of the patient is not limited to the paper form now the digital form is generated to share with the insurance companies to claim reimbursement and other health care practices. nnIn all these scenarios the data of the patient’s health record is traveling through different platforms and the access is not limited to only one person.nnSo the records of the patient are not saved, a study suggests that in 2019 most of the medical records violations are due to hacking activity. It’s the responsibility of the health care services to secure all the data. HIPAA penalties can range between $50-$50,000 up to $1.5 Million as per the incidents reported. nnThe only way to avoid these security breaches is to secure your data transfer and maintaining system and follow the guideline by HIPPA.n

4. Settlements Cost

nWhile the non-compliant can damage your financial circuit, the penalties and allegations also open the doors of lawsuits. There are costs related to settlements, it not only costs you but also consumes your time and damages the reputation of your system. To lower the settlement cost you have to assure that you would take measures to deal with the violations. n

5. Loss of Staff

nThe violations and penalties damage the reputation of any organization, the same case is with the health care sector when people found that a health care sector is involved in violations of rules and has not a good reputation. nnThen they avoid joining that health care system. It is not only the loss of some potential staff but current staff members also left the system to at least save their status.n

Road To Compliance

nThe only way to get rid of all these damages which were done by non-compliance practices is to take firm decisions and policymaking and ensure that all the stakeholders are fulfilling their role effectively. Here are some measures that can help you to ensure compliance in your medical practices. n

1. Effective Policies

nTo assure compliance you must formulate policies that can reduce the risks of non-compliance. These policies help your organizations to perform better yet additionally help to restore the image of your services. nnBut making policies is one thing and implementation is another. You have to make sure that every supporting staff is aware of the rules and regulations of the system. Initially, these policies will help you to reduce the risk of non-compliance and restore the confidence of the masses. Who eventually realized that the health care system is showing resistance to those violations.n

2. Create a Committee

nA committee led by the chief compliance officer can be helpful to maintain compliance. Most of the health sector appoint CCOs to support the compliance efforts and guide the health care system to maintain accountability. nnLed by the CCO the hospital compliance committee also takes on onboard the revenue management team, case management, and health information management team. The effective coordination between them can assure compliance in the organization. Moreover HHS officer OIG also recommends that effective communication between these experts provides much-needed support to the health sector.n

3. Track The performance

nAfter devising the policies and making a committee, it is crucial to keep track of the performance of the whole system. As there is always room for improvement. Consistent tracking will help in the long run.nnTo track the performance of compliance program effectiveness, The OIG suggested some criteria which can help measure the effectiveness of compliance. Which includes: n


  •   Standard policies and procedures
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  • · Measuring the performances of the physicians and other staff members 
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  • · Building effective communication followed by awareness programs
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  • · Compliance program management  
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  • · Monitoring auditing and building a system for internal reporting
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nAny health care sector used these metrics to evaluate the performance of their compliance program. To track the performance of the compliance program the key is to be consistent. Consistency in tracking all the sectors not only assures good results in the long run but also saves the organization from the worst consequences of non-compliance practices. 

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