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Riddle Compliance
Riddle Compliance

Healthcare Compliance

healthcare compliance consulting services

Healthcare facilities are heavily regulated and scrutinized by federal and state agencies on an ongoing basis. Our healthcare compliance consulting solutions assist organizations in refining risk mitigation practices to avoid regulatory pitfalls and fines. Clients benefit from proven methodologies to enhance their operations, monitoring initiatives, and auditing functions. Our legal professionals and subject-matter experts formulate customized plans for effective implementation given an entity’s place in the marketplace.

ensuring compliance with federal and state regulations

  • U.S. Department of Health and Human Services (HSS)
  • Centers for Medicare and Medicaid Services – (CMS)
  • U.S. Department of Justice – Criminal Division (Fraud Section) /Antitrust Division (DOJ)
  • Affordable Care Act (ACA)
  • Centers for Disease Control and Prevention (CDC)
  • Occupational Safety and Health Administration (OSHA)
  • Health Insurance Portability and Accountability Act – (HIPAA)
  • State health agencies – all 50 states
  • Fraud, waste, and abuse regulations
  • Patient safety and quality of care regulations

some of the healthcare services and solutions we offer

  • Outsourced Chief Compliance Officer/Compliance Support
  • Outsourced Chief Privacy OfficerCompliance program implementation
  • Deployment of gap analyses and risk assessments
  • Risk-based auditing and monitoring
  • Third-party management
  • Governance, policies and procedures, and Code of Conduct
  • Manage internal and external Investigations
  • Mock surveys, screening and evaluation of employees, physicians, business partners, vendors and stakeholders
  • Communication, trainings, and educational Workshops

compliance consulting for healthcare organizations

  • Hospitals
  • Nursing homes
  • Skilled nursing homes
  • Assisted living facilities
  • Home health agencies
  • Adult daycare communities
  • Medical offices
  • Physician groups
  • Dental offices
  • Healthcare clinics
  • Psychologists
  • Independent pharmacies
  • Public or government-run healthcare facilities
  • Related healthcare professionals and practices

comprehensive regulatory compliance consulting for healthcare entities

Healthcare practitioners and medical facilities must comply with numerous regulations, align business functions with best practices, and perform due diligence on operational controls to foster adherence with federal and state mandates. These requirements are cumbersome when managed properly, and they require outsourced external support as well as periodic independent review to guarantee a culture of compliance, risk mitigation, and proper governance of policies and controls. Our solutions support healthcare organizations with numerous initiatives including but not limited to: extensive outsourced compliance support; risk assessments and gap analyses; data security, privacy and HIPAA compliance; fraud, waste, and abuse consulting; safety workshops; organizational trainings and healthcare compliance investigations. All healthcare compliance services and outsourced solutions are tailored to fit each organization’s corporate culture and overall climate to inspire more spirited and progressive compliance practices.

some of the major healthcare compliance considerations and concerns we encounter

  • What is an effective corporate compliance program? – U.S. Department of Health and Human Services
  • How to maintain an ethics and compliance program? – Centers for Medicare and Medicaid Services
  • HIPAA compliance, data privacy and security
  • Protected Health Information (PHI) compliance
  • Medical billing and coding transparency
  • Compliance manual development and monitoring
  • Facilitation of compliance work plans
  • Government over-payment rule
  • Due diligence and monitoring
  • Annual risk assessment
  • Exclusion checks and conflicts of interest reviews
  • Bribery and kickbacks
  • Antitrust and fair competition rules
  • Evaluation of compensation agreements

the regions where we offer compliance consulting and outsourced medical compliance solutions

Riddle Compliance provides healthcare compliance consulting services across the United States. Our solutions are primarily designed for growing organizations and independent healthcare facilities that require outsourced support or independent guidance from an external provided. Our experts are knowledgeable and capable of managing regulatory compliance matters with varying degrees of complexity.

Regulators are more aggressive in evaluating the effectiveness of compliance programs more than ever before. With increased scrutiny, healthcare organizations must proactively embrace the regulatory environment to avoid fines. The only way to ensure full compliance with the regulatory landscape is to routinely refine processes and operational controls. Riddle Compliance provides healthcare organizations with valuable external resources, assessment tools, training workshops, and a range of advisory solutions.

our healthcare compliance consulting services and solutions

Riddle Compliance offers healthcare practitioners, assisted-living facilities, skilled nursing homes, hospitals, physician groups, and other growing healthcare organizations with governance, risk, and compliance consulting services to meet federal and state regulatory mandates.