8 Pillars of HealthEdge Compliance

Legal compliance refers to the adherence to laws, regulations, and standards that are applicable to a specific industry or organization. At HealthEdge, Compliance is an essential component of business operations, as it helps to mitigate legal and financial risks and ensures HealthEdge operates ethically and in the best interests of stakeholders.

What is Legal Compliance at HealthEdge?

Legal compliance is the ongoing process of ensuring that a company, business, or other organization is adhering to the applicable laws, regulations, and industry standards. This can include complying with financial reporting requirements, implementing privacy and security safeguards, training workforce members, and conducting operations in accordance with the numerous laws that govern businesses, such as employment, tax, and insurance laws.

The purpose of having a strong compliance program is to help organizations operate at a high level and to avoid the penalties, financial losses, and reputational damage that can result from violations caused by non-compliance. The financial penalties for violations can be significant and have the potential to cause additional harm that can be devastating to the success of a business.

A quality compliance program provides assurance to prospects and customers that a business is well-managed, trustworthy, and reputable. A compliance program can be tailored to support an organization maintain its ethical standards (like transparency, honesty, and respect) which also helps build trust with stakeholders, customers, workforce members, and shareholders.

HealthEdge prioritizes compliance throughout the company so that all workforce members are aware of and involved with its success. The compliance group takes a cross-functional approach to engage company-wide support and increase the efficiency of compliance efforts. By working with multiple departments, HealthEdge ensures that the compliance requirements are met, and regular work is unaffected so business can continue as usual.

HealthEdge is committed to working for the best interests of its customers, and the strength of its compliance program helps demonstrate that commitment.

How does HealthEdge achieve Compliance?

Implementing company-wide compliance is a complex process that requires knowledge and awareness of the many laws, regulations, rules, and standards that require strict adherence. HealthEdge takes a detailed approach to ensure the compliance program is performing at a high level, and that the compliance program is working as intended. The program is designed around the seven foundational elements of a compliance program outlined by the United States Sentencing Commission, incorporating an additional element from the Department of Health and Human Services (HHS) Officer of Inspector General (OIG) Compliance Guidelines:

1. Governing Authority: HealthEdge has a Compliance Officer (CO) and the Risk Compliance and Governance Committee, that is comprised of members of the executive leadership team is responsible for the execution, correction, and oversight of all aspects of the compliance program.
2. Policies and Procedures, and Code of Conduct: HealthEdge commits to complying with all applicable federal and state regulations and standards–this includes providing guidance to workforce members on compliance-related matters. HealthEdge also provides procedures that assist in the identification and correction of non-compliance. These policies and procedures are reviewed on a regular basis and updated as needed based on requirement changes or regulations.
3. Training and Education: HealthEdge provides various training to its workforce members, including new hire, annual refresher, and role or product-specific training.
4. Reporting: HealthEdge is committed to fostering a culture of compliance, good corporate governance, and ethical behavior and encourages the reporting of improper, unlawful, or unethical behavior. Workforce members are encouraged to discuss any suspected violations with appropriate individuals within HealthEdge. HealthEdge has a strict non-retaliation policy–there can be no retaliation, penalty, or retribution for good faith reporting of any suspected compliance issue.
5. Monitoring & Auditing: Proactive auditing and monitoring of routine business practices is vital for the identification of potential compliance issues. HealthEdge routinely conducts audits and monitors business processes to identify risks. These processes help:

• Ensure compliance with policies and procedures, laws, and regulations.
• Confirm that corrective actions have been implemented.
• Evaluate the overall effectiveness of the compliance program.

6. Enforcement & Discipline: HealthEdge does not tolerate non-compliance with company policies or applicable laws. Any non-compliance could compromise HealthEdge’s operations, the services provided to customers, or its Violations of the HealthEdge Code of Conduct and other policies and procedures require a corrective action and reporting to the appropriate regulatory or law enforcement agency when applicable. HealthEdge has well-publicized disciplinary standards that:

• Prohibit authorization or participation in activities that violate HealthEdge policy.
• Articulate expectations for reporting compliance issues and assists in their resolution of issues.
• Provide timely, consistent, and effective enforcement of the standards when non-compliance or unethical behavior is detected.
• Encourage good-faith participation in the compliance program.

7. Response & Prevention: HealthEdge has a well-developed compliance program, with established procedures, processes, and system implementation for promptly responding to compliance issues. The HealthEdge compliance program ensures that:

• Issues are acknowledged as they arise.
• Potential compliance problems are investigated.
• Concerns are proactively identified through rigorous auditing and monitoring.
• Problems are corrected promptly and thoroughly to reduce the potential for recurrences.

8. Background Checks: In addition to the seven foundational elements of a compliance program outlined above, HealthEdge also incorporates Background Checks that include an investigation of criminal history, exclusions, and reference checks. HealthEdge makes reasonable efforts to ensure personnel and business partners are not engaged in illegal activities or conduct that is inconsistent with an effective compliance program.

Conclusion

Achieving compliance requires a thorough understanding of all applicable laws and regulations, the development of policies and procedures to ensure compliance, the implementation of controls and monitoring systems, and ongoing maintenance and updates to ensure compliance with changing requirements. HealthEdge’s compliance program ensures the company meets established standards, upholds its commitments, protects its business reputation, and avoids financial penalties. By prioritizing compliance, HealthEdge mitigates legal and financial risks, operates ethically, and serves the best interest of its customers.