The process of ensuring that healthcare organizations and professionals follow laws, regulations, and standards to protect patient welfare and maintain ethical integrity.
Federal law enacted in 1996 to safeguard patient health information (PHI) by establishing standards for its privacy and security.
Also known as the Physician Self-Referral Law, prohibits physicians from referring patients to entities for certain designated health services if the physician or an immediate family member has a financial relationship with that entity.
Prohibits the exchange of anything of value to induce or reward referrals or generate federal healthcare program business, ensuring that healthcare decisions are made based on patient needs rather than financial incentives.
Imposes liability on individuals and companies who defraud governmental programs, including Medicare and Medicaid, by submitting false claims for payment.
A designated individual within a healthcare organization responsible for overseeing and ensuring compliance with laws, regulations, and policies.
Federal agency within the Department of Health and Human Services (HHS) responsible for enforcing laws and regulations about healthcare fraud and abuse.
Formalized policies, procedures, and systems implemented within healthcare organizations to promote adherence to laws, regulations, and ethical standards.
Federal agency within the Department of Health and Human Services responsible for administering Medicare, Medicaid, and other healthcare programs.
Organizations contracted by CMS to monitor and improve the quality of care provided to Medicare beneficiaries, often involving compliance oversight and assistance to healthcare providers.