Top Mistakes Healthcare Providers Make During Compliance Audits

Maintaining healthcare compliance is not easy for medical practices. For this, they deal with several sensitive and complex issues. Moreover, the US federal audits are getting stricter due to rising compliance violations and security incidents. Even the healthcare practices that follow formal procedures leave gaps in their organizational structure. Many of the mistakes happen because healthcare staff have limited knowledge about the compliance requirements. Compliance audits reveal these inconsistencies that cost medical practices hefty penalties. 

What are compliance audits?

The process of reviewing an organization’s workflow is a compliance audit. Auditors check if workflows follow standard rules and regulations. Their main goal is to find and fix errors early. Audits help improve workflow efficiency and strengthen data security.

In the US, some audits are mandatory for healthcare. To pass them, practices must maintain HIPAA compliance. They should always stay ready for audit checks. Sometimes, federal auditors observe operations without notice. So, healthcare practices must always stay audit-ready.

Core compliance standards in healthcare

Some regulatory frameworks are essential for healthcare practices. These rules promote data safety and accuracy. They also ensure secure and efficient financial processes. Here are a few key compliance standards every healthcare organization must follow:

HIPAA & HITECH

The Health Insurance Portability and Accountability Act (HIPAA) ensures medical data safety. To meet HIPAA requirements, auditors review how healthcare organizations share data. Following HIPAA rules ensures patient records stay protected and helps avoid legal penalties.

However, the Health Information Technology for Economic and Clinical Health Act (HITECH) promotes the use of Electronic Health Records (EHRs). Adhering to HITECH makes HIPAA compliance stronger for medical practices.

HHS

The US Department of Health and Human Services (HHS) checks over healthcare organizations. It especially inspects clinics to confirm HIPAA compliance. 

CMS 

Centers for Medicare & Medicaid Services (CMS) plays its role in preventing healthcare billing fraud. These departments oversee national healthcare programs such as Medicare and Medicaid. Moreover, CMS sets standards for medical billing, coding, and reimbursements to maintain transparency and fairness. The officials of this institution check the doctor’s bills to prevent overbilling.

OIG

The Office of Inspector General (OIG) investigates fraud and misuse of healthcare programs. Protecting taxpayer money while ensuring healthcare funds are properly used are the main objectives of this regulatory body.

SOC 2

Service Organization Control 2 (SOC 2) sets technology security standards for healthcare organizations. Moreover, SOC 2 sets clear rules for cloud service providers to protect and manage patient data. It ensures that technology systems are secure and reliable. The audit focuses on five main areas, which are:

• Data security
• Availability
• Processing integrity
• Confidentiality
• Privacy

Let us discuss healthcare compliance mistakes that medical practices often make during compliance audits. As a result, they fail to comply with essential regulations while increasing the chances of mistakes.

Common compliance mistakes and risks in healthcare audits

There are some common audit mistakes in healthcare that practices make in audits, leading to risk and security breaches. Many of these mistakes occur because they do not have systematic workflows and trained staff. Therefore, many operational and systematic issues go unnoticed, increasing risks for compliance failures.

Professional auditors quickly find these errors while using proper compliance programs and performing audits with proper planning. Here are the most common mistakes auditors find in healthcare practices. Let us learn from them to improve accuracy and maintain compliance.

Ignoring security risk evaluation

Often, medical practices believe their systems are secure and that data is safe. Without substantial reports or evidence, they skip or delay regular security checks. With such approaches, they do not detect HIPAA compliance audit errors. As a result, hackers take advantage of these vulnerabilities. Ignoring essential regular evaluations increases significant healthcare compliance risks for healthcare organizations. Moreover, HIPAA law requires healthcare organizations to conduct regular risk analysis. Failing to do so can result in substantial fines for healthcare practices.

Using outdated and unsecured devices

The latest devices and operating systems offer enhanced security features. However, many healthcare organizations manage their routine operations using outdated and unsecured devices due to limited budgets. It makes their healthcare data more vulnerable to cyber attacks. Outdated systems skip essential security updates. So, they can not offer enough protection from advanced security threats.

Using outdated and unsecured devices puts healthcare data at significant risk. Outdated devices become a weak link in the security chain, increasing the likelihood of data breaches and unauthorized access. In 2019, a breach affected the lives of  6 million patients. Outdated systems and unpatched software were the major cause behind this.

Weak access controls

Setting up the mechanism of access control allows healthcare professionals to limit data accessibility. In this way, only authorized personnel can view, modify, or share the sensitive data. Improper implementation of weak access control systems increases compliance risks. 

Failing to address weak access controls is a common compliance mistake. Some medical practices do not protect patient health information (PHI) with role-based restrictions or login protections. Such ignorance becomes a significant reason for the leakage of sensitive information. At the same time, data exposure to unauthorized people also violates HIPAA rules. Similarly, using weak, simple, and shared passwords is also a common mistake in healthcare practices. In this way, healthcare data becomes accessible to unauthorized people.

Unauthorized PHI disclosures

Saving patient health information (PHI) is a significant challenge for healthcare organizations. It includes very sensitive information like medical history, treatment details, and billing data. Sometimes, medical practices fail to set policies and procedures for data handling. Moreover, they do not monitor data access, which increases risks of PHI disclosures. It is a serious compliance issue for medical practices. Beyond regulatory violations and penalties, it also impacts patients’ trust.

A lack of proper procedures also increases the risk of accidental data sharing. For example, staff may share data with the wrong person. Such minor mistakes also increase the risk of HIPAA privacy violations. Because sharing data without consent violates the HIPAA privacy rule. 

Missing Business Associate Agreements

A Business Associate Agreement (BAA) is a formal contract between a healthcare provider and third-party vendors who manage PHI. As per HIPAA privacy security rules, a BAA is essential before handing over access to patient data to third parties. Many healthcare practices make big mistakes while failing to secure a contract. Because the contract clearly mentions the responsibilities of vendors in safeguarding data. 

The mistake occurs because of a lack of providers’ awareness. They rush towards vendor onboarding without knowing the consequences. Lack of written agreements also impacts the credibility of healthcare organizations. And, they become answerable for their vendors’ mistakes.

Lack of written practices

Often, healthcare practices do not clearly write policies and procedures to handle healthcare data. However, it is a fundamental requirement to maintain healthcare compliance. Written data explains well about data billing, clinical processes, and emergency protocols. HIPAA regulations also require healthcare organizations to maintain formal documentation of policies.

Moreover, the unavailability of written policies also makes healthcare staff inconsistent about compliance requirements. Auditors consider the use of outdated policies a serious issue. In 2018, a large number of outpatient clinics faced fines in Texas. Because they failed to demonstrate written privacy policies and consistent procedures. Collectively, the fines amount to $5,00,000.

Training gaps among staff

Not providing proper training to their healthcare staff is a common mistake that practices make to maintain compliance. Targeted training teaches them techniques for avoiding compliance violations in healthcare. It helps them understand the proper procedures of data handling, sharing, and storage. Such a mistake put both patients and the organization at risk. Because healthcare staff act as the first line of defense to protect information. Therefore, their training is important to avoid unintentional data breaches.

Moreover, staff training is an ongoing process, not just for one time. It must explain practical scenarios and the latest policies and procedures to healthcare staff.

Inefficient record management processes

Proper record maintenance and data management using advanced digital tools play a significant role in maintaining healthcare compliance. Proper documentation reflects the effectiveness of robust security measures. Contrary to this, manual processes make audits harder because they contain errors. Relying on manual processes is one of the common mistakes health practices make in record maintenance. However, ensuring data security is the major requirement of HIPAA regulations. 

Moreover, inefficient record management also increases financial challenges for healthcare organizations. Because missing documentation leads to claim denials or payment delays. To deal with this challenge, healthcare organizations must use standardized documentation protocols and secure EHRs.

Non-compliant billing practices

Relying on non-compliant billing practices to manage routine operations results in severe financial penalties. Failing to meet payer requirements, submitting claims with incorrect medical codes, and lacking proper documentation are the frequent errors. Such mistakes disrupt the financial flow of a healthcare organization while damaging its overall reputation. 

Medical practices must implement clear billing policies and cross-check claims against documentation. Third-party reviews support the medical compliance audit process while strengthening adherence to HIPAA compliance. They work with proper planning, such as defining audit scope based on regulations and comparing internal controls to find deficiencies.  Audit professionals help medical practices in developing corrective action plans, updating policies, and adjusting IT systems.

Not partnering with experts

Professional auditing services help medical practices ensure regulatory compliance with healthcare data protection regulations. However, some medical practices make a common mistake of not outsourcing cybersecurity services for their business. Professional auditors provide an unbiased perspective while identifying the hidden security gaps. Moreover, they provide training to your staff on the latest security measures. 

Compliance experts guide small, medium, and large healthcare organizations about regulatory requirements. They prepare them for audits, ensuring compliance is thorough and up-to-date. The right outsourcing partner helps medical practices in building a strategy of securely managing their routine operations.

Cloud Computing and HIPAA Compliance Requirements

In the era where cloud computing has simplified data accessibility. At the same time, it raises questions about the protection of sensitive patient data. Therefore, it is essential for data storage systems to meet HIPAA compliance requirements. HIPAA has special guidelines for healthcare providers who use cloud computing systems to manage patient data. 

HIPAA laws permit healthcare organizations to avail services from cloud service providers such as Amazon and Salesforce. But meeting compliance requirements is essential for the service providers. Here are some of the key requirements:

• System availability.
• Data backups.
• Recovery procedures. 
• Security responsibilities.

Both the healthcare organization and the cloud provider must have a formal HIPAA-compliant plan. They must explain their response strategies to data breaches or security incidents. 

Conclusion

Healthcare compliance audits are more than just meeting regulations. It reflects a continuous commitment to data integrity, protection, and operational excellence. Conducting regular compliance audits is very important for healthcare organizations to strengthen their market reputation.

Moreover, regulatory requirements evolve rapidly, and professional auditing services also provide ongoing vigilance. Their services help medical organizations ensure proactive protection. Medical practices must consider it a long-term investment.

Ensure protection of your organization with proactive compliance. Schedule consultation services with CyRx360 to stay prepared for regulatory audits.