Healthcare officials often chuckle when they see questions like, “Who regulates health care?” If only one law or organization oversaw every aspect of healthcare in this country, life would be a lot simpler for medical professionals and the organizations in which they work.
In reality, many different organizations are involved with regulating healthcare. And they enforce rules and regulations that may appear at the federal, state, or local level.
Who Regulates Health Care at the Federal Level?
The largest and most complex healthcare laws originate at the federal level. They are enforced by a variety of different agencies.
These three main federal agencies oversee healthcare organizations:
- The U.S. Department of Health and Human Services: The Health Insurance Portability and Accountability Act (HIPAA) passed in 1996 includes multiple rules regarding patient privacy and recordkeeping. The DHS is responsible for enforcing those laws.
- The U.S. Inspector General: Seated within the DHS, the Office of the Inspector General creates compliance documents to help hospitals and doctors comply with a bevy of federal laws.
- The United States Department of Labor: The Occupational Safety and Health Administration creates rules that ensure a safe workplace. Since so many people work in healthcare, the rules are critical.
All of these groups offer guidance to help organizations comply with their rules and regulations. But compliance means paperwork. Hospitals and other care organizations must prove that they both understand and comply with the rules.
Who Else Is Involved in Regulating Health Care?
Healthcare providers are also required to abide by laws that originate from outside the federal system. The landscape varies from organization to organization.
A provider might have rules that originate in:
- State agencies. Some states have rules regarding workers’ rights, patient access, and payment caps.
- Federal payors, like Medicare. Some organizations must follow rules about payment options.
- Private payors. Some companies like Blue Cross have rules about payments and access.
- Nonprofit boards. Some hospitals and other care organizations are ruled by a board of directors. That group may also have compliance rules.
The landscape can be complex. An organization may face competing or conflicting rules regarding patient care and payments.
Navigate Health Care Industry Regulations
Healthcare providers need to focus on patient care, not paperwork. As one of the largest healthcare law firms in the nation, we can help. Let us assess your regulatory environment and help you come up with a comprehensive compliance plan. We can help you craft appropriate reports too, so you can prove you’re doing your job. Contact us to find out more.