SAI Global Compliance Predicts Major Trends in Healthcare Governance, Risk Management and Compliance for 2012

As Healthcare Reform Continues to Transform the Industry, Priorities Move to Demonstrating Compliance Effectiveness

ALPHARETTA, Ga.--(BUSINESS WIRE)-- SAI Global Compliance, the world’s leading provider of governance, risk and compliance (GRC) products, services and technology including the Compliance 360® GRC Software Suite, today announced its healthcare industry predictions for 2012. As regulatory requirements evolve and the public focus on the business of healthcare continues, compliance officers and general counsels are concentrating on areas that will impact their daily responsibilities and the good standing of their organizations.

Healthcare GRC Trends for 2012 include:

  • Bounty Hunter Threats Continue to Increase: As personal greed has long been the primary motivator behind fraud and abuse, regulators and private payers are financially motivating third parties, to help identify and prosecute offenders. Examples of this can be found in the RAC for Medicaid and pending pre-payment RAC audits, as well as audit contractors hired by private payers to conduct post-payment audits. Providers need to prepare themselves for the increasing volume and complexity of audits.

To prepare, compliance departments can establish a system of record for centrally managing all revenue recovery audits and utilize automation to cope with the complexity and increasing volume of these audits. The appeals process for every audit type is unique. An automated “virtual audit coordinator” can be used to establish accountability and ensure that critical dates are not missed during the appeal process. If not managed properly, missed dates lead to lost revenue.

  • Proactive Compliance Effectiveness is Becoming Essential: Regulators are no longer satisfied with the mere presence of a compliance program – instead, providers and payers must now demonstrate that their compliance programs are effective. Examples of this growing requirement include the CMS Compliance Program Effectiveness Self-Assessment Questionnaire for payers, made available in July 2011, and the New York State Office of Medicaid Inspector General’s Compliance Program Assessment Tool for providers, published in October 2010. Progressive providers and payers are taking steps to keep their friends close and their auditors closer by preparing to share compliance assessments and mitigation programs with regulators.

To learn more about how healthcare organizations can utilize assessment tools to demonstrate compliance, a demo of the New York State Office of Medicaid Inspector General’s Compliance Program Assessment Tool is available here: and a demo of the CMS Compliance Program Effectiveness Self-Assessment Questionnaire is available at:

  • Healthcare Boards are Becoming Increasingly Accountable: Compliance is now seen as a strategic risk area with brand reputation and significant revenue at stake. In the past, many boards have simply left compliance in the hands of the General Counsel, who may have no real hands-on experience. Many healthcare boards are now expanding their sought-after expertise to include compliance as a strategic competency.
  • Analytics is Becoming More Critical: Automation is important, but trends can be difficult to monitor due to high volumes of data being collected. Healthcare organizations require the ability to identify root-cause issues before auditors connect the dots. As an example, providers and payers can benefit by linking training programs to the types of issues received via whistleblower hotlines. By monitoring the hotline trends and using these trends to drive training programs, healthcare organizations can be more proactive in addressing potential compliance issues before they become the target of audits. If and when the auditors come calling, these organizations can demonstrate the effectiveness of their proactive compliance measures.

“Healthcare organizations are under great pressure to maintain their revenue levels and now must cope with the increasingly frequent bounty-induced revenue recovery audits and the demands for demonstrating an effective compliance program,” said Steve McGraw, Compliance 360 President. “As these threats to revenues and brand reputation continue to increase, our healthcare customers will continue to benefit from new and enhanced applications in the Compliance 360 line of GRC Solutions.”

About Compliance 360® GRC Software Suite

The original Governance, Risk and Compliance (GRC) software solutions born in the cloud, Compliance 360 brings order and efficiency to the complexity of enterprise governance, risk management, compliance and audit management. The Compliance 360 GRC Software Suite includes regulatory compliance software, policy management software, internal audit software, incident management software, ERM software and a wide variety of specialty applications. More than 250,000 professionals every day in healthcare, insurance, financial services, distribution and other regulated industries rely on Compliance 360 applications to help protect their revenues, reputations and brands.

About SAI Global Compliance

SAI Global Compliance provides organizations with a wide range of governance, risk and compliance (GRC) products, solutions and services that help build organizational integrity and meet overall business objectives. With more than twenty-five years experience and offices in more than 25 countries, SAI Global’s solutions include a wide range of GRC products and services including the Compliance 360 GRC Software Suite, best practice Code of Conduct program services and training, compliance and ethics training and awareness, risk and culture assessments, a full range of advisory services, whistleblowing hotline services, regulatory knowledge, policy management, case management, and third party compliance management including automated due diligence workflow and management.


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