Close Compliance Gaps with Confidence

Healthcare compliance incidents can emerge at any time, like an anonymous report of an over payment, suspicious ePHI access alert, or a whistleblower allegation of suspected fraud. For compliance teams, managing these incidents quickly, accurately, and within federal and other regulations is mission-critical.  

That’s why our Compliance Advisory Services team recommends Healthicity’s Incident Module within Compliance Manager to take control of the full lifecycle of incident management from documentation and investigation to remediation and closure. 

Whether an issue is internally discovered or externally reported, the Incident Module allows your team to capture, triage, and resolve every case with consistency and transparency. This centralized, secure system supports robust documentation, promotes timely corrective action, and delivers regulatory compliance. 

Example: A Structured Approach to Billing Fraud Allegations 

What happens when a healthcare organization receives an anonymous tip alleging that a provider is upcoding evaluation and management (E/M) visits and submitting duplicate claims? Rather than relying on email threads or disparate files, the compliance team can log the allegation directly into the Incident Module, assigning it a case number and setting a category (e.g., Billing Fraud, Waste, and Abuse). 

Within the module, the investigation might include: 

• Assigning a lead investigator and scheduling interviews with the provider and billing staff 
• Document the random samples of claims data and the results 
• Uploading relevant audit results, payer remittances, and internal policies 
• Documenting all findings and corrective actions using time-stamped notes 

The tool helps guide the investigation to closure, ensuring that the outcome, whether it involves provider education, self-disclosure, or disciplinary action, is fully documented in accordance with recommended guidance. 

Example: Investigating a HIPAA Privacy Breach 

In another scenario, an IT alert reveals unauthorized access to a shared network drive containing unencrypted ePHI. Using the Incident Module, the compliance team can initiate a new investigation, record the incident details, and begin a structured HIPAA breach investigation. 

The module supports: 

• Documenting access logs, forensic findings, and root-cause analysis 
• Uploading the required four-factor risk assessment under the HIPAA Breach Notification Rule 
• Storing patient notification letters and HHS submissions 
• Logging mitigation efforts, such as employee re-training or system access updates 

By managing every step within a centralized system, compliance leaders can ensure transparency, adherence to the 60-day notification deadline, and readiness for any inquiry or OCR audit. 

Why It Matters: Centralized Oversight, Scalable Results

Across all investigation types, the Incident Module provides a defined, repeatable, scalable framework for your compliance team: 

• Ensure alignment with the OIG’s Seven Elements of an Effective Compliance Program 
• Maintain complete and defensible records of investigative activities 
• Simplify internal oversight and leadership reporting 
• Reduce the risk of noncompliance or missed regulatory deadlines 

With customizable templates, investigation tracking dashboards, audit-ready exports, and secure storage of evidence and communications, the Incident Module becomes a vital asset in transforming compliance from reactive to proactive. 

Supporting Smarter Incident Management

At the core of effective compliance is the ability to respond swiftly and responsibly when incidents arise. Our Compliance Advisory Services team recommends the Incident Module not just as a tool, but as an integral part of a broader risk management strategy. By providing consistent processes, streamlined documentation, and clear resolution paths, the module helps ensure that no detail is missed and no incident is left unresolved. 

For organizations seeking to modernize their compliance infrastructure, this approach offers both peace of mind and practical result, turning every investigation into an opportunity to strengthen your program. 

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