What are Key Compliance Issues in Home Healthcare?

May 31, 2021 •

Government regulations and compliance rules are designed to protect patients, home healthcare providers, insurance companies, and taxpayers. They are typically focused on organizations providing and billing for appropriate levels of care and preventing fraudulent claims.

In order to stay in business and avoid legal battles or compliance penalties or fines, home healthcare organizations should stay abreast of current common compliance issues. In addition, it’s critical for these groups to appoint a professional to implement and manage a compliance program on an ongoing basis, including overseeing audits and handling violations with appropriate disciplinary action. Those home healthcare organizations that do so will be better positioned to succeed in the marketplace and within their communities.

Identifying Key Compliance Issues

Before setting up an infrastructure to manage home healthcare compliance issues, it’s important to understand which ones are most relevant to your particular organization. These may vary with size, type of care provided, and experience levels.

According to a presentation made by the law firm Phelps & Phillips, in coordination with the chief compliance and HIPAA privacy officer, the following areas were identified as key compliance issues common in today’s home healthcare industry.

  • Home healthcare providers failing to include all eligibility criteria.
  • Organizations providing services deemed medically unnecessary.
  • Providers not verifying or documenting a patient’s homebound status.
  • Businesses billing for personal care without skilled service.
  • Home healthcare groups not providing required documentation on time.
  • Providers skipping face‐to‐face meeting with a physician for certification.
  • Organizations failing to write or update a patient’s plan of care.
  • Groups holding inappropriate financial relationships with referral sources, physicians, hospitals, or patients.
  • Providers not recording cash and in‐kind benefits.

In some cases, poor management or operational procedures can lead to inadvertent violations of compliance issues. Establishing a clear process for all employees and caregivers as well as communication channels, training programs, and consequences for violations can improve compliance for any home healthcare organization.

How to Establish a Successful Compliance Program

Just like most operational procedures and processes in any business or organization, a successful compliance program must have someone in a leadership role who is responsible for program management. In addition, the complex nature of rules, regulations, and compliance issues must be communicated effectively and clearly to all affected parties.

The U.S. Department of Health and Human Services suggests the following seven elements be included in every comprehensive compliance program.

  • Home healthcare organizations should develop written policies and procedures.
  • Each group should designate a compliance officer to be accountable and lead the organization’s efforts in this area.
  • Home healthcare groups should develop and run effective training and education programs that focus on compliance.
  • These businesses must develop and maintain effective lines of communication throughout the organization.
  • Leadership should enforce standards by using well-understood disciplinary actions.
  • Home healthcare organizations should regularly audit and evaluate compliance performance.
  • Groups should have procedures to respond to compliance offenses as well as remediation plans.


Once a home healthcare organization establishes a compliance program that has a strong leader and clear, written guidelines, it will be much more likely to avoid violations and fraudulent activity. In addition, the business will find itself gaining many advantages.

Benefits of a Solid Compliance Plan

Home healthcare organizations that invest in establishing a solid compliance plan will reap many benefits. Some of these cited by the Department of Health and Human Services include:

  • Meeting legal duty to ensure that home healthcare organizations are not submitting false or inaccurate claims.
  • Demonstrating to employees and the public a commitment to honesty.
  • Gaining an accurate view of employee and contractor fraudulent behavior.
  • Preventing illegal and unethical behavior.
  • Boosting the quality, efficiency, and consistency of patient care.
  • Centralizing information on health care statutes, regulations, and other program directives related to fraud.
  • Establishing a process for employees to report potential problems.
  • Setting up procedures that allow the prompt, thorough investigation of alleged misconduct.
  • Creating a channel for immediate, appropriate, and decisive correction and remediation.
  • Reducing exposure to civil damages and penalties, criminal sanctions, and administrative disciplinary actions.

It’s clear from this extensive list that establishing a solid compliance program is worth the investment for home healthcare organizations. Not only can legal and business ramifications be avoided, but compliance can also lead to a good reputation, resulting in long-term business growth.

Home Healthcare Provider Insurance

Even an organization that has a compliance program in place and follows all regulations perfectly is still at risk of facing a malpractice lawsuit. Home healthcare registered nurses, certified nurse assistants, licensed practical nurses, and other allied health workers need to be protected from mistakes and errors that will happen from time to time. Healthcare related errors may happen because of poor treatment issues, medical misinformation, legal compliance failures, or regulatory issues.

Home healthcare professionals can access affordable and simple insurance quickly and easily. NOW Insurance offers comprehensive coverage for allied healthcare workers as well as other healthcare practitioners. Get an immediate quote from our quick and easy online application in under three minutes today.