Healthcare firms, whether healthcare providers, or payers (insurance firms), are subject to the numerous compliance regulations. Outsourcing of business processes is a growing trend in healthcare, as providers and payers seek to streamline business processes and reduce costs. Outsourcing examples in healthcare include medical transcription services, billing services, clearinghouses, and payroll services.

The healthcare industry is subject to the Health Insurance Portability and Accountability Act (HIPAA) Security and Privacy rules. These regulations provide privacy rights and protection for healthcare consumer’s protected health information (PHI, or EPHI for electronic information). In addition, the regulations are very specific regarding requirements for IT security. The HIPAA Security rule includes 74 specific requirements, spanning Administrative, Physical, and Technical Safeguards. The HIPAA Administrative safeguards specify that covered entities must perform risk assessments, manage security risks, and assess application and data criticality. They also require organizations to assess which of their business partners have access to the organization’s EPHI, and to execute Business Associate Agreements with business partners ensuring that the partner will appropriately safeguard the information. The Department of Health and Human Services administers the HIPAA regulations.

Beyond HIPAA, healthcare organizations may also be subject to compliance regulations such as SOX, FISMA, PCI, and GLBA, depending on whether they are part of a publicly traded organization, are a government healthcare entity, accept credit cards for payment of services, or store personal financial data on consumers in the course of their business.

While healthcare firms are not subject to audits by regulators, there are fines associated with HIPAA non-compliance. In addition, other negative consequences of non-compliance or of a public security breach apply, including brand damage and loss of market capitalization.

The ControlPath Compliance Suite can greatly benefit healthcare organizations struggling to adhere to the HIPAA Privacy and Security rules, and more effectively assess risk and manage their security program. ControlPath enables a single compliance and risk management process to ensure compliance with multiple regulations simultaneously. ControlPath increases the effectiveness and decreases the cost of compliance for healthcare providers and payers.