Regulatory Compliance

Constantly evolving, often complex federal and state regulations intersect with the demands of the marketplace, confronting health care organizations with both compliance and business challenges. Noncompliance with CMS’ requirements for Medicare Advantage, Private Fee-for-Service and Part D plans can mean litigation, exclusion from federal programs and a damaged reputation among current and potential enrollees. Licenses to conduct business are put at risk by violations of state insurance regulations. At the same time, healthcare companies face increasing financial pressures, with enrollees and legislators demanding lower costs and business costs escalating. Additionally, a shrinking pool of new Medicare beneficiaries is intensifying competition among plans, not only for enrollees but also for agents and brokers who are qualified, productive and compliant in their interactions with members.

Kaplan EduNeering works with leading health care plans and their downstream entities to assure regulatory compliance through the production, distribution, testing and documentation of training. The same hosted learning management system (LMS) that supports scores of compliance training programs throughout the US serves as the technology backbone for company-specific initiatives such as reinforcement of corporate culture, broker and agent management, licensure oversight and control, physician relationship management, and patient education. Kaplan EduNeering’s healthcare curricula meets the requirements of regulatory agencies including CMS, HHS, the US Department of Labor, and the SEC, while custom courses are developed to meet specific health plan programs, products and company initiatives. Our complete compliance solution identifies and mitigates knowledge gaps, enables a more productive workforce, optimizes oversight and management of training and compliance functions, and minimizes the risk of noncompliance and enrollee dissatisfaction. These programs ensure that employees have the knowledge needed to perform their job functions effectively and accurately.

Kaplan EduNeering's provides the resources for healthcare companies and service providers to meet compliance responsibilities in areas including:

Employee Training, Validation and documentation
Broker, Agent and Subcontractor training
Fraud, Waste and Abuse
False Claims Act
HIPAA
Interactions with physicians, pharmacies, pharmaceutical and medical device providers, and medical facilities
Sarbanes-Oxley