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@Regulatory: August 2014

How effective is your health insurance exchange compliance program?


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In today’s complex healthcare landscape, many health plans face a significant challenge - establish a rigorous Health Insurance Exchange regulatory compliance program or risk potential financial losses and operational disruptions by ‘getting compliance wrong.’ Deploying an effective compliance program should be a strategic aspiration for health plans. The program should aid the business in managing the full scale of risk across business lines, eliminating silos and proactively addressing risk before non-compliance events occur. Organizations that are successful in this endeavor apply an integrated approach to assessing and managing compliance risk, and delivering an organization-wide response to the highest priority risks. In this edition of @Regulatory, we discuss the expected enforcement of compliance standards for plans participating in exchanges, key areas that qualified health plans (QHPs) on the Federally-Facilitated Marketplace (FFM) should focus on in the short-term, and steps that plans should consider to build strong compliance programs.

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