Healthcare Industry Bracing for Increased Regulatory Scrutiny According to Surveys from SAI Global Compliance

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Healthcare Reform Driving Most Payers and Providers to Focus on Demonstrating Compliance Effectiveness

SAI Global Compliance, the world’s leading provider of governance, risk and compliance (GRC) products, services and technology including the Compliance 360® GRC Software Suite, today announced the findings of its 2012 Health Insurance Compliance Benchmark Study and 2012 Healthcare Compliance Benchmark Study. As the Centers for Medicare and Medicaid Services (CMS) continues to increase its emphasis on proactive compliance, both healthcare providers and insurers cited “demonstrating compliance effectiveness” among their top compliance program priorities for 2012.

Seventy five percent of the survey participants from the provider organizations noted compliance self-assessments and demonstrating compliance effectiveness as their highest priority. This indicates a sharp increase in prioritization, up from only 40 percent in the survey just two years ago. Similarly, participants from payer organizations noted compliance self-assessments and demonstrating compliance effectiveness among their top three priorities. Additionally, 82 percent of the payers cited increasing proactive focus and audits from CMS as the main driver of their compliance priorities.

In July 2011, CMS issued a compliance program self-assessment questionnaire for payers, largely based on the Seven Elements of an Effective Compliance and Ethics Program as outlined in the U.S. Sentencing Guidelines. Many healthcare organizations viewed this as signaling a shift from retrospective audits to more proactive measures and began to focus on demonstrating compliance effectiveness as a higher priority.

“Healthcare reform is shining a brighter light on compliance, so we were not surprised to see healthcare providers and payers placing higher priorities on demonstrating their compliance program effectiveness this year,” said Steve McGraw, GRC President, SAI Global Compliance. “As budgets continue to be stretched and regulatory scrutiny increases, healthcare organizations must be confident that their compliance programs can withstand intense examination. Self-assessment tools provide one of the most effective means for doing this and we expect to see their continued growth and popularity in the year ahead.”

To download copies of the free surveys or learn more about the seven elements of effective compliance programs, visit the Healthcare Resource Center at or the Health Insurance Resource Center at .

About Compliance 360® GRC Software Suite
The original Governance, Risk and Compliance (GRC) software solutions born in the cloud, Compliance 360 brings order and efficiency to the complexity of enterprise governance, risk management, compliance and audit management. The Compliance 360 GRC Software Suite includes regulatory compliance software, policy management software, internal audit software, incident management software, ERM software and a wide variety of specialty applications. More than 250,000 professionals every day in healthcare, insurance, financial services, distribution and other regulated industries rely on Compliance 360 applications to help protect their revenues, reputations and brands.

About SAI Global Compliance
SAI Global Compliance provides organizations with a wide range of governance, risk and compliance (GRC) products, solutions and services that help build organizational integrity and meet overall business objectives. With more than twenty-five years experience and offices in more than 25 countries, SAI Global’s solutions include a wide range of GRC products and services including the Compliance 360 GRC Software Suite, best practice Code of Conduct program services and training, compliance and ethics training and awareness, risk and culture assessments, a full range of advisory services, whistleblowing hotline services, regulatory knowledge, policy management, case management, and third party compliance management including automated due diligence workflow and management.


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Ashleigh Egan
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