The Biggest Reasons Your Compliance & Legal Teams Need to Be On the Same Page
Healthcare organizations deal with a constant stream of regulations, contractual requirements, operational decisions, audits, investigations, and changes in how care is delivered. With so many moving parts, one question comes up repeatedly for compliance professionals: When does an issue belong with compliance, and when does it require legal involvement?
The answer depends heavily on the situation, the level of risk, and what the organization is trying to accomplish. Understanding the relationship between the law and healthcare compliance helps organizations use both functions effectively while keeping day-to-day operations moving.
Compliance and Legal Have Different Responsibilities
Compliance is often focused on prevention and ongoing oversight. That can include auditing, risk management, policy development and updates, contract compliance, regulatory monitoring, investigations, accreditation requirements, and working with operational teams to address issues as they arise.
Legal has a different role. Attorneys can help interpret statutes and regulations, review contractual language, frame policies, address disputes, advise on potential liability, and communicate with regulators or other parties when a significant legal issue develops. Compliance then helps make sure the resulting guidance actually works within the organization and is followed consistently.
That distinction matters because legal advice still has to be implemented within the realities of healthcare operations. An attorney may provide the appropriate legal framework, while compliance and operational teams have to determine how that framework functions in practice.
When Should Compliance Involve Legal?
I encourage compliance professionals to think about legal involvement early when an issue could develop into a meaningful legal or regulatory risk. You do not have to wait until there is already a violation, regulator involvement, or litigation before bringing your legal colleagues into the conversation.
There are several situations where that early conversation can be particularly valuable:
A new business line creates questions about whether existing compliance processes still apply.
New federal or state regulatory guidance requires legal interpretation.
A contractual dispute develops or the organization may be unable to meet an agreement requirement.
An audit identifies an issue that could result in reporting, sanctions, financial penalties, or other significant consequences.
A potential HIPAA breach, fraud, waste, abuse concern, investigation, or litigation requires legal guidance.The goal is to create enough space for compliance and legal to evaluate the situation together and determine an appropriate course of action.
Risk Should Drive Escalation
One of the challenges in healthcare compliance is determining which issues actually require legal attention. Every compliance issue matters, but every issue does not carry the same level of risk.
For example, an employee missing annual compliance education may initially be an operational or HR issue. If the same problem is happening repeatedly across the organization, however, the pattern could indicate a larger compliance or legal risk that needs additional attention.
This is where understanding the law and healthcare compliance becomes especially important. Compliance professionals need to recognize when an isolated operational problem has become a trend, when a trend has created meaningful exposure, and when legal expertise is necessary to determine the appropriate response.
The Importance of Legal and Compliance Collaboration
Some of the strongest examples of legal and compliance collaboration happen when both teams bring different perspectives to the same problem. In one example discussed on the podcast, an audit identified documentation inconsistencies in an EMR. Compliance was focused on correcting the documentation appropriately, while legal helped narrow the proposed language to reduce unnecessary risk.
That kind of collaboration can also be critical during mergers and acquisitions. Legal may coordinate the transaction, but healthcare compliance professionals need to evaluate the organization's actual compliance practices, policies, procedures, and regulatory exposure. Missing that perspective during due diligence can create problems that affect the transaction and potentially leave significant liability with the seller.
There is also an important operational boundary. Outside counsel generally works as an advisor on specific assignments and may not be involved in the organization's daily processes. Compliance often becomes the function responsible for making sure policies, procedures, and legal guidance are actually implemented and followed.
That is why I believe the relationship between compliance and legal works best as a partnership. Compliance professionals should feel comfortable saying, "I'm not sure whether this needs legal involvement. Can we talk through it?" That conversation can help determine the appropriate path before a manageable issue becomes something much more difficult to address.
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