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, health-care companies face increasing financial pressures, as enrollees and legislators demand lower costs while business costs escalate. Additionally, a shrinking pool of new Medicare beneficiaries is intensifying competition among plans, not only for enrollees but for agents and brokers who are qualified, productive and compliant in their interactions with members.

UL 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

UL’s health-care curricula meets the requirements of regulatory agencies, including the CMS, HHS, US Department of Labor and 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.

UL provides the resources for health-care 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 Act.