Healthcare Law, Ethics, and Compliance Essentials

EDURISE

Healthcare Compliance Program Audit and Evaluation Report

Included in course price

• Intro 00:59

  • 1: Healthcare Compliance Officer 00:59

• Video Material 2:06:49

  • 2: Module 1 Fundamentals of Healthcare Regulations and Laws 22:44
  • 3: Module 2Risk Assessment and Management in Healthcare 20:33
  • 4: Module 3Corporate Governance and Compliance Leadership 22:02
  • 5: Module 4Advanced Healthcare Privacy and Security 21:25
  • 6: Module 5 Compliance Auditing and Monitoring 19:40
  • 7: Module 6Healthcare Fraud, Waste, and Abuse Prevention 20:25

• PDF Material 1:01:00

  • 8: Module 1_ Fundamentals of Healthcare Regulations and Laws 11:00
  • 9: Module 2_ Risk Assessment and Management in Healthcare 09:00
  • 10: Module 3_ Corporate Governance and Compliance Leadership 09:00
  • 11: Module 4_ Advanced Healthcare Privacy and Security 09:00
  • 12: Module 5_ Compliance Auditing and Monitorin 09:00
  • 13: Module 6_ Healthcare Fraud, Waste, and Abuse Preventio 09:00
  • 14: MCQs 05:00
  • 15: Healthcare Compliance Strategy and Audit Plan -

• Bouns Material 16:19

  • 16: Podcast 13:19
  • 17: MCQs 03:00

This professional training course provides a comprehensive and practical understanding of healthcare compliance, equipping learners with the tools and insights to navigate legal obligations, prevent fraud, manage organizational risk, and ensure ethical operations in healthcare environments. Through six advanced modules, participants are trained to become skilled compliance professionals capable of maintaining regulatory integrity and leading organizational transformation in hospitals, clinics, insurers, and public health systems.

Module 1: Fundamentals of Healthcare Regulations and Laws
This foundational module introduces learners to the critical legal frameworks that govern modern healthcare. Participants explore key U.S. federal laws including HIPAA, HITECH, the Affordable Care Act (ACA), Stark Law, Anti-Kickback Statute, False Claims Act, and their corresponding state-level equivalents. The module emphasizes the historical evolution of healthcare regulation, the function of the Office of Inspector General (OIG), Centers for Medicare & Medicaid Services (CMS), and the Department of Justice (DOJ) in enforcement. Topics such as medical necessity, billing compliance, overpayment refunds, and whistleblower protections are explored through real-world case studies. Ethical decision-making and professional conduct in compliance reporting are introduced as foundational competencies.

Module 2: Risk Assessment and Management in Healthcare
This module develops advanced risk identification and mitigation skills specific to healthcare operations. Learners assess clinical, financial, and reputational risks and study how to construct a comprehensive risk management framework. Techniques such as risk matrices, severity-probability ranking, root cause analysis, and scenario planning are applied to real compliance challenges such as data breaches, fraudulent billing, and unauthorized access to protected health information (PHI). The module emphasizes risk-based compliance strategies that prioritize high-impact areas like coding accuracy, claims submission, and third-party vendor risk. Learners are guided through constructing dynamic policies and controls that adapt to regulatory updates and operational shifts.

Module 3: Corporate Governance and Compliance Leadership
This module shifts focus to the organizational and leadership dimensions of compliance. Learners examine the role of corporate governance structures in promoting accountability and ethical oversight. The responsibilities of compliance officers, legal counsel, executive leadership, and board members are clearly defined. The course presents models of effective governance, including the use of compliance committees, enterprise risk management (ERM) integration, and whistleblower protection mechanisms. Strategic communication, internal reporting systems, cross-functional collaboration, and tone-at-the-top leadership are emphasized. Case-based scenarios provide practical insight into resolving conflicts of interest, responding to subpoenas, and managing internal investigations without compromising confidentiality or due process.

Module 4: Advanced Healthcare Privacy and Security
This module offers in-depth coverage of the complex privacy and cybersecurity landscape affecting healthcare organizations. Learners explore HIPAA Privacy, Security, and Breach Notification Rules, along with global regulations like GDPR and Australia's My Health Record Act. Topics include data encryption, role-based access controls, multi-factor authentication, and secure data transmission protocols. Participants learn how to develop and implement privacy impact assessments (PIAs), respond to data breach incidents, and structure breach notification protocols in line with federal timelines. Learners are exposed to cybersecurity threats such as phishing, ransomware, insider misuse, and unsecured devices, and are guided through the creation of security incident response plans. The module reinforces how compliance professionals must balance legal obligations with patient rights and operational demands.

Module 5: Compliance Auditing and Monitoring
This module equips learners with technical expertise in conducting internal audits and implementing ongoing monitoring programs. Participants examine audit methodologies including sampling, documentation review, trend analysis, and audit trail examination. Key topics include audit scope planning, selection of audit subjects, use of compliance dashboards, and handling unannounced audits. Learners explore how to draft audit findings, recommend corrective actions, and follow up to ensure accountability. Compliance monitoring techniques—such as automated alert systems, hotline analytics, and key performance indicators (KPIs)—are introduced as tools to measure program effectiveness and detect emerging risks. Case studies address improper billing practices, inadequate documentation, and inconsistent training practices that can trigger investigations or penalties.

Module 6: Healthcare Fraud, Waste, and Abuse Prevention
This final module focuses on detecting, reporting, and preventing healthcare fraud, waste, and abuse (FWA). Learners study how to identify red flags in medical billing, duplicate payments, unbundling of services, upcoding, and kickbacks. The module examines real enforcement actions from the DOJ and OIG to understand patterns of systemic fraud and the legal consequences of non-compliance. Students learn how to establish fraud prevention programs including employee education, third-party risk controls, and claims audits. Participants also explore anti-fraud analytics using algorithms and AI, the use of exclusion databases (LEIE, SAM.gov), and processes for conducting internal investigations. Ethical whistleblower protection and the False Claims Act retaliation provisions are also covered to ensure safe and compliant reporting environments.

Conclusion and Outcomes
Through these six intensive modules, learners gain practical expertise in regulatory compliance, risk assessment, governance, auditing, data security, and fraud prevention—building a skillset essential for high-stakes healthcare roles. Graduates will be prepared to:

• Develop and implement risk-based compliance programs

• Conduct internal audits and investigations

• Ensure privacy and cybersecurity compliance

• Mitigate fraud, waste, and abuse risks

• Navigate federal and international health regulations

• Lead cross-functional compliance teams with strategic insight

This course ensures learners are well-positioned to become certified compliance officers, managers, or advisors in diverse healthcare settings. From hospitals and clinics to insurance providers and health tech firms, the demand for trained compliance professionals continues to grow—making this training a powerful credential for career advancement.

This course is designed for professionals and aspiring leaders seeking to advance their careers in healthcare compliance, risk management, and regulatory oversight. It is ideal for:

• Healthcare Compliance Officers and those preparing for roles in legal and regulatory affairs

• Hospital Administrators, clinic managers, and health system executives responsible for ensuring ethical operations

• Medical Auditors, billing specialists, and coders seeking advanced compliance training

• Healthcare Lawyers and legal assistants focusing on fraud, privacy, and risk issues

• Risk and Quality Managers overseeing clinical governance and patient safety

• IT and Security Professionals managing protected health information (PHI) and HIPAA compliance

• Public Health Officials involved in monitoring population-level health program compliance

• Students and Graduates of health administration, public health, or health law looking to build practical, job-ready skills

Whether you work in a hospital, private practice, insurance firm, or government agency, this course equips you to lead, protect, and ensure integrity in today’s complex healthcare environment.

Graduates can pursue roles such as Healthcare Compliance Officer, Privacy Officer, Risk Manager, or Regulatory Affairs Specialist. These positions offer strong earning potential, with average salaries ranging from £40,000 to £85,000+ per year in the UK, depending on experience, sector, and certifications like CHC or CCEP.

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