As one of the most heavily regulated industries, healthcare compliance involves adhering to a number of regulations that are enforced at different jurisdictional levels. Laws and regulations range from protecting patients’ data privacy rights under the Health Insurance Portability and Accountability Act (HIPAA) to preventing medical referrals for compensation (i.e., the Anti-Kickback Statute).
With such a complex regulatory landscape to navigate, professionals and entities rely on healthcare compliance monitoring, which might include dedicated staff, documented policies and processes, software implementations, and outside experts or vendors.
But healthcare compliance monitoring standards and best practices are constantly evolving. With the information below, you can stay on top of changing standards and avoid non-compliance consequences in healthcare.
What Is Healthcare Compliance Monitoring?
Regulatory compliance monitoring in healthcare refers to the combination of people, processes, and technologies responsible for ensuring all individuals and entities adhere to applicable healthcare laws and regulations. This responsibility is shared by all healthcare professionals, but certain administrative and compliance-focused roles assume the majority.
For example, notable careers in healthcare compliance monitoring include roles such as:
- Compliance officers – Usually leading their own team, compliance officers oversee individual auditors’ assessments and shape compliance training, policies, and decisions.
- Compliance auditors – Working under a compliance officer, auditors carry out the hands-on evaluations and assessments to verify whether a healthcare facility and all its employees adhere to clinical compliance regulations in their day-to-day duties.
- Patient privacy and protection specialist – After the passing of HIPAA in 1996, patient privacy protections continue to become more robust—especially regarding electronic protected health information (ePHI). This position navigates HIPAA and related regulations, filling a niche but crucial compliance role.
- Administrators – Whether dedicated compliance professionals or not, a healthcare entity’s administrators bear responsibility for regulatory compliance as an extension of their authority over business processes, including billing. These professionals will also likely be involved with credentialing new or existing employees to remain compliant with healthcare background check requirements.
Outside of these broader categories, healthcare entities may also employ compliance professionals with more narrow focuses. For example, someone’s role might focus exclusively on billing processes and paperwork to ensure that patient information is kept safe—combining aspects of a privacy specialist and administrator. Learn how our healthcare compliance monitoring solutions can help automate oversight and maintain continuous compliance across systems.
Why Monitoring Matters More Than Ever in 2025
Every year, regulations seem to grow more complex, data continues accumulating, and new technologies emerge that could either simplify compliance or upend it. Whereas healthcare professionals in 1965 mostly minded Medicare and Medicaid, those entering the field over the last 30 years (since the US Congress passed HIPAA in 1996) may find it difficult to keep up with all the additional regulations and rulemaking.
And, coinciding with the growing regulatory complexity, audits and enforcement occur more often. Healthcare entities need to implement robust internal controls and perform internal audits to make sure there aren’t any surprises during a government assessment.
Patients often call the loudest for accessibility, transparency, and compliance monitoring as they cheer on initiatives and advocacy over the years. They’ve seen further pushes to protect patient privacy (Health Insurance Technology for Economic and Clinical Health (HI-TECH)), to protect themselves from surprise out-of-network billing (i.e., No Surprises Rule), or to hold professionals accountable for waste, fraud, and abuse (e.g., Department of Health and Human Services’s (HHS) OIG Exclusion List).
Now, the data transfer between technologies like telehealth or devices like wearables poses new challenges regarding how to monitor compliance in healthcare.
Key Trends in Compliance Monitoring for 2025
Perhaps one of the biggest trends in compliance monitoring for 2025 is the continued development of artificial intelligence (AI) in healthcare compliance. But this isn’t the only trend to be aware of:
Real-Time Monitoring & Automation
In real time, AI monitoring systems will be able to predict or detect potential healthcare compliance issues due to irregularities in datasets or patterns. These capabilities range from unusual user authentications caught by continuous monitoring (e.g., indicating potential HIPAA violations) to catching billing statements that violate the No Surprises Rules (e.g., charging out-of-network costs rather than in-network costs).
Healthcare compliance monitoring has traditionally been reactive—only responding once notified of violations. However, AI-driven capabilities and automated audits are now changing this approach, allowing compliance teams to preempt and prevent violations.
Focus on Data Integrity and Interoperability
Continual—and growing—reliance on integrated technology platforms to augment healthcare compliance monitoring highlights the critical importance of data. Overcoming the traditional challenge of data silos, integrations will drive efficiency and ensure all operations work from the same datasets (e.g., a ‘single source of truth’).
However, for these possibilities to be realized, the data itself must be accurate, current, and properly formatted. Plus, data transfers—if not encrypted—potentially increase the odds of HIPAA violations.
Expansion of Third-Party Oversight
Following the passage of the HI-TECH Act, any outsourced services contracted by healthcare entities—specifically those involving ePHI—should always be covered by a Business Associate Agreement. These agreements contractually outline the permissible uses of sensitive data and help both parties remain compliant.
As healthcare entities adopt more outsourced services or partner with vendors in ways that might involve patient data, the risk of HIPAA compliance violations increases. This is where vendor credentialing compliance becomes crucial. To strengthen third-party oversight and mitigate risk exposure, healthcare entities can leverage healthcare background screening solutions that vet vendors and contractors for compliance, licensing, and exclusion status before engagement.
Common Challenges in Keeping Up With Compliance
Although the biggest trends in healthcare compliance revolve around data and enhanced visibility, the challenges do, too:
- Data silos – On the one hand, disparate systems lead to insufficient visibility across teams and departments. This can cause critical matters to go unnoticed or create confusing, duplicate datasets. On the other hand, integrations break down those silos and improve visibility. However, the data synchronizations and transfers—especially when involving cloud environments—may introduce a greater likelihood of violating HIPAA.
- Training gaps – Technological developments keep accelerating and introducing new capabilities, but compliance monitoring teams need time to understand and acclimate to using them. Without adequate training or leadership support, technology initiatives could cause as many headaches as the compliance violations they prevent. Support compliance and training initiatives across teams with our workforce management for healthcare solutions, integrating staff oversight and credentialing in one platform.
Best Practices for Staying Ahead of Compliance Trends
The ideal approach to managing this influx of technologies is to orient compliance operations toward them:
- Build cross-functional teams – As visibility extends across a healthcare entity—driven by AI, automations, and data—and traditional department boundaries blur, different teams must begin collaborating and communicating more. With interconnected systems, small changes can lead to major impacts on other workflows.
- Utilize dashboards – Integrating systems and data across an organization only provides visibility when healthcare entities also leverage dashboards presenting data visualizations, alerts, and real-time updates. From a central dashboard, compliance professionals can monitor critical processes and data integrity while gaining operational insight.
- Invest in compliance software – Compliance monitoring software is fundamental to system and data security during the integration and operation of an interconnected tech environment. Processes and data will often flow fast enough that personnel cannot monitor or respond to everything, making this use case especially suited to AI capabilities.
- Conduct regular risk assessments and internal audits – For the same reasons that investing in compliance software is so important, compliance monitoring teams must also perform analysis and audits almost continuously. Here, compliance audit preparations for healthcare organizations are key.
Future-Proofing Your Compliance Strategy
Through the rest of 2025 and beyond, the biggest healthcare compliance monitoring trends exhibit promising tradeoffs. With the continued adoption of AI, automation, data-driven capabilities, and interconnected technology environments, compliance teams can support operations better than ever before by responding to violations in real time or preemptively.
However, these technologies also introduce new exposures to risk and compliance violations that will require teams to communicate, collaborate, undergo training, and stay on top of internal audits. The time to improve the underlying systems, data, and monitoring tools is now.
Take compliance monitoring further with our provider compliance solutions, combining automated audits, real-time alerts, and credential data management to reduce risk and enhance accuracy.
Sources:
Seattle University School of Law. Exploring Career Paths in Healthcare Compliance Post-MLS. https://onlinelaw.seattleu.edu/blog/career-paths-in-healthcare-compliance/
KFF. Timeline: History of Health Reform in the US. https://www.kff.org/wp-content/uploads/2011/03/5-02-13-history-of-health-reform.pdf
CMS. Overview of rules & fact sheets (No Surprises Billing). https://www.cms.gov/nosurprises/policies-and-resources/overview-of-rules-fact-sheets
HHS. Business Associate Contracts. https://www.hhs.gov/hipaa/for-professionals/covered-entities/sample-business-associate-agreement-provisions/index.html
