The healthcare sanctions background check process remains one of the most critical operations for direct care organizations in 2025. For health systems, pharmacies, health plans, and other entities, healthcare sanction screening supports compliance efforts and ensures high-quality care.
But what is a healthcare sanctions background check, practically speaking? Which trends and technologies should direct care organizations and compliance partners look out for in 2025 and beyond? This guide will break down these and other common queries in the healthcare sanctions conversation.
Compliance professionals, risk managers, and administrators must understand emerging practices, tech tools, and enforcement priorities in a changing healthcare landscape—one where pristine, real-time data has the potential to transform the compliance process.
What Is Healthcare Compliance Monitoring?
Healthcare compliance monitoring is about more than sanction checks on employees—it’s a direct care organization’s overall approach to regulatory conformity.
Multiple parties play a role in compliance monitoring: compliance officers, administrators, auditors, and more. With multiple professionals across disciplines on a compliance team, organizations can meet wide-ranging regulatory needs.
Healthcare regulations are complex, and today’s administrators must monitor various operational elements to ensure compliance. Some examples include:
- The billing process
- Data privacy
- Clinical compliance
- Vendor credentialing
Sanctions are a key element of vendor credentialing compliance, in particular. Simply put, a healthcare sanction can result from an administrative, civil, or criminal hearing; if an individual (like a licensed provider) or an entity (like a healthcare system, health plan, or risk management partner) commits wrongdoing, sanctions are one possible consequence.
An example of sanctions monitoring in action is the healthcare license verification process. When organizations review a provider’s license, they check their legal and professional records for past or current sanction history.
Why Monitoring Matters More Than Ever in 2025
While sanctions monitoring has been a critical element of healthcare compliance for decades, the current regulatory landscape demands additional diligence.
In 2025, regulations are only growing more complex:
- The Centers for Medicare and Medicaid Services (CMS) has adopted new evidentiary standards for terminating health insurance agents, brokers, and web-broker marketplace agreements.
- The US Department of Health and Human Services (HHS) issued new HIPAA amendments at the end of 2024; some of these have already been overturned as of June 2025. Final rules for 2025 are still subject to change.
- The HHS Office of Inspector General (OIG) has issued a new strategic plan for 2025 to 2030. This plan prioritizes grant compliance, contract regulation, and managed care financial auditing.
Whether your organization is reviewing its healthcare compliance audit preparation process or updating its routine operational compliance efforts, it’s never been more important to stay abreast of changing regulatory requirements. The demand for transparent, accountable healthcare delivery is mission-critical in 2025 and beyond.
Key Trends in Compliance Monitoring for 2025
In the face of changing regulations, direct care organizations and compliance partners have adopted new technologies and approaches to prevent healthcare legal issues.
Real-Time Monitoring & Automation
With emerging technologies, organizations can monitor sanctions, data, and risk in real time.
- With AI, companies can automate and streamline records monitoring, regulatory review, and more.
- Automated audits are becoming the norm—even when they’re not specifically requested by oversight agencies. In-house auditing can help organizations prepare for inevitable audits and strengthen their regulatory processes proactively.
- In many cases, organizations are pairing automated audits with continuous risk assessments—ongoing oversight and analysis of financial, regulatory, and administrative risk factors.
Focus on Data Integrity and Interoperability
As a result of a 2018 federal incentive program, organizations have widely adopted electronic health records (EHR)—experts estimate that over 90% of inpatient and outpatient organizations have incorporated EHR.
As the body of digital healthcare data grows, interoperability has become even more important. However, for organizations to share data effectively (and make clinical, financial, and regulatory decisions based on these data records), the integrity of these digital reserves is essential.
Data accuracy also plays a central role in regulatory compliance. When data is incorrect, direct care providers may encounter:
- Medical errors (e.g., incorrect clinical decisions and diagnoses)
- Inaccurate billing
- Penalties for non-compliance
Today’s companies must use every tool at their disposal (from third-party compliance software to AI-powered data review platforms) to ensure that accurate data is shared between healthcare stakeholders.
Expansion of Third-Party Oversight
In 2025, healthcare background screening is just the tip of the iceberg when it comes to third-party oversight—and not just for provider hiring.
The expanding regulatory reach of CMS, HHS, OIG, and other entities has already resulted in new scrutiny on:
- Healthcare vendors (from materials suppliers to digital platforms)
- Credentialing partners
- Outsourced services (e.g., billing services, outsourced HR)
As oversight expands, so will regulatory enforcement. In 2025 and beyond, healthcare organizations are under a microscope; organizations must implement enhanced sanction screening and other risk management approaches to ensure compliance.
Common Challenges in Keeping Up With Compliance
In the face of growing scrutiny, your organization may seek out provider compliance solutions. But which pain points should these solutions address? Some of the most common compliance challenges for today’s healthcare entities include:
- Siloed systems and manual processes – While EHR is on the rise, these systems perform at their best when they’re interoperable—not siloed. Data solutions providers must provide organizations with a mechanism to share clinical and operational data across departments. In addition, this shared data must have integrity; switching to automated, digital data entry and review can help prevent the human error implicit in manual processing.
- Gaps in staff training or leadership support – In large healthcare organizations, training gaps can pave the way for compliance nightmares. Direct providers and compliance partners need solutions that facilitate staff training, continuing education, and clear leadership support mechanisms. Even in the digital age, the people behind the data (and their professional skills) are just as critical as data itself.
- Lack of visibility across departments – While information cannot be siloed in a successful healthcare organization, compliance efforts can’t be, either. Regulatory processes, audit results, and similar information should be accessible to all relevant stakeholders to facilitate compliant decision-making and operational success.
Best Practices for Staying Ahead of Compliance Trends
The benefits of compliance programs in healthcare are clear—but which approaches should healthcare organizations consider as they combat the challenges above?
- Invest in compliance software and dashboards – In the face of regulatory sprawl and ongoing digital evolution, it’s never been a better time for healthcare organizations to invest in third-party compliance support. Compliance-centered software, dashboards, and consultation can all help direct care organizations take a proactive, informed approach to regulatory efforts.
- Develop cross-functional compliance committees – Compliance officers, administrators, auditors—these are just a few of the professionals typically involved in regulatory processes in healthcare organizations. Instead of working alone (or pursuing individual goals), consider creating a means for these experts to collaborate. With shared expertise, they can develop an organization-wide compliance plan that helps every department operate above board.
- Conduct regular risk assessments and internal audits – As mentioned above, AI and automation tools are powerful resources when it comes to internal auditing and risk assessment. Organizations can use these to their advantage to speed up the audit process, improve the quality of audit insights, and audit more frequently.
Future-Proofing Your Compliance Strategy
Healthcare sanctions background checks and other compliance-driven processes are more critical than ever in the face of ever-changing regulations. In 2025, a forward-thinking strategy (complete with high-tech resources and expert insights) is a must.
Organizations in search of compliance, credentialing, and risk mitigation solutions should turn to Verisys. We empower healthcare organizations with real-time, verified data tools—resources that ensure patient safety, streamline HR processes, improve the integrity of financial operations, and simplify compliance.
With better data, you can make better decisions—and discover better outcomes. Talk to an expert today to learn more.
Sources:
Equifax. What Are Healthcare Sanctions and Exclusions and Why Do They Matter?. https://totalverify.equifax.com/blog/all-blogs/-/post/what-are-healthcare-sanctions-and-exclusions-and-why-do-they-matter-
US Centers for Medicare and Medicaid Services. 2025 Marketplace Integrity and Affordability Final Rule. https://www.cms.gov/newsroom/fact-sheets/2025-marketplace-integrity-and-affordability-final-rule
American Psychological Association. Understanding the Now-Reversed Reproductive Health Privacy Amendments. https://www.apaservices.org/practice/business/hipaa/july-2025-court-decision-reproductive-health-privacy-rule
US Department of Health and Human Services. Regulatory Initiatives. https://www.hhs.gov/hipaa/for-professionals/regulatory-initiatives/index.html
US Department of Health and Human Services Office of Inspector General. Strategic Plan. https://oig.hhs.gov/about-oig/strategic-plan/
Health Services Research. Interoperability: What Is It, How Can We Make It Work for Clinicians, and How Should We Measure It in the Future?. https://pmc.ncbi.nlm.nih.gov/articles/PMC6153178/
Journal of Healthcare Leadership. An Information Quality Framework for Managed Health Care. https://pmc.ncbi.nlm.nih.gov/articles/PMC11445674/
Investopedia. Information Silo: What It Is, How It Works. https://www.investopedia.com/terms/i/information-silo.asp
