Healthcare Security & Compliance Specialist
Healthcare compliance is no longer optional—it’s mission-critical.
Whether your organization provides hospice, palliative, geriatric, skilled nursing, or specialized care for veterans, individuals with disabilities, or pediatric patients, today’s regulatory landscape demands unwavering vigilance. Providers reimbursed by Medicare, Medicaid, or private insurers must now meet rigorous federal mandates—HIPAA and Privacy compliance, ongoing Security Risk Analyses, full audit readiness, and strict adherence to NIST, HITRUST, and documentation protocols. With CMS, HHS, and private payers intensifying oversight, enforcement is more aggressive—and more costly—than ever.
R32 Solutions is your dedicated partner in healthcare cybersecurity and compliance.
We work alongside your internal IT and security teams or Managed Service Providers to harden infrastructure, mitigate liability, and maintain operational and regulatory readiness. From deep-dive risk assessments to active cyber defense and audit-proof compliance strategies, we help ensure your reimbursements remain uninterrupted and your organization fully protected.
With Medicare and Medicaid funding at stake, noncompliance isn’t just a risk—it’s a direct threat to your revenue, operations, and reputation. Even a single lapse in cybersecurity or documentation can trigger audits, penalties, or payment suspensions. An R32 Solutions Senior Consultant would welcome the opportunity to schedule a strategic consultation with you, your CFO, or CIO to strengthen your compliance posture, reinforce your cyber defenses, and secure the future of your care delivery.
To Get Paid by Medicare/Medicaid, Providers Must:
✅ Be HIPAA-compliant
✅ Conduct a Security Risk Analysis (SRA)
✅ Be audit-ready
✅ Follow data security, privacy, and documentation protocols
HIPAA – Required
- Required for all Covered Entities and Business Associates.
- Divided into two main rules relevant to cybersecurity and compliance:
- HIPAA Privacy Rule – Governs the use and disclosure of Protected Health Information (PHI).
- HIPAA Security Rule – Mandates administrative, physical, and technical safeguards to protect electronic PHI (ePHI).
- Requires:
- Risk assessments
- Access controls
- Encryption
- Incident response
- Workforce training
- Breach notification protocols
CMS Safeguards – Required
- CMS requires all Medicare and Medicaid-participating providers to implement appropriate safeguards for health information.
- Includes compliance with:
- 42 CFR Part 2 (for substance use data)
- HITECH Act enhancements to HIPAA
- Periodic security risk analyses (SRAs) in accordance with HIPAA and meaningful use programs.
What Medicare & Medicaid Require for Reimbursement
Healthcare providers that receive Medicare or Medicaid reimbursement must meet strict federal compliance standards—these are enforced by CMS (Centers for Medicare & Medicaid Services), HHS (U.S. Department of Health and Human Services), and the OCR (Office for Civil Rights). These requirements are not optional—failure to comply can lead to denied claims, recoupments, civil penalties, or exclusion from government programs.
HIPAA Compliance (Mandatory)
HIPAA is a condition of participation in all CMS programs. To remain eligible, providers must protect patient health data (ePHI/PHI), implement administrative, physical, and technical safeguards, and maintain up-to-date privacy and access control policies. Conducting and documenting a Security Risk Analysis (SRA) is a foundational HIPAA requirement.
Security Risk Analysis (Mandatory)
An annual SRA is required under the HIPAA Security Rule and Promoting Interoperability programs. Providers must identify and document risks to ePHI, implement mitigation plans, and show ongoing security improvements. A missing or outdated SRA can result in incentive loss or compliance penalties.
HITECH Act Compliance (Mandatory)
The HITECH Act strengthens HIPAA by tying EHR usage to compliance. It requires providers to report breaches, maintain audit trails, and encrypt protected health data—ensuring accountability in electronic systems.
CMS Program Integrity Rules (Mandatory)
Providers must implement programs to detect and prevent fraud, waste, and abuse, and ensure timely, complete, and accurate documentation. CMS requires breach reporting procedures, FWA training, and strong data security practices. Noncompliance can lead to investigations, fines, or criminal charges.
Audit Readiness (Mandatory)
Providers must be ready for CMS and HHS audits—including TPE, RAC, UPIC/ZPIC, and HIPAA audits. Readiness includes maintaining compliance documentation, risk assessments, workforce training records, incident response plans, and Business Associate Agreements (BAAs).
State Medicaid Requirements (Mandatory, Varies by State)
Medicaid providers must also meet state-specific security and health IT standards, which may include additional encryption policies, data-sharing agreements, or state-level compliance programs.
OCR and CMS Audits – Required Compliance
- Both random and complaint-driven audits check for:
- Security risk analysis documentation
- Policies and procedures
- Business Associate Agreements
- Employee training logs
- Breach response and documentation
Breach Notification Rule – Required
- Under HIPAA and HITECH, any breach involving 500+ individuals must be reported to:
- HHS within 60 days
- Affected individuals
- Sometimes the media
NIST Cybersecurity Framework (NIST CSF) – Strongly Recommended
- Referenced in HIPAA Security Rule guidance as a best practice.
- Used to:
- Identify and manage cybersecurity risks
- Improve infrastructure protection
- Prepare for audits and cyber events
CMS encourages alignment with NIST standards, especially NIST SP 800-53 and NIST SP 800-66 Rev. 1 (which maps directly to HIPAA).
What’s Not Federally Required—but Increasingly Expected
In today’s healthcare environment, many private payers, insurers, and strategic partners expect providers to adopt enhanced cybersecurity and compliance frameworks—even when they aren’t federally mandated.
- NIST 800-53 / 800-66 – Aligns with HIPAA; commonly referenced in audits and by partners
- HITRUST CSF – A widely accepted framework, often required by payers and business associates
- SOC 2 / ISO 27001 – Optional, but demonstrates a mature security posture for organizations working with sensitive data