Medical Practices
Running a medical practice today means meeting rising regulatory expectations while controlling costs and staffing pressure, without losing focus on patient care. Federal enforcement has reached record levels, HIPAA scrutiny is rising, and operating without a structured compliance program is no longer low risk. Fortestra works with independent and small group practices on OIG compliance program design, HIPAA policy governance, staff training, workflow standardization, and change management for new systems.
Fortestra works with independent and small group medical practices on the operational and governance layer:
OIG compliance program architecture, HIPAA Privacy and Security policy governance, staff training frameworks, workflow standardization, and change management for new system and process adoption.
What We Hear from Medical Practice Leaders
Compliance Programs Exist in Name Only
The HHS Office of Inspector General has published compliance program guidance for physician practices for decades. In 2025, enforcement is at unprecedented levels. The DOJ’s healthcare fraud enforcement actions have reached record scale, and enforcement agencies explicitly treat the absence of a structured compliance program as evidence of deliberate indifference when determining penalties. [A] The most common situation: a compliance program that was set up years ago and has not been actively maintained since. The program exists. It does not function.
HIPAA Policies Are Outdated or Incomplete
OCR enforcement of HIPAA Privacy and Security Rules is intensifying in 2025. HHS has updated civil monetary penalty tiers, and OCR has signaled increased focus on audit scope, technical safeguards, and staff training documentation. [B] The most common failure mode is not a major breach. It is the slow drift between what policies say and how PHI is actually handled by staff. Policies written for 2018 workflows that have not been reviewed since. Vendor relationships where Business Associate Agreements either do not exist or have not been updated.
Staff Training Is an Event, Not a System
OIG compliance program guidance for physician practices calls for role-specific, ongoing staff training that is documented and tracked. [C] Most practices do some version of annual training. Very few have the role-specific training curriculum, the documented completion records, and the systematic gap-tracking process that OIG guidance expects. Training that happens but is not documented provides almost no protection under OIG compliance standards.
Processes Vary by Provider, Not by Policy
In multi-provider practices, the way a clinical workflow, documentation requirement, or patient communication is handled often depends more on which provider is in the office than on what the practice’s written policy says. Variation at this level creates inconsistency in patient experience, gaps in compliance evidence, and the kind of documentation discrepancies that surface during audits and licensing reviews.
New Systems and Workflows Don’t Stick
According to Physicians Practice’s 2025 annual survey of medical practice administrators, nearly 4 in 10 identified administrative burdens and EHR friction as a top challenge, and KLAS research confirms that even practices recently live on new EHR platforms still struggle to achieve satisfactory adoption levels. [D] Technology gets installed. The old workflows persist alongside it. The adoption failure is not a technology problem. It is a change management problem.
Administrative Burden Is Absorbing Clinical Capacity
MGMA’s August 2025 survey of 343 medical group leaders found that 41% identified margin and costs as leadership’s top priority, with staffing pressures as the primary driver of cost pressure. [E] Reducing administrative burden in a medical practice does not start with technology. It starts with mapping the workflows where staff time is being consumed by rework, unclear ownership, or unnecessary steps, and redesigning them with the clinical team’s input.
How Fortestra Helps
Every medical practice engagement begins with an honest assessment of your compliance program’s current state: what exists, what functions, what is documented but not followed, and where the highest-risk gaps are.
OIG Compliance Program Architecture
We build the compliance program structure your practice needs: the seven elements of an OIG-aligned program, built for your practice’s size, specialty, and specific risk profile. Written standards, designated oversight, training framework, internal monitoring calendar, incident response protocol, and enforcement mechanisms. A working program designed for how your practice actually operates.
HIPAA Privacy & Security Policy Governance
We assess the gap between your current HIPAA policies and how your practice actually handles PHI. We update your Privacy and Security policies, build the staff training documentation framework, establish the BAA review cadence, and create the breach response procedure your practice needs to be prepared for an OCR review.
Staff Training Program Design
We design the role-specific training framework your practice needs, structured to align with OIG compliance guidance, organized by staff role rather than just by topic, and documented in a way that creates an auditable completion record. We build the training calendar and the tracking system that converts compliance training from an annual event into a continuous, documented function.
Workflow Standardization
We map the clinical and administrative workflows where variation is highest and process failures most frequent, and design the common standards and documentation that bring consistency across providers and staff. Processes documented clearly enough that any qualified team member can follow them, regardless of how long they have been with the practice.
Change Management for Rollouts
When a new EHR system, new clinical workflow, new compliance requirement, or new documentation standard needs to be adopted across your practice, we build the structured adoption plan: the readiness preparation, the provider and staff communication tools, and the reinforcement mechanisms that ensure the change actually holds after go-live.
Compliance Program Health Check
For practices that already have a compliance program but have not actively maintained it, we conduct a structured outside-in assessment, evaluating the current state of each of the seven compliance program elements, identifying the highest-risk gaps, and producing a prioritized action plan your team can execute within a defined timeline.
Fortestra does not handle Protected Health Information by default. If an engagement requires access to PHI, the appropriate data handling agreements are established before any such access occurs.
No commitment required. Inquiry responses within one business day.
Fortestra's Scope in Medical Practices
WHAT WE DO:
- OIG compliance program design: the seven elements, built for your practice’s size, specialty, and risk profile
- HIPAA Privacy and Security policy governance: current policies, staff training documentation, breach response procedures, and vendor BAA management
- Staff training framework design: role-specific curriculum, documentation, and tracking that meets OIG guidance expectations
- Workflow standardization: clinical and administrative processes mapped and documented so outcomes are consistent across providers and staff
- Change management for new system and process adoption: structured readiness preparation and adoption planning for EHR upgrades, new workflows, and compliance program rollouts
OUTSIDE OUR SCOPE:
- Billing, coding, and revenue cycle management: those require a specialist in medical billing and RCM
- Clinical documentation compliance (clinical coding accuracy, medical necessity documentation): that requires a coding compliance specialist
- Technical cybersecurity testing: penetration testing and technical security audits require a specialist cybersecurity firm
- Legal opinion on HIPAA enforceability, OIG penalties, or specific compliance determinations: those require qualified healthcare counsel