Understanding Healthcare Compliance: What Legal Professionals Must Know

The modern healthcare industry is one of the most highly regulated work ecosystems. Healthcare professionals must be mindful of their legal obligations under legislation such as the Health Insurance Portability and Accountability Act (HIPAA), which governs the privacy and security of medical information,¹ and regulations from the Occupational Safety and Health Administration (OSHA), which governs workplace safety.² Healthcare professionals also have additional responsibilities under the state and federal laws that cover the region in which they practice, as well as a need to be compliant with insurance companies’ rules.

Almost everyone working in healthcare, from medical professionals to administrators, benefits from having some legal knowledge.³ William & Mary Law School’s online Master of Legal Studies (MLS) with a Concentration in Health Law is designed to support non-lawyer professionals in navigating the healthcare industry’s increasingly complex legal landscape.

This post examines some of the key complexities within the industry and considers where a grounding in healthcare law basics and advanced principles of health law can help accelerate successful and rewarding careers in the healthcare industry.

The Scope of Healthcare Compliance Today

The importance of healthcare compliance is perhaps best illustrated by the sheer range of regulations encompassed within it.

Healthcare compliance means proactively seeking to detect and prevent fraud, waste and abuse within an institution or system—meaning everything from fraudulent insurance claims to theft.⁴ It’s also a term that covers compliance with laws governing patient data and digital records,⁴ such as HIPAA and the Health Information Technology for Economic and Clinical Health (HITECH) Act, which is intended to encourage providers to keep electronic health records.⁵

Laws that define a healthcare provider’s obligations aren’t limited to those requiring them to safeguard their practices from external bad actors. Other regulations—such as the Anti-Kickback Statute and the Stark Law (intended to ensure that referrals for treatment are based on patient needs, not on the physician’s financial gain)—define the provider’s own ethical responsibilities.⁴

The consequences of non-compliance can be substantial. In 2025, Florida’s Baycare Health System received an $800,000 penalty for HIPAA violations exposed by a complaint from a single patient,⁶ and eyewear company Warby Parker has been faced with a $1.5 million penalty after a data breach drew investigators’ attention to inadequate data protection measures.⁷

Those are just the penalties imposed by regulators. Egregious acts of non-compliance may also attract lawsuits from the injured or aggrieved parties. For example, in 2025, a plaintiff filed a class action lawsuit against Blue Shield of California, alleging that Blue Shield’s usage of Google Analytics resulted in users’ personal medical information being shared with Google.⁸

Perhaps most importantly, in an industry that places a premium on credibility, high-profile non-compliance issues can result in healthcare institutions losing the reputation for competence and trustworthiness they need to effectively serve their communities.

Healthcare administrators are challenged daily to identify and implement strategies for maintaining compliance with various regulations. Understanding the legal principles and frameworks that drive these regulations can be a key step toward consistent compliance.

The Intersection of Law and Healthcare Operations

A 1994 article published in the Journal of Health Administration Education insisted that health administrators need "meaningful education regarding the sources and structure of the legal system" because "regulation and governmental oversight will only increase, and affect virtually everything health administrators do."⁹ HIPAA was enacted two years later,¹⁰ and the HITECH Act became law in 2009.¹¹ Healthcare reform is at the center of a near-constant political debate. As was predicted 30 years ago, healthcare administrators need legal fluency because they are working in an environment governed by constantly shifting regulations.

Successful compliance strategies require collaboration between legal, compliance and clinical teams, often coordinated by administrators. Just as the types of compliance issues vary, what success looks like and how it can be achieved also take many forms. For example, some institutions can identify a clear compliance failure, such as a record-keeping issue, and buy out-of-the-box solutions or consulting services.¹²

Ovation Healthcare reports a case study involving a midsize hospital that knew it needed a new compliance program, but the previous consultants hired to deliver the message had failed to connect with the staff at the hospital. A new messaging approach won the necessary buy-in to get the hospital back on track.¹³

How the MLS in Health Law Supports Career Readiness

From foundational courses on healthcare law basics to electives on cybersecurity or the ethics of biotech, the online Master of Legal Studies curriculum examines healthcare regulation, ethics and policy from a variety of perspectives. From a HIPAA regulations overview to courses on patient rights and dispute resolution, MLS coursework will thoroughly prepare you for the challenges of a career in health law. Our renowned faculty at William & Mary Law School will help you learn how to interpret laws and manage compliance programs, preparing you to join the next generation of leaders in the healthcare industry.

Ultimately, the program can equip you with the skills and knowledge needed for success in a variety of healthcare roles, including those in hospital administration, public health and insurance.

Find Your Leadership Edge With William & Mary Law School Online

Understanding healthcare compliance is not just a legal necessity; it’s a leadership advantage in a highly regulated industry. William & Mary Law School’s online Master of Legal Studies with a Concentration in Health Law will equip you with the skills you need to compete and thrive in a broad range of healthcare settings.

To learn more, review our admissions process today, or schedule an appointment with one of our admissions outreach advisors to discuss the next step in your career in health law.