The cost of compliance is enormous. One study estimates that, depending on size, financial services firms, for example, can spend about 19% of their revenue on compliance activities.
In healthcare, U.S. organizations paid over $1.8 billion in settlements and penalties related to false claims.
And the costs go beyond dollars. Brand reputations, careers and customer trust are all on the line. So how do regulated organizations move from reactive enforcement to creating a proactive culture of compliance — one that’s built in, not bolted on?
Common compliance pitfalls
Compliance failures rarely stem from a single issue. More often, they result from a combination of poor training, outdated policies, human error and, in some cases, deliberate misconduct.
“Take healthcare, fraud can be intentional to show a higher bill,” says Surekha Nagpal, senior director, Fincrime & Compliance, TaskUs. “Others could be policy lapses or simply insufficient documentation.”
Common errors include:
- Poor documentation practices: Incomplete or inaccessible records, making audits or legal reviews difficult
- Licensing and credentialing gaps: Allowing unlicensed or underqualified staff to deliver care
- HIPAA violations and GDPR breaches: Mishandling of personal data whether due to poor access controls or unsecured systems
- Medical billing errors and improper coding: Submitting inaccurate claims, either by mistake or in an attempt to maximize reimbursement
When left unchecked, these issues expose organizations to hefty fines, increased scrutiny and long-term reputational damage.
That’s why compliance must be deeply embedded in every aspect of operations, continuously updated and reinforced from the top down.
Building a culture where compliance comes first
Compliance requires structures and systems but can’t be driven by these alone. It has to be lived — woven into the values, behaviors and decisions of the organization. That kind of culture starts with leadership.
According to Surekha, management must view compliance as non-negotiable. “There should be no cost-cutting, no shortcuts. Revenue growth cannot happen at the cost of compliance.”
To cultivate a compliance mindset, she advises periodic training at every level (ideally every 6 months), clear accountability within roles and processes and shared ownership rather than leaving it to a single team.
“When everyone understands the ‘why’ behind the rules and feels responsible for upholding them, compliance becomes second nature,” Surekha explains.
3 lines of defense
Next, structure strengthens what culture starts. “Sometimes organizations don’t even realize they need to create lines of defense,” Surekha notes. “And when they’re not in place, even a strong culture can fall short.”
She says that a typical compliance framework includes three distinct layers — each with a specific role to play in identifying, managing and mitigating risk:
- Operations management: Embeds compliance into the everyday, owning the frontline execution of policies, procedures and controls to make compliance second nature
- Risk and compliance team: Keeps a pulse on performance, monitoring key metrics, spotting red flags early and ensuring teams stay aligned with internal and external standards
- Internal audit function: Acts as an independent safeguard, regularly testing the strength of internal controls and surfacing risks before they turn into headlines
Expanding your compliance function
Even with the right intent, many regulated organizations — especially smaller or more traditional ones — may struggle to build and maintain a framework on their own. Compliance and risk management providers can help.
Such partners handle end-to-end or parts of existing workflows. As examples, they can provide identity verification services and help ensure that onboarding processes for digital platforms follow guidelines and
are user-friendly.
“We also specialize in disputes and chargebacks, a growing issue in the age of digital health and flexible payment models,” Surekha adds.
The growing role of AI
Like in other functions, AI is also increasingly supporting compliance efforts across both healthcare and fintech. AI-powered tools are making processes more efficient, transparent and proactive — augmenting human oversight rather than replacing it.
In healthcare, that means real-time monitoring of billing, prescriptions and patient records, with AI flagging anomalies for human validation and follow-up. In fintech, AI scans transaction patterns, automates KYC and AML checks and identifies suspicious behavior before it becomes a regulatory issue.
AI also strengthens documentation, generating audit-ready logs with minimal effort. It can tailor compliance training to individual needs, forecast emerging risk areas and detect cybersecurity threats before they escalate — all helping organizations stay a step ahead in high-stakes environments.
What’s next in compliance
As organizations increasingly leverage AI to deliver care and streamline operations, regulations will only become more complex.
Surekha says, “Managing the risks effectively will require both human expertise and smart automation to operate at scale, anticipate change and build more resilient systems.”
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