Question

As a health care manager, you are responsible for ensuring compliance with various healthcare-related laws in your department.

For this assignment, you will create a fictional scenario involving yourself as a manager:

Construct a scenario where one of the following laws is violated: False Claims Act Anti-Kickback Statute Physician Self-Referral Law Criminal Healthcare Fraud Statute

Explain your role (as manager) in the department. Explain the violation that occurs, including the circumstances that led up to it.

Outline the action steps you, as a manager, must take to address the situation.

Summarize the impact of your scenario in a concise, closing paragraph. Include in-text citations to support the information you provided. A minimum of three references should be used.

Answer 1

-- Healthcare is one of the important and regulated industries,making healthcare compliance a growing and crucial field within the industry.

-- The Bureau of labor and statistics projects the overall need for compliance officers to grow by over 8% from 2016 through 2026.

-- Healthcare compliance professionals are needed to help clinical facilities and organizations address the ever growing government regulations that set usage and privacy standards for patients information,ensuring quality patient care,prevent fraud and protect healthcare staff.

some of the major laws,acts and regulations that healthcare organizations needs to stay in compliance are:-

1) The Health care information portability and accountability Act(HIPPA) ,spurred the need for healthcare compliance across the industry,it also mandates industry wide standards and processes for the protection and confidential handling of patient health information.

2) The Health information technology for economic and clinical Health Act(HITECH),promotes standardized electronic health records.

3) The Emergency Medical Treatment and LaborAct (EMTALA),ensures public access to emergency services regardless of patients insurance coverage or ability to pay.

4) The affordable care Act (ACA),brought mandatory,subsidized healthcare to the US,but this is only one part of the ACA.The full name is THE PATIENT PROTECTION AND AFFORDABLE CARE ACT.The law requires healthcare providers implement a compliance and ethics program as a condition for reimbursement for patients enrolled in federally funded healthcare programs.

But sometimes these laws are violated:False Claims Act Anti kickback statute:- The federal Anti kickback statute is healthcare fraud and abuse statute that prohibits the exchange of remuneration,which the statute defines broadly as anything of value-for referrals for services that are payable by a federal program,which in the context of healthcare providers,is medicare.

>>As a healthcare manager action steps that i can take to address or prevent the situation is,

1) Development and distribution of written conduct standards and policies that promote the hospitals commitments to compliance by including compliance adherence as a part of staff evaluation and that address areas of potential fraud,such as claims management and financial relationships with other providers.

2) Implementation of continuous education and training for staff.

3) Maintenance of process to receive healthcare fraud reports and complaints,such as hotline and the development of procedures to protect anonymity and whistleblowers from retaliation.

4) Use of audits and evaluations to track compliance adherence and help reduce issues.