Healthcare Compliance

 

Week 7 Assignment – Healthcare Compliance

Overview

This assignment will explore compliance issues with federal and state laws and regulations governing healthcare organizations, such as the Anti-Kickback Law, the False Claims Act, the Stark Law, credentialing, medical errors, and patient safety. It is important to understand healthcare compliance for the benefit of improving patient care. It is also important to promote adherence to applicable laws, payer healthcare requirements, and to protect the organization against fraud, waste, abuse, and other potential liabilities.

Instructions

Write a 23 page paper in which you:

  1. Summarize one statute, one regulation, and one guidance document that impose compliance obligations on healthcare organizations.
  2. Explain what healthcare organizations must do to comply with legal requirements.
  3. Describe the standards for corporate compliance programs set forth in the OIG Compliance Guidance and the .
  4. In addition to the textbook, provide two sources to support your writing. Choose sources that are credible, relevant, and valid. Cite each source listed on your source page at least one time within your assignment. For help with research, writing, and citation, access the or review .

This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course. Check with your professor for any additional instructions.The specific course learning outcome associated with this assignment is:

  • Develop a compliance plan associated with issues surrounding fraud, waste, and abuse.

KEY TAKEAWAYS BEFORE ATTEMPTING THIS ASSIGNMENT

Healthcare compliance is a critical element of providing safe and effective patient care. It is important for healthcare organizations to adhere to applicable federal and state laws and regulations, payer healthcare requirements, and other standards in order to ensure the organization is protected from fraud, waste, abuse, and other potential liabilities. This essay will explore various compliance issues, such as the Anti-Kickback Law, the False Claims Act, the Stark Law, credentialing, medical errors, and patient safety. The essay will
Healthcare compliance is a crucial component of the healthcare industry, as it sets the standards for protecting patients and providers from illegal activities. As such, legal statutes have been created to ensure that certain regulations have been met in order to protect both parties. These statutes include the Anti-Kickback Law, False Claims Act, and the Stark Law. According to R Fabrikrant and GE Solomon (1999), the Anti-Kickback Law is a criminal law that prohibits the exchange of anything of value in return for the referral of Medicare or Medicaid patients. This law aims to prevent people from offering or accepting kickbacks in order to influence their decisions, as it can lead to fraudulent practices. The False Claims Act is a civil law that prohibits the submission of false or fraudulent claims to the federal government. This law incentivizes individuals to report any claims that they believe are fraudulent, as they are rewarded with a percentage of the recovered funds. Lastly, the Stark Law is a civil law that prohibits physicians from referring patients for certain designated health services to entities with which they have a financial relationship. This law ensures that healthcare providers are not receiving illegal financial incentives for referrals, which could lead to the over utilization of services. Overall, these three statutory requirements play an important role in ensuring that healthcare compliance is upheld.
Regulatory requirements for healthcare compliance are an important part of patient safety. According to B. Hurwitz and A. Sheikh (2011), there are three key areas to consider when exploring regulatory requirements for healthcare compliance: credentialing, medical errors, and patient safety. Credentialing involves verifying the qualifications of healthcare professionals and ensuring that they are qualified to provide the care that patients require. Medical errors can be prevented through effective communication between healthcare professionals, and by ensuring that the right procedures are followed. Patient safety is also improved by ensuring that healthcare professionals have the necessary knowledge, skills, and experience to provide safe and effective care. By exploring these three areas, healthcare organizations can ensure that they are meeting regulatory requirements and providing a safe and effective environment for their patients.
The Office of Inspector General (OIG) Compliance Guidance and the Corporate Compliance Program Standards are both important aspects of evaluating healthcare compliance requirements. According to DE Murphy in the Iowa Law Review in 2001, the OIG Compliance Guidance is a set of suggestions for preventing, detecting, and correcting fraud, waste, and abuse in healthcare programs administered by the U.S. Department of Health and Human Services (HHS). The Corporate Compliance Program Standards are a set of standards developed by the OIG to help healthcare organizations create a culture of compliance. These standards include implementing written policies and procedures, conducting training and education, monitoring and auditing, and responding to identified problems. Both of these guidance requirements are integral to effective healthcare compliance, as they provide organizations with a roadmap for creating and maintaining a compliant environment. Murphy argues that while the OIG Compliance Guidance provides helpful advice, it is the Corporate Compliance Program Standards that are the most effective way to ensure healthcare compliance. By following the compliance program standards, organizations can ensure that their healthcare programs adhere to all the necessary guidelines and regulations.
In conclusion, it is clear that healthcare organizations are required to comply with numerous laws, regulations, and guidance documents that affect patient care and protect organizations against fraud, waste, and abuse. Adherence to applicable laws, regulations, and payer-mandated requirements is essential to effectively managing a healthcare organization and maintaining patient safety. The OIG Compliance Guidance and OIG Compliance Program Requirements set standards for corporate compliance programs to help organizations protect themselves from financial, legal, and operational liability. When properly implemented, compliance programs ensure organizations provide quality patient care, protects patient rights, and fosters an ethical and compliant culture.
Work Cited
A Sheikh.”Health care errors and patient safety.”https://books.google.com/books?hl=en&lr=&id=RQI8yHNT_mIC&oi=fnd&pg=PT15&dq=2.+Exploring+Regulatory+Requirements+for+Healthcare+Compliance:+Credentialing,+Medical+Errors,+and+Patient+Safety&ots=J7XRGaLczQ&sig=qfAmQb5BKdF3pfM2YJgX02bzGwQ
“The federal sentencing guidelines for organizations: A decade of promoting compliance and ethics.”https://heinonline.org/hol-cgi-bin/get_pdf.cgi?handle=hein.journals/ilr87&section=28
“Application of the Federal False Claims Act to Regulatory Compliance Issues in the Health Care Industry.”https://heinonline.org/hol-cgi-bin/get_pdf.cgi?handle=hein.journals/bamalr51&section=10

 

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