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ASSIGNMENT INSTRUCTIONS:
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 2–3 page paper in which you:
Summarize one statute, one regulation, and one guidance document that impose compliance obligations on healthcare organizations.
Explain what healthcare organizations must do to comply with legal requirements.
Describe the standards for corporate compliance programs set forth in the OIG Compliance Guidance and the Federal Register.
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 library or review library guides.
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.
HOW TO WORK ON THIS ASSIGNMENT(EXAMPLE ESSAY / DRAFT)
Healthcare compliance is critical to ensure quality patient care and prevent potential legal liabilities. Healthcare organizations must comply with various federal and state laws and regulations, including the Anti-Kickback Law, the False Claims Act, the Stark Law, credentialing, medical errors, and patient safety.
One statute that imposes compliance obligations on healthcare organizations is the Anti-Kickback Law (AKL), 42 U.S.C. § 1320a-7b. The AKL prohibits the solicitation, receipt, or payment of any remuneration in exchange for referrals of patients or business reimbursed by federal healthcare programs. The regulation that imposes compliance obligations on healthcare organizations is the False Claims Act (FCA), 31 U.S.C. §§ 3729-3733. The FCA prohibits submitting false or fraudulent claims to government programs, such as Medicare and Medicaid. One guidance document that imposes compliance obligations on healthcare organizations is the Compliance Program Guidance for Hospitals, issued by the Office of Inspector General (OIG). This guidance provides recommendations on how hospitals can implement effective compliance programs to prevent fraud, waste, and abuse.
To comply with legal requirements, healthcare organizations must establish effective compliance programs, including policies and procedures, training and education, and monitoring and auditing. Healthcare organizations must also ensure that their employees, contractors, and agents understand the legal requirements and comply with them. For example, to comply with the AKL, healthcare organizations must avoid any financial arrangements that may be perceived as a kickback or referral fee. To comply with the FCA, healthcare organizations must ensure that their claims for reimbursement are accurate and supported by documentation.
The OIG Compliance Program Guidance for Hospitals sets forth standards for corporate compliance programs, including seven elements that a compliance program should have. These elements include implementing written policies and procedures, designating a compliance officer and committee, conducting effective training and education, establishing effective lines of communication, conducting internal monitoring and auditing, enforcing standards through disciplinary actions, and responding appropriately to detected offenses. The Federal Register provides additional guidance on the implementation of effective compliance programs and the obligations of healthcare organizations.
In conclusion, healthcare compliance is essential to promote quality patient care and prevent legal liabilities. Healthcare organizations must comply with various federal and state laws and regulations, including the Anti-Kickback Law, the False Claims Act, and other legal requirements. Effective compliance programs that meet the standards set forth in the OIG Compliance Program Guidance and the Federal Register can help healthcare organizations prevent fraud, waste, and abuse, and protect themselves from potential liabilities.
References:
Compliance Program Guidance for Hospitals, U.S. Department of Health and Human Services, Office of Inspector General. (1998, October). Retrieved from https://oig.hhs.gov/authorities/docs/physician.pdf
False Claims Act, 31 U.S.C. §§ 3729-3733. (1863).
Anti-Kickback Law, 42 U.S.C. § 1320a-7b. (1972).
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