Week 7 Discussion

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American Military University *

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501

Subject

Health Science

Date

Feb 20, 2024

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docx

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1

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Hello mates. Welcome to week 7; this week's reading and resources cover many fascinating and essential topics. Fraud laws and Healthcare Organization compliance have been the core of this week. Several case studies speak to the False Claims Act, Anti-kickback Law, Stark self-referral laws, and the importance of corporate compliance initiatives such as triple Check. During my research, I explored the TRI-CITY MEDICAL CENTER case in California that resulted in a settlement of $3.2 Million to Settle Allegations of Violation of the Physician Self-Referral Law. Tri-City Medical Center, a hospital located in Oceanside, agreed to pay $3,278,464 to resolve allegations that it violated the Stark Law and the False Claims Act by maintaining financial arrangements with community-based physicians and physician groups that violated the Medicare program's prohibition on financial relationships between hospitals and referring physicians (DOJ,2017). The Stark Law generally forbids hospitals and providers from billing Medicare for certain services referred by physicians who have a financial relationship with the hospital unless that relationship falls within an enumerated exception; however, Tri-City Medical Center maintained 97 financial arrangements with physicians and physician groups that did not comply with the Stark Law. I agree with the outcome of the case not only because it helps reflect the protection of the integrity of the healthcare system but also because I believe that Patient referrals should be based on a physician's medical judgment and a patient's medical needs and necessity, not on a physician's financial interests or a hospital's business goals. It is imperative to highlight that healthcare fraud and Abuse can be minimized, and the legal liability of such an act can be managed through a well-defined active corporate compliance program that promotes organizational adherence to applicable federal and state law and private payer healthcare requirements, compliance program such as triple Check is an internal audit system that is used in Long Term Care to review residents information including medical records, care plan, billing information, and Minimum Data Set (MDS) data before transmitting such data to CMS for reimbursement claim, thus eliminating the risk of submitting incomplete or incorrect documentation, impacting a facility's financial stability and potential legal consequences. In conclusion, the benefit and importance of a compelling corporate compliance program is to protect its patients, employees, and the organization's reputation while providing exceptional care services. By establishing clear policies and procedures, regular auditing processes, improved risk management practices, and enhanced quality assurance measures, healthcare providers can remain compliant with all applicable laws while also providing excellent care services (HCP,2022). References Benefits of an effective compliance program for Healthcare. Healthcare Compliance Pros. (2022, August 11). https://www.healthcarecompliancepros.com/blog/benefits-of-an-effective-compliance- program-for-healthcare-organizations#:~:text=Compliance%20programs%20give%20healthcare %20providers,receive%20the%20best%20possible%20care . US DOJ. (2017, April 28). California hospital to pay more than $3.2 million to settle allegations that it violated the physician self-referral law. Office of Public Affairs | California Hospital to Pay More Than $3.2 Million to Settle Allegations That It Violated the Physician Self-Referral Law | United States Department of Justice. https://www.justice.gov/opa/pr/california-hospital-pay-more-32- million-settle-allegations-it-violated-physician-self-0
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