Health Care Compliance Case Study

It is often recommended for (HCO)’s to have a corporate compliance plan to be more efficient, reduce errors, and not have small errors turn into large errors. As (OIG) it’s a necessary and fundamental need to incorporate a corporate compliance plan to have for staff and management to stay organized and lessen the chance of fraud, waste, and abuse in the company. Stated by, (Cleverly, Song, & Cleverly, 2011), it is effective only if it includes management support, effective communication, continuous monitoring, and individual accountability. All these aspects are a continual monitoring requirement as long the corporate compliance is in place for the duration.

The American Health Care system needs to be constantly improved to keep up with the demands of America’s health care system. In order for the American Health Care system to improve policies must be constantly reviewed. Congress still plays a powerful role in public policy making (Morone, Litman, & Robins, 2008). A health care policy is put in place to reach a desired health outcome, which may have a meaningful effect on people. People in position of authority advocates for a new policy for the group they have special interest in helping. The Health care system is formed by the health care policy making process (Abood, 2007). There are public, institutional, and business policies related to health care developed by hospitals, accrediting organizations, or managed care organizations (Abood, 2007). A policy is implemented to improve the health among people in the United States. Some policies

Administrators that practice in a healthcare setting are used to the turbulence and at times rapid change in healthcare. They find themselves in the private, public, or non-profit sectors of health care, managed care arrangements, integrated service networks, or community agencies. To be an effective manager, it is important to understand the legal and ethical principles that are included in this environment and the legal relationship between consumer and the organization. The Health Insurance Portability and Accountability Act of 1996, also known as HIPAA, was created to prevent the unauthorized release of patient information. The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of

The Department of Health and Human Services Office of Inspector General (OIG) on April 20, 2015, working in partnership with the American Health Lawyers Association and the Association of Healthcare Internal Auditors, published Practical guidance for health care governing boards on compliance oversight. The guidance describes the OIG’s expectations of the compliance oversight and the roles governing boards should play in a healthcare organization.

The Medicare Learning Network aims to solve that problem by providing a variety of training and educational materials that break down Medicare policy into plain language with actionable tips to use in day-to-day work. CMS has created a Quarterly Provider Update system as another tool to assist affected entities. The Quarterly Provider Update system. The QPU is intending to make it easier for providers, suppliers, and the public to understand the changes we are suggesting or making in the programs we administer. CMS publishes the QPU at the beginning of each quarter to inform the public about regulations currently under development during each quarter. The clear majority of CMS regulatory issuances involve modifications to prior regulations. Compliance systems and instructions already exist for the prior regulations, and are revised as regulations are amended. For example, there are rules establishing “Conditions of Participation” for most types of Medicare providers. These rules are proposed to assure patient safety and quality care. Although rules are periodically modified, affected providers are already used to, and competent in complying with the existing rules, and the inspection and other administrative mechanisms used in their enforcement. Genuinely new regulatory requirements that create brand new sets of “compliance” burdens on providers are

Hospitals implement HCAHPS with the support of the Hospital Quality Alliance (HQA), a public or private partnership that includes key hospital and medical associations, consumer groups, measurement and accrediting bodies and government agencies that have the same interest in improving the quality of hospitals. The Hospital Quality Alliance (HQA) program that is overseen by and public and private entities, that include the Centers for Medicare and Medicaid Services (CMS) as well as the Joint Commission, is dominating this effort in the hospital district, generating reports quarterly on the delivery of effective services for mutual conditions. Even though the Hospital Quality Alliance has made this data more available to the public, there has not been enough information on the quality of hospital care from a patients ' point of view. As the Institute of Medicine shows, the foundation of patient centered care is a key factor to having a premium health care system. The HQA backs HCAHPS.

Research identity-theft cases from medical offices.Explain the case and prepare a one-page paper on prevention strategies based on the case found.

comply with any policies or procedures that have been put in place for your health and

Healthcare professionals are faced with making multi-faceted decisions on a daily basis. These decisions are not just limited to clinical matters, but they include the total patient care experience. Because of emerging healthcare trends and complex health law and ethics, it is imperative that healthcare administrators have a professional organization that they can belong to. “The

Roles of regulatory agencies that influence health care are ensuring the delivery of safe care and that high quality health care is being provided to patients and clients. There are several organizations that monitor healthcare providers and others that set the standards for quality healthcare, including: the Centers for Medicare and Medicaid Services (CMS), American Health Quality Association, The Joint Commission, National Committee for Quality Assurance, and others. The Agency for Healthcare Research and Quality (AHRQ) produces annually the National Healthcare Quality Report (NHQR). This report is built on a set of health care quality standards or measures – effectiveness of care, patient safely, timeliness, and patient centeredness (Knudson, Gibbens & Fischbach, 2014). The role of these agencies are important to the people that are receiving the care. The roles ensure that patients are receiving the effective care they deserve in a safe, timely manner.

The goal of adopting the lean system by our health care organization was driven by obtaining the GCI accreditation and becoming one of the lead healthcare organizations in the middle east. At the beginning It was difficult to fully implement that system by a highly hierarchical organization. Until now we have consistent modifications in order to transit from a partial lean approach to a larger scale ( Graban, 2011). One of the most challenging issues in PICU sitting was regarding chronic patients who required long term ventilation. The hospital administration received numerous complaints from the admission office, ER manger, PICU manger and nursing staffs. The bed occupancy of the PICU reduced, which in turn lead to increase the waiting time

Implementing all of these standards and policies within a company is certainly not an easy thing to do, and therefore it is imperative to understand whether or not your company will need it or not. In fact, it is easy to say that any company working within the federal healthcare system, whether it be insurance, practice, healthcare education, or many others, will need this sort of regulation used efficiency internally in order to prevent federal violations, which will be entirely detrimental to your reputation and ability to produce a

The health administrator is new to Well Care Hospital, and the hospital for the past six months has been under scrutiny for breach of medical compliance. It is important that the top administrator be concerned about the importance of his or her conduct within

Shared governance is important to compliance in order to keep all staff accountable for compliance measures. Shared governance is an organizational model that gives all management and staff control over their actions and practices and extends the influence of administrative areas (Hess, 2004). Giving all managers a voice can help improve governance compliance and operations by promoting teamwork and accountability among staff throughout the entire organization.

Corporate compliance involves keeping a watchful eye on a fast-changing legal and regulatory climate, and making the changes necessary for the business to continue operating in good standing within its industry, community, and customer base. In a broader sense, corporate compliance extends beyond mere legal and regulatory conformity into the realm of promoting organizational ethics and corporate integrity.