from managing legal complince in health care industry 1st ed

from managing legal complince in health care industry 1st edition (book)

answere the question

1. Since 1998, the Office of the Inspector General (OIG) has been strongly recommending that all health care organizations adopt 7-part compliance programs. The enactment of the 2010 health reform law (Patient Protection and Affordable Care Act) changed that in a very significant way. What was the change?

2. There are numerous benefits to an organization that adopts a compliance program. Name three of them.

3, Is every health care-related organization required by law to appoint a Compliance Officer? Explain your answer

4. There are three motivations for carrying out some sort of internal investigation. List and briefly explain

5. There are numerous entities to which a health care organization might choose to voluntarily disclose Medicare or Medicaid billing errors. Name four of them.

6. What is the major difference in the way that the Stark Law Self-Referral Disclosure Protocol and the OIG Self-Disclosure Protocol must be used?

Solution

Answer-1- A compliance plan refers to a statement to conduct a healthcare practice ethically in relation to government rules and regulations, patients services and care etc. The Office of Inspector General has recommended voluntary compliance program for individual and group healthcare practices. Since 1998, it has been working to stop fraud and abuse in different healthcare programs. The department of Health and Human Services and OIG also provided compliance tools and resources to avoid unlawful conduct in healthcare programs. But the guidance of these organizations were voluntary, so all healthcare organizations were not bound to develop a compliance program.

The enactment of the 2010 Health reform law (Patient protection and Affordable Care Act) has made complaince program mandatory for all health organizations or nursing homes. Now all health care providers need to establish a compliance program in order to get enrolled in medicare, medicaid or the Children\'s health insurance program.

Answer-2- The benefits for adopting a compliance program for an organization are-

Answer-3- Yes, every health care related organization required by law to appoint a compliance officer. This officer can be the doctor, employee or manager of the organization but he requires proper training for it. The role of a compliance officer in health care sector is very important because he looks after the planning, implementing and monitoring the compliance and also helps to solve issues related with the organization or compliance program.

Answer-4- The three motivations for carrying out some sort of internal investigation are-