Assignment #2: Goverance and Fraud in Health Care Organizations – Legal and Ethical Responsibilities (12.5 points)
- The False Claims Act (1986 amendments)
- The “Anti-kickback Statute” (1972 and subsequent updates)
- Ethics in Patient Referrals Act of 1989 (inclusive of “Stark laws”)
- falsification of medical records; criminal prosecution
- Health Care Quality Improvement Act of 1986 (also called Health Care Anti-trust)
- federal grant accounting principles (OMB circulars)
- how organizational ethics are transmitted
- conflicts of interest and the Ethics Reform Act of 1989
- The Sarbanes-Oxley Act of 2002
- tax-exempt status and community benefit
- state incorporation laws for health care organizations
- governance and organizational structures to promote responsible management
- executive committee
- financial and audit committees
- financial policy and financial transactions procedures manuals
- compliance offices and officers
- external auditors
- the Joint Commission accreditation processes
- standardized procedures (mandatory reporting)
- employee handbooks, training, and work contracts
From the topics covered in Weeks 3-4, select one law related to financial management in health care organizations. We discussed such laws as False Claims Act, Stark Law etc. Include a cover page and a list of references at the end of the paper in APA Format. Paper will be double spaced and be 4-5 pages in 12 point New Times Roman font.
The assignment is to be written in clear, concise narrative. All sections in the outline for Assignment #2 are required.
Outline: Must use the headings from the outline below in your paper and the paper must be in narrative form not outline or bullet format. A penalty will be deducted from paper if underlined headings not used in your paper.
1. Name of the Law and or laws:
State the official title of the federal and/or state law, the statute and section number. Must be either a federal statute or state statute and you must cite both if applicable. Thus if there is both a federal and state law that covers your subject picked then you must cite both. Do not assume that there is just a federal and or state law. In most cases there is both a federal and state law. You must use the laws cited in this section throughout the rest of the paper.
2. Management’s Financial Responsibilities:
What are the health care organization’s responsibilities under this financial management statute you stated above? Provide a comprehensive discussion of three (3) specific responsibilities under the financial management statute. State specifically after each responsibility where this responsibility is stated in the federal or state law. Describe the appropriate behavior and expectation. Include the citations and source of documents describing the organization’s responsibilities.
Discuss in general the civil and criminal consequences from the law. Then identify from the news, three (3) specific case examples of health care organizations or health care providers found guilty of a legal or ethical breach relative to the law you have cited in first part of paper. Identify the specific legal and/or ethical breach and the penalties assessed to the health service organizations and/or individuals found guilty of violating the law or ethics [provide citation of law]. At the end of each case, discuss in detail whether you agree or not with the decision and why. Bring in the facts of the case to support your comments. Students should use a minimum of three (3) documented specific examples retrieved from the print media.
Describe in detail three (3) specific management actions or remedial steps you would take to ensure the financial management in the health care organization meets or exceeds the federal law or state law relative to the requirements of the law you cited above. Discuss specifically how each of the three management actions specifically meets or exceeds the specific federal or state law you cited. Note: These actions may include specific uses of technology, procedures, human resource training, and other management tools. However these action steps must be within the control of a manager.
5. Conclusion: Summary your findings above
The paper must be:
Example of an in text citation:
(Ernst, & Young, 2000 p14).
Example of source cited on Reference page:
Healthcare Financial Management Association (U.S.), Ernst, & Young. (2000). Health care system reform: A provider perspective : survey results. Westchester, Ill.: Healthcare Financial Management Association.
Except where noted, the assignment is written in clear, concise narrative. All sections of Assignment #2 are required.
Grading Rubric for written Assignment #2 is in Assignments area of the class.
Assigned reading materials:
- Medicare Fraud and Abuse: Prevention, Detention, & Reporting – https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fraud_and_abuse.pdf
- Stark and AKS Chart-http://oig.hhs.gov/compliance/provider-compliance-training/files/StarkandAKSChartHandout508.pdf
- Breakdown of False Claims Act-(Control>>Click>>From Drop down Menu select Open in New Window or Copy/Paste into your URL) https://www.justice.gov/sites/default/files/civil/legacy/2011/04/22/C-FRAUDS_FCA_Primer.pdf
- The Stark Truth about the Stark law Part I http://www.aafp.org/fpm/2003/1100/p27.html
- Deficit Reduction Act-http://www.crowell.com/documents/docassocfktype_articles_919.pdf
- Brown, J. (2008). Develop a policy for amended records. Journal of Health Care compliance, January-February, 37- 38. [must use UMUC library]
- Mekel, M. (2012). The Health Care Quality Improvement Act of 1986 Meets the Era of Health Care Reform: Continuing Themes and Common Threads. Journal of Legal Medicine, (33), 106. [must use UMUC library]