Regulatory Compliance, Healthcare Law, and Ethics

Case Study Instructions:

You are halfway through the course and your capstone project. That is a milestone of which to be proud.
In this section of your project, you will be researching laws, regulations, guidelines, and specifications relevant to the business processes of your organization/facility.
Case Assignment- MEMIC ORDER # 00152068 FORMAT PLEASE.
1. Regulatory Compliance and Health Care Law
a. Regulatory compliance in health care is all about a health care organization's adherence to laws, regulations, guidelines, and specifications relevant to its business processes. Complete an extensive review of federal, state, and local laws, regulations, and guidelines relevant to the business processes of your organization/facility.
i. Prepare an executive summary of federal, state, and local laws, regulations, and guidelines applicable to your organization/facility. Be sure to identify how patient safety will be maintained.
b. Corporate Compliance Program (Showalter, 2017, pp. 569-572)
i. Using the outline created in the Module 2 Discussion and the feedback received from your colleagues, develop a comprehensive document outlining the Organizational Policies and Procedures for your organization/facility. I will upload this portion by 9/4/22.
2. Health Care Ethics and Diversity
a. Using the outline created in the Module 2 Discussion and the feedback received from your colleagues, develop a comprehensive Code of Ethics for your organization/facility.
b. Design a health care ethical committee.
i. Identify members.
ii. Distinguish the roles and responsibilities of the committee.
c. Develop an Ethics and Compliance Training Course for your organization. Your training should be health care-based but specific to your organization. Be creative. Your training should be interactive and provide a setting to ask questions (i.e., gamifications or possibly role play to provide a platform for scenarios to be presented and feedback provided). Your course should include the following components:
Introduction
i. Course Description
ii. Course Objectives
iii. Evaluate the Relationship between Ethics and Cultural Competence
a. Relevance of culture to health care and the social determinants of health Ethical implications for lack of cultural competence
Section 2. Compliance and Ethics Overview
iv. Compliance Defined
v. Ethics Defined
vi. Goals & Purpose
vii. Advantages of Training
Section 3. Components of Ethics and Compliance
viii. Ethics
ix. Compliance
x. Leadership Example/Tone
xi. Fraud and Abuse
xii. High Risk Activities
Section 4. Investigations
xiii. Investigations and Penalties
xiv. Discuss two payment programs that are relevant to your organization (i.e., The Deficit Reduction Act or The Medicaid Integrity Program
xv. State/Federal Sentencing Guidelines
xvi. Federal False Claims Act
Section 5. Reporting
xvii. Activities That Should be Reported
xviii. Rights of Employees
d. Provide a summary or detailed (descriptive) plan of implementation. In addition, provide a timeline of when employees will complete training upon employment, setting of the course, and your plan to incorporate each piece into the training. The training should be the same for all employees and include training materials.
3. Conclusions and Recommendations
a. Bring this section to a close and provide 3 recommendations for your organization based on the information researched and identified.
Assignment Expectations
1. Conduct additional research to gather sufficient information to justify/support your analysis.
2. Case papers should be at least 5 pages, not including the title and reference pages.
3. Support your paper with peer-reviewed articles with at least 5 references.
4. Please cite all author's work to reduce the reduction of points.
Use the following link for additional information on how to recognize peer-reviewed journals:
• Angelo State University Library. (n.d.). Library guides: How to recognize peer-reviewed (refereed) journals. Retrieved from https://www(dot)angelo(dot)edu/services/library/handouts/peerrev.php
4. You may use the following source to assist in formatting your assignment:
• Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from https://owl(dot)english(dot)purdue(dot)edu/owl/resource/560/01/
5. For additional information on reliability of sources, review the following source:
• Georgetown University Library. (n.

Case Study Sample Content Preview:

Regulatory Compliance, Healthcare Law, And Ethics
Student Name
Department, University
Course Code: Course Name
Professor’s Name
Due Date
Regulatory Compliance, Healthcare Law, And Ethics
Introduction/Background Information
Corporate integrity programs play a central role in enhancing legal compliance and ethical practice within an effectively-managed healthcare organization. Upright healthcare organizations should consider the potential of their staff to commit fraud, abuse, or illegal conduct. That said, healthcare organizations must demonstrate commitment to ensuring high ethical practice thresholds and compliance principles to create a moral respectability image. This report evaluates the University of Maryland Medical System (UMMS) regulatory compliance and healthcare laws framework, healthcare ethics, and diversity measures and provides relevant conclusions and recommendations.
Regulatory Compliance and Health Care Law
Federal, State, and Local Laws, Regulations, and Guidelines
For this discussion, this report will consider selected federal, state, and local regulations, laws, and guidelines central to UMMS’s business conduct standards. UMMS should respect the False Claims Act (FCA), the federal government’s tool for the war against abuse and fraud. According to FCA, UMMS cannot knowingly submit fraudulent or false claims to be reimbursed by the federal government and decrease or avoid a duty to reimburse funds to the national government. The Criminal False Claims Act is a distinct federal law that institutes a criminal offense tag on any false claims. If convicted for this offense, UMMS would be required to pay $500,000 or twofold the false claim amount in fines, whichever is more significant. The antikickback statute also applies to UMMS. In this law, the federal government can penalize the healthcare facility for any fraudulent act involving Affordable Care Act healthcare programs or other health benefits programs funded via insurance premiums or otherwise (Showalter, 2017). Maryland Medicaid Fraud Law is a Maryland-enacted regulation similar to the federal FCA, providing for civil and criminal measures when the organization submits fraudulent or false claims to the Medicaid health plan. Under this state law, it is a crime for UMMS to willfully or knowingly take action to swindle the Medicaid plan in healthcare services reimbursement or delivery (Chrencik et al., n.d.).
Patient safety would be maintained through guidelines and regulations requiring the healthcare organization to deliver high-quality healthcare to clients and per professional standards safely. The Medical System’s primary goal is to furnish high-quality healthcare services to patients per medical orders issued by facility physicians or any other authorized healthcare professional based on each patient’s needs. The healthcare organization should uphold safe patient care practices by fostering an organization-wide safety culture. For example, spaces and buildings must be sustained to protect visitors, staff, and patients (Chrencik et al., n.d.). In addition, equipment employed to furnish health services must be effective, safe, and working properly.
Corporate Compliance Program
UMMS’s ind...

Updated on January 26, 2024

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Regulatory Compliance, Healthcare Law, and Ethics

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