This document provides a summary of an article in the Winter 2013 issue of the National Tactical Medical Association journal. The article discusses legal issues that can arise for tactical medical providers in their work. It notes that tactical medical providers are subject to oversight from their state licensing boards and must practice within their scope. It also discusses protections from liability, the importance of medical control and documentation, and preserving evidence when providing care in tactical situations.
If you or a loved one has been a victim of medical malpractice that has caused you harm or injury, you may be entitled to medical malpractice recovery. To file a medical malpractice case, you need to contact a medical malpractice lawyer, the concerned medical professional and medical licensing board. If you need help filing a medical malpractice claim, call 203-445-6542 or email george@ganiminjurylawyers.com
website: http://www.ganiminjurylawyers.com
All product and company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
If you or a loved one has been a victim of medical malpractice that has caused you harm or injury, you may be entitled to medical malpractice recovery. To file a medical malpractice case, you need to contact a medical malpractice lawyer, the concerned medical professional and medical licensing board. If you need help filing a medical malpractice claim, call 203-445-6542 or email george@ganiminjurylawyers.com
website: http://www.ganiminjurylawyers.com
All product and company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
Healthcare fraud is costing the United States tens of billions of dollars a year and according to William Rudman of AHIMA foundation, the most frightening fact is that the major chunk of fraud happens under the radar and majority of the frauds are left unnoticed; besides that, those of frauds which are identified are not brought into litigation for many years together. Financial fraud and false claims are the most common types of healthcare fraud, according to the AHIMA Foundation report, this includes false claims for medically unnecessary services; false claims that include purposeful overstatement of the amount, number, type, or complexity of the service provided; or false claims that include services that were never rendered or were not rendered on the individuals claimed or by the provider claimed. Another issue associated with fraud and abuse are when physicians refer patients out of financial interest rather than curing the patients. This short presentation is intended to give an overview on two major statutes that help to fight against a variety of fraud, The False Claim Act & Stark Law.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
Hospital Workers’ Compensation Claims: Strategies for Successitduediligence
Workers’ compensation claims typically account for only 3-5% of a hospital’s revenue, but require an inordinate amount of effort to bill and collect in a compliant manner. On the surface, workers’ compensation claims may appear to be similar to claims from any other payer. The patient is registered, insurance coverage is identified, the patient is treated, and bills are submitted. Any denials are addressed and ultimately cash is posted after confirming proper reimbursement. Hospitals have processes in place to deal with these functions every day. As demonstrated in this white paper, however, each step in the revenue cycle related to a workers’ compensation claim involves unique challenges.
Sampling of training program material for health care fraud, abuse and compliance training for health care providers. contact Chiropractic Compliance Consultants for more at 913-369-9000, or visit our website at cccpfc.com
Louisiana Medical Malpractice Basics - how to navigate the Louisiana Medical Malpractice Act when dealing with defending hospitals and physicians. This presentation will provide information on statutes, medical review panel process, defense strategies on defending physicians/hospitals from medical malpractices
Healthcare QualityPolicy and LawChapter 121ChaSusanaFurman449
Healthcare Quality
Policy and Law
Chapter 12
1
Chapter Overview
(1 of 2)
Discusses licensure and accreditation in the context of healthcare quality
Describes the scope and causes of medical errors
Describes the meaning and evolution of the medical professional standard of care
Identifies and explains certain state-level legal theories under which healthcare professionals and entities can be held liable for medical negligence
Chapter Overview
(2 of 2)
Explains how federal employee benefits law often preempts medical negligence lawsuits against insurers and managed care organizations
Describes recent efforts to measure and incentivize high-quality health care
Quality Control Through
Licensing and Accreditation
(1 of 3)
Licensing of healthcare professionals and institutions is an important function of state law, as it filters out those who may not have the requisite knowledge or skills to practice medicine
State licensure laws define the qualifications required to become licensed and the standards that must be met for purposes of maintaining and renewing licenses
Quality Control Through
Licensing and Accreditation
(2 of 3)
Historically, licensing has been used in the promotion of healthcare quality in only the bluntest sense. This is because the only method by which to promote quality through licensure is the granting or denial of the license to practice medicine—no real middle ground.
Private professional and industry ethical and practice standards exist, though their effect on day-to-day quality is debatable.
State licensing schemes were designed not with healthcare quality per se in mind, but rather with an eye toward protecting the medical professions from unscrupulous or incompetent providers and bad publicity.
5
Quality Control Through
Licensing and Accreditation
(3 of 3)
Licensure plays an important role in defining the permissible “scope of practice” of the various types of healthcare providers.
It is one thing for state legislators to define the meaning of practice for various broad medical fields, but quite another for legislators to define, for example, the lawful activities of doctors as compared to physician assistants as compared to nurses.
6
Medical Errors
(1 of 3)
Although medical errors are not a new problem, framing the issue as a public health problem is a relatively new phenomenon.
Overall, more people die each year from medical errors than from motor vehicle accidents, breast cancer, or AIDS.
Medical Errors
(2 of 3)
Causes of medical errors may include the failure to complete an intended medical course of action, implementation of the wrong course of action, use of faulty equipment or products in effectuating a course of action, failure to stay abreast of one’s field of medical practice, health professional inattentiveness, the fact that optimal treatments for many illnesses are not yet known, and the culture of medicine itself.
Medical Errors
(3 of 3)
Policy makers have begun shifting their ...
Healthcare fraud is costing the United States tens of billions of dollars a year and according to William Rudman of AHIMA foundation, the most frightening fact is that the major chunk of fraud happens under the radar and majority of the frauds are left unnoticed; besides that, those of frauds which are identified are not brought into litigation for many years together. Financial fraud and false claims are the most common types of healthcare fraud, according to the AHIMA Foundation report, this includes false claims for medically unnecessary services; false claims that include purposeful overstatement of the amount, number, type, or complexity of the service provided; or false claims that include services that were never rendered or were not rendered on the individuals claimed or by the provider claimed. Another issue associated with fraud and abuse are when physicians refer patients out of financial interest rather than curing the patients. This short presentation is intended to give an overview on two major statutes that help to fight against a variety of fraud, The False Claim Act & Stark Law.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
Hospital Workers’ Compensation Claims: Strategies for Successitduediligence
Workers’ compensation claims typically account for only 3-5% of a hospital’s revenue, but require an inordinate amount of effort to bill and collect in a compliant manner. On the surface, workers’ compensation claims may appear to be similar to claims from any other payer. The patient is registered, insurance coverage is identified, the patient is treated, and bills are submitted. Any denials are addressed and ultimately cash is posted after confirming proper reimbursement. Hospitals have processes in place to deal with these functions every day. As demonstrated in this white paper, however, each step in the revenue cycle related to a workers’ compensation claim involves unique challenges.
Sampling of training program material for health care fraud, abuse and compliance training for health care providers. contact Chiropractic Compliance Consultants for more at 913-369-9000, or visit our website at cccpfc.com
Louisiana Medical Malpractice Basics - how to navigate the Louisiana Medical Malpractice Act when dealing with defending hospitals and physicians. This presentation will provide information on statutes, medical review panel process, defense strategies on defending physicians/hospitals from medical malpractices
Healthcare QualityPolicy and LawChapter 121ChaSusanaFurman449
Healthcare Quality
Policy and Law
Chapter 12
1
Chapter Overview
(1 of 2)
Discusses licensure and accreditation in the context of healthcare quality
Describes the scope and causes of medical errors
Describes the meaning and evolution of the medical professional standard of care
Identifies and explains certain state-level legal theories under which healthcare professionals and entities can be held liable for medical negligence
Chapter Overview
(2 of 2)
Explains how federal employee benefits law often preempts medical negligence lawsuits against insurers and managed care organizations
Describes recent efforts to measure and incentivize high-quality health care
Quality Control Through
Licensing and Accreditation
(1 of 3)
Licensing of healthcare professionals and institutions is an important function of state law, as it filters out those who may not have the requisite knowledge or skills to practice medicine
State licensure laws define the qualifications required to become licensed and the standards that must be met for purposes of maintaining and renewing licenses
Quality Control Through
Licensing and Accreditation
(2 of 3)
Historically, licensing has been used in the promotion of healthcare quality in only the bluntest sense. This is because the only method by which to promote quality through licensure is the granting or denial of the license to practice medicine—no real middle ground.
Private professional and industry ethical and practice standards exist, though their effect on day-to-day quality is debatable.
State licensing schemes were designed not with healthcare quality per se in mind, but rather with an eye toward protecting the medical professions from unscrupulous or incompetent providers and bad publicity.
5
Quality Control Through
Licensing and Accreditation
(3 of 3)
Licensure plays an important role in defining the permissible “scope of practice” of the various types of healthcare providers.
It is one thing for state legislators to define the meaning of practice for various broad medical fields, but quite another for legislators to define, for example, the lawful activities of doctors as compared to physician assistants as compared to nurses.
6
Medical Errors
(1 of 3)
Although medical errors are not a new problem, framing the issue as a public health problem is a relatively new phenomenon.
Overall, more people die each year from medical errors than from motor vehicle accidents, breast cancer, or AIDS.
Medical Errors
(2 of 3)
Causes of medical errors may include the failure to complete an intended medical course of action, implementation of the wrong course of action, use of faulty equipment or products in effectuating a course of action, failure to stay abreast of one’s field of medical practice, health professional inattentiveness, the fact that optimal treatments for many illnesses are not yet known, and the culture of medicine itself.
Medical Errors
(3 of 3)
Policy makers have begun shifting their ...
Medical State Boards are political bodies. This presentation outlines challenges in implementing policy with, oftentimes, dysfunctional politics and poor leadership especially as it relates to physician issues. Competency issues are difficult to adjudicate on and expert opinion (the "hired guns") do not make the process any more effective. Institutional bias ends up being the basis for decision making.
Legal PrinciplesNon- Malfeasance- Do n.docxsmile790243
Legal Principles
Non- Malfeasance- Do no harm
The legal principles are rules of human behavior that used to be considered as just, before the law started being written.
The ethical category of Non-Malfeasance represents the doctor’s try to avoid any act or treatment plan that would hurt the patient or violate the patient’s trust, and has been popularized in the phrase “first, do no harm.” Non-Malfeasance is supported through discretion and avoidance. It is critically important that the specialist provider of highly persistent treatments uphold Non-Malfeasance.
(Rodak, 2012)
Beneficence- Promote the welfare of others
Beneficent actions and motives have usually occupied a middle place in morality. Ordinary examples today are found in social welfare programs, policies to improve the welfare of animals etc.
Distributive Justice- All involved should have equal entitlements
The economic structure that each society has its laws, institutions, policies, etc. results in different distributions of economic benefits and burdens across members of the society. These economic frameworks are the result of human political processes and they continually change both across societies and within societies over time.
Autonomy- non influenced decisions for both patients and physicians
The term “autonomy” has appeared more and more often in the medical literature. According to this interpretation of autonomy, the goal for an autonomous person is to decide on his or her own, without undue manipulation by others.
One of the first empirical papers in medical decision making on patient autonomy thus linked autonomy to the question of whether patients wanted to make decisions themselves. In the descriptive medical decision making literature, this meaning has become the default.
The patient described in the informative model from the well known paper of Emanuel and Emanuel corresponds with an autonomous patient in this sense.
Healthcare Rights
Non- Discrimination- race, religion, sexual orientation
In human social affairs, discrimination is treatment or consideration of, or making a difference in favor of or against, a person or thing based on the group, class, or category to which that person or thing is apparent to belong to rather than on individual merit. This includes treatment of an individual or group, based on their real or perceived membership in a certain group or social group.
(Lamont, 2016)
Credentialing/ Scope of Practice
When you go for health care, identity matters a lot. You need to verify certain proofs. Following are the things that you need:
Verification of identity
(NAMSS, n.d.)
Legal Employment Qualifications
The Immigration Reform and Control Act of 1986 (IRCA) required employers to verify that all newly hired workers present "facially valid" documentation verifying the employee's identity and legal authorization to accept employment in the United States. The I-9 form or more properly ...
Running head U.S. HEALTH CARE SYSTEM AND GOVERNANCE1U.S. HEA.docxtoltonkendal
Running head: U.S. HEALTH CARE SYSTEM AND GOVERNANCE 1
U.S. HEALTH CARE SYSTEM AND GOVERNANCE 6
Health care administrator’s role and patient protection
Student’s Name:
Course Name and Number
Instructor
Institutional Affiliation
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Abstract
More rules and regulations have been proposed by government and various organizations in order to improve the overall health care system of the country. There is increasing compliant and requirement for high-quality health care system which can be provided only using the proper law, regulation and health care administrator. There are many issues faced by the people due to non-compliance and negligence which can be reduced only through proper governance. Health care administrator has more concern over the legal, ethical and code of conduct of the medical professionals. Effective laws governing the health care system cannot bring any changes in the entire system; it is the administrator who ensures that this system is performing as per the requirement of law. In this paper we will first discuss the role of health care administrator in the health care system and a brief discussion about the penalties in case of any violations. In the later part of paper, we will discuss about the basic elements required by the patients to prove the medical negligence and a brief discussion about non-compliance by the medical professionals.
Health care administrator’s role and patient protection
Health care administrator’s role:
Healthcare system of the country compared with the other organization or any other community which is governed by various rules, regulations, principles, laws and ethics. Administrator must be aware of all the governing laws, ethical behavior, what are the roles and responsibilities, so that the entire system will get benefitted. About health care system, patients are given priority as a health care administrator one has to ensure that patients are not facing any difficulty at any point of time. Must immediately address any concerns of the patients, and any violation must immediately report.
There are some problems identified in the governance of health care system, there are more gaps in the corporate and clinical governance, and they are not effectively managed (The Dowton Consulting International, 2011). The corporate side mainly concern with the rules, regulations, policies, laws, people and professionals. Next is a clinical side that mainly deals with the safety and security of the patient, patient care standards and creating an excellent environment for the patient (The Dowton Consulting International, 2011).
As an administrator, it is essential to bridge the gap between these two in order to accomplish the desired result. As an administrator it is essential to governing the relationship between both the medical professional and patient, for providing the best service to the patients. Relationship with the patients, gaining their confidence, discharging the duty a ...