This document summarizes a group project presentation on healthcare compliance laws that was never actually presented. It introduces four speakers who were each assigned topics on compliance officer duties, the Stark Law and Anti-Kickback Statute, corporate integrity agreements and compensation agreements, and how these laws aim to resolve false claims act issues. The document provides details on the assigned topics for each speaker in slide format.
Are you aware of Medicare Fraud and Abuse?Jessica Parker
Most physicians strive to work ethically, provide high-quality medical care to their patients, and submit proper claims for payment. Trust is at the core of the physician-patient relationship. The Federal Government also places enormous trust in physicians. Medicare and other Federal health care programs rely on physicians’ medical judgment to treat patients with appropriate, medically necessary services.
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.
The effects on insurance coverage for people living with HIV/AIDS in the Philadelphia EMA (including Philadelphia, Montgomery, Delaware, Chester, and Bucks Counties in PA and Salem, Gloucester, Camden, and Burlington Counties in NJ)
Health Reform Bulletin – Implementation Update: Women’s Preventive Health Se...CBIZ, Inc.
The women’s health services component of the Affordable Care Act’s (ACA) preventive services mandate continues to evolve. As background, the ACA requires non-grandfathered plans to provide specified preventive services at no cost to plan participants. These preventive services require coverage of certain women’s health services including contraceptive coverage. Recent challenges to this requirement have reached the Supreme Court.
Unpacking the SUPPORT for Patients and Communities Act: Trends in Behavioral ...Epstein Becker Green
The SUPPORT Act takes sweeping aim at the opioid crisis, focusing on numerous aspects of opioid prevention, treatment, and recovery and expanding various types of coverage, use of telemedicine, and electronic prescribing, among other things.
This webinar will highlight important parts of the new law as it pertains to SUD treatment providers and how the law will potentially impact profitability and treatment offerings.
Presented by Harry Nelson – Founder & Managing Partner, Nelson Hardiman; Chairman, Behavioral Health Association of Providers - and Paul D. Gilbert – Member of the Firm, Epstein Becker Green.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/unpacking-the-support-for-patients-and-communities-act-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Chapter 2Fraud and Abuse StarkPhysician Self-Referral and EstelaJeffery653
Chapter 2
Fraud and Abuse: Stark/Physician Self-Referral and Anti-Kickback
Learning Objectives
Physician Self-Referral (Stark) Law and Anti-Kickback Statute (AKS)
Services, individuals, organizations, and transactions affected by these laws.
Specific behaviors prohibited.
Exceptions and “safe harbors” for avoiding liability.
Anticipating and preventing violations.
Physician Self-Referral Law (Stark)
Initial law (Stark I) sponsored by Congressman Pete Stark enacted in 1989 and applied only to clinical laboratory services.
Omnibus Budget Reconciliation Act of 1993 (Stark II) expanded law to additional 10 types of clinical services.
Patient Protection and Affordable Care Act of 2010 added restrictions on physician-owned hospitals and required the issuance of a self-referral disclosure protocol.
Stark Prohibition
“... If a physician (or an immediate family member of such physician) has a financial relationship with an entity ..., then the physician may not make a referral to the entity for the furnishing of designated health services for which payment otherwise may be made” under Medicare (also applicable to Medicaid). (underlining added).
“Physician”
The person making the referral may be a(n)
MD
Osteopath
Dentist
Podiatrist
Optometrist, or
Chiropractor
“Immediate family member”
Besides the referring physician herself, this person may be a
spouse;
parent, child, or sibling (by birth or adoption);
stepparent, stepchild, step-brother, or step-sister;
father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law;
grandparent or grandchild; or
spouse of a grandparent or grandchild.
“Entity”
The entity with which there is a financial relationship must be one that bills CMS for designated health services (DHS) or that furnishes all or most of the components of the DHS.
This includes the person or entity that actually performs the DHS, or presents a claim for DHS services to the Medicare program.
7
“Financial relationship”
Direct or indirect ownership of an entity:
Equity stock, interest in a limited liability company, holding debt in an entity.
Direct or indirect compensation from an entity:
Physician’s compensation from an entity, lease between physicians and health care facilities, medical director agreements, and independent contract with physicians.
“Designated health services” (I)
Clinical laboratory services.
Physical therapy services.
Occupational therapy services.
Outpatient speech-language pathology services.
Radiology and certain other imaging services.
Radiation therapy services and supplies.
“Designated health services” (II)
Durable medical equipment and supplies.
Parenteral and enteral nutrients, equipment, and supplies.
Prosthetics, orthotics, and prosthetic devices and supplies.
Home health services.
Outpatient prescription drugs.
Inpatient and outpatient hospital services.
Penalties for Stark Violations
Payment for services in response to prohibited referral must ...
Are you aware of Medicare Fraud and Abuse?Jessica Parker
Most physicians strive to work ethically, provide high-quality medical care to their patients, and submit proper claims for payment. Trust is at the core of the physician-patient relationship. The Federal Government also places enormous trust in physicians. Medicare and other Federal health care programs rely on physicians’ medical judgment to treat patients with appropriate, medically necessary services.
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.
The effects on insurance coverage for people living with HIV/AIDS in the Philadelphia EMA (including Philadelphia, Montgomery, Delaware, Chester, and Bucks Counties in PA and Salem, Gloucester, Camden, and Burlington Counties in NJ)
Health Reform Bulletin – Implementation Update: Women’s Preventive Health Se...CBIZ, Inc.
The women’s health services component of the Affordable Care Act’s (ACA) preventive services mandate continues to evolve. As background, the ACA requires non-grandfathered plans to provide specified preventive services at no cost to plan participants. These preventive services require coverage of certain women’s health services including contraceptive coverage. Recent challenges to this requirement have reached the Supreme Court.
Unpacking the SUPPORT for Patients and Communities Act: Trends in Behavioral ...Epstein Becker Green
The SUPPORT Act takes sweeping aim at the opioid crisis, focusing on numerous aspects of opioid prevention, treatment, and recovery and expanding various types of coverage, use of telemedicine, and electronic prescribing, among other things.
This webinar will highlight important parts of the new law as it pertains to SUD treatment providers and how the law will potentially impact profitability and treatment offerings.
Presented by Harry Nelson – Founder & Managing Partner, Nelson Hardiman; Chairman, Behavioral Health Association of Providers - and Paul D. Gilbert – Member of the Firm, Epstein Becker Green.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/unpacking-the-support-for-patients-and-communities-act-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Chapter 2Fraud and Abuse StarkPhysician Self-Referral and EstelaJeffery653
Chapter 2
Fraud and Abuse: Stark/Physician Self-Referral and Anti-Kickback
Learning Objectives
Physician Self-Referral (Stark) Law and Anti-Kickback Statute (AKS)
Services, individuals, organizations, and transactions affected by these laws.
Specific behaviors prohibited.
Exceptions and “safe harbors” for avoiding liability.
Anticipating and preventing violations.
Physician Self-Referral Law (Stark)
Initial law (Stark I) sponsored by Congressman Pete Stark enacted in 1989 and applied only to clinical laboratory services.
Omnibus Budget Reconciliation Act of 1993 (Stark II) expanded law to additional 10 types of clinical services.
Patient Protection and Affordable Care Act of 2010 added restrictions on physician-owned hospitals and required the issuance of a self-referral disclosure protocol.
Stark Prohibition
“... If a physician (or an immediate family member of such physician) has a financial relationship with an entity ..., then the physician may not make a referral to the entity for the furnishing of designated health services for which payment otherwise may be made” under Medicare (also applicable to Medicaid). (underlining added).
“Physician”
The person making the referral may be a(n)
MD
Osteopath
Dentist
Podiatrist
Optometrist, or
Chiropractor
“Immediate family member”
Besides the referring physician herself, this person may be a
spouse;
parent, child, or sibling (by birth or adoption);
stepparent, stepchild, step-brother, or step-sister;
father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law;
grandparent or grandchild; or
spouse of a grandparent or grandchild.
“Entity”
The entity with which there is a financial relationship must be one that bills CMS for designated health services (DHS) or that furnishes all or most of the components of the DHS.
This includes the person or entity that actually performs the DHS, or presents a claim for DHS services to the Medicare program.
7
“Financial relationship”
Direct or indirect ownership of an entity:
Equity stock, interest in a limited liability company, holding debt in an entity.
Direct or indirect compensation from an entity:
Physician’s compensation from an entity, lease between physicians and health care facilities, medical director agreements, and independent contract with physicians.
“Designated health services” (I)
Clinical laboratory services.
Physical therapy services.
Occupational therapy services.
Outpatient speech-language pathology services.
Radiology and certain other imaging services.
Radiation therapy services and supplies.
“Designated health services” (II)
Durable medical equipment and supplies.
Parenteral and enteral nutrients, equipment, and supplies.
Prosthetics, orthotics, and prosthetic devices and supplies.
Home health services.
Outpatient prescription drugs.
Inpatient and outpatient hospital services.
Penalties for Stark Violations
Payment for services in response to prohibited referral must ...
Equity Transactions In The Ambulatory Surgical CenterJerrySokol
In today's market, there are a myriad of equity transactions taking place in the ambulatory surgical center (ASC) industry. These transactions typically fall into one of three categories. The first is the sale of ownership interests in an ASC to physicians who use or will be using the ASC. These transactions can involve the initial syndication of equity interests to physicians in a new ASC or the sale of equity interests to physicians in an existing ASC. Second is the redemption (i.e., buy-back) of a physician's equity interest in an ASC. Third is the sale of an equity interest to a corporate investor (e.g., ASC management companies and health systems).
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 ...
· 7.4 Assignment Comparing Between-subjects and Within-subjects R.docxgerardkortney
· 7.4 Assignment: Comparing Between-subjects and Within-subjects Research
Design or locate a published study that illustrates application of between and within subjects design. Explain the merits of each and the limitations of each (between and within). Indicate which you believe is more informative of the results.
· Demonstrate understanding of the task and be able to address requirements using creativity and application of research design knowledge.
· Must demonstrate ability to analyze existing research to compare strengths and limitations of between-subjects and within-subjects analysis.
1
Course Learning Outcomes for Unit I
Upon completion of this unit, students should be able to:
1. Compare and contrast health services organizations within the healthcare system.
1.1 Explain the primary organizational components of the healthcare system and the
commonalities and differences among health services organizations.
Reading Assignment
Chapter 2:
Why and How Health Care Organizations Need to Change, pp. 13-34
Chapter 11:
Leading Change: First Steps in Employing Strategic Intelligence to Get Results, pp. 259-310
Unit Lesson
The Ideal Health System
Imagine you are now the Secretary of Health and Human Services; you have a magic wand and you can
create the perfect healthcare system. What components would it have? Would it include:
1. improving health outcomes for individuals, families and communities,
2. defending your population against threats to their health,
3. protecting your population against financial the consequences of bad health,
4. providing access to all with equality and no disparity, and
5. making it possible for people to make decisions in their own plans of care as well as have input into
the decisions that affect your country’s overall health system?
If you answered yes to these components, your definition matches the World Health Organization’s
Components of a Healthcare System (2010).
How This Course & Content Have Real-Word Application
We are witness to history and are living in one of the most active times in our country’s history for healthcare
reform. In 1966, the Medicare Act was signed into law by President Johnson, the most significant piece of
healthcare legislation in our country to that point. Fast forward from 1966 to 2010 and the passing of the
Affordable Care Act, which arguably is the second most impactful piece of legislation on U.S. health care
since the Medicare Act.
Medicare has grown significantly since 1966 and is now about 14% of our national budget, covering 47 million
Americans (Kaiser Family Foundation, 2015). Government health plans (Medicare, Medicaid, Tri-Care,
Veteran’s Administration) are growing and are on pace to insure more lives in the near future than lives
covered by commercial plans (Cigna, United, Blue Cross, etc.)
Speaking of this growth, Sylvia Burwell, Health & Human Secretary Director, announced that by 2018 the
Centers for Medicar.
Auditing Healthcare Focus Arrangements for Regulatory CompliancePYA, P.C.
PYA Principal Tynan Kugler and Consulting Manager Susan Thomas presented “Auditing Healthcare Focus Arrangements for Regulatory Compliance: Physicians, Management Services, Post-Discharge Care, Ambulance Services, and Specialty Care.” Their presentation:
- Describes what constitutes a focus arrangement for healthcare organizations.
- Explains the implications of Stark Law and Anti-Kickback violations, along with Corporate Integrity Agreement focus arrangement requirements.
- Discusses essential focus arrangement procedures to facilitate regulatory compliance.
- Provides an example design of an audit plan approach for focus arrangements.
The Anti-Kickback Statute: 2021 – Year in ReviewConference Panel
Anti-Kickback Statute 2021 webinar will focus on cases and enforcement actions taken by the HHS OIG and its law enforcement partners in 2021. We will also briefly review the Anti-Kickback Statute, discuss safe harbors, particularly the new proposed safe harbor for coordinated care and associated value-based arrangements, and OIG Advisory Opinions that have been issued in 2021, as well as pertinent cases involving the AKS.
Forensic and Valuation Issues in HealthcarePYA, P.C.
PYA Principal Carol Carden co-presented “Forensic and Valuation Issues in Healthcare” at the AICPA Forensic & Valuation Services Conference in New Orleans, LA, November 10, 2014.
INDIVIDUAL RIGHTS AND THE HEALTHCARE SYSTEMThe global perspec.docxdirkrplav
INDIVIDUAL RIGHTS AND THE HEALTHCARE SYSTEM
The “global perspective” you just read was brief for two reasons. First, a full treatment of international and foreign health rights is well beyond the scope of this chapter, and second, historically speaking, international law has played a limited role in influencing this nation’s domestic legal principles. As one author commented, “Historically the United States has been uniquely averse to accepting international human rights standards and conforming national laws to meet them.”15(p1156) This fact is no less true in the area of health rights than in any other major area of law. As described earlier in this chapter, universal rights to health care are virtually nonexistent in the United States, even though this stance renders it almost solitary among industrialized nations of the world.
This is not to say that this country has not contemplated health care as a universal, basic right. For instance, in 1952, a presidential commission stated that “access to the means for attainment and preservation of health is a basic human right.”16(p4) Medicaid and Medicare were the fruits of a nationwide debate about universal healthcare coverage. And during the 1960s and 1970s, the claim that health care was not a matter of privilege, but rather of right, was “so widely acknowledged as almost to be uncontroversial.”17(p389) Nor is it to say that certain populations do not enjoy healthcare rights beyond those of the general public. Prisoners and others under the control of state governments have a right to minimal health care,18 some state constitutions expressly recognize a right to health or healthcare benefits (for example, Montana includes an affirmative right to health in its constitution’s section on inalienable rights), and individuals covered by Medicaid have unique legal entitlements. Finally, it would be inaccurate in describing healthcare rights to only cover rights to obtain health care in the first instance, because many important healthcare rights attach to individuals once they manage to gain access to needed healthcare services.
The remainder of this section describes more fully the various types of individual rights associated with the healthcare system. We categorize these rights as follows:
· 1. Rights related to receiving services explicitly provided under healthcare, health financing, or health insurance laws; for example, the Examination and Treatment for Emergency Medical Conditions and Women in Labor Act, Medicaid, and the Affordable Care Act.
· 2. Rights concerning freedom of choice and freedom from government interference when making healthcare decisions; for example, choosing to have an abortion.
· 3. The right to be free from unlawful discrimination when accessing or receiving health care; for example, Title VI of the federal Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, or national origin by entities that receive federal funding.12(p12),19
Right.
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
Date:
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 ...
False accusation of plagiarism by professor discriminationModupe Sarratt
Unforgettable higher education injustice
I considered the accusation of plagiarism is an unforgettable injustice to any foreign origin as well as the lack of career readiness for job placement as an injustice to the college graduates.
In my experience of false accusation of plagiarism is by discrimination due to my national origin as foreign students to share my experience in English class. In all my endeavors I am proud of myself for working hard to earn an “A” for grade is what I cherished to go forward to do better because I was lucky that the plagiarism accusation is discrimination for demotion or reduction of my grade from A to D to end up with an associate degree in medical assisting with GPA 3.15. As a result of the experience, I took the opportunity to prove myself with pursuing a bachelor degree in psychology to take college writing for researching with GPA 3.25 in Psychology. Then progress to earn my master degree in healthcare administration with GPA 3.75
Although I love Anne Arundel College, however, the experiences of false accusation of plagiarisms feel as discrimination to hamper/hinder my progress for higher education. I do wish that the rule or the policy is being evaluated to be fair so that some student will not feel as if they are the target for plagiarism due to their national origin.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
HCAD 650 group 2 project oral presentation for the role of a compliance officer
1. Hello to Everyone: this is oral presentation of
a Group Project that never get to be
presented.
I, Modupe Sarratt invented a fictitious
Hospital called Layman Hospital System
(LHS) for the group project. The name of the
hospital is to simplify healthcare system in
which a layman will understand the laws that
Group Project Modification
By
Modupe Sarratt
2. Roles
As a moderator for my colleagues, I will introduce our group as the
speakers and the concept each speaker is going to present for their part.
The speakers
Speaker One, will speak on
…..Slides 3-7 for the role of compliance officer & the type of case report to
the Board of Director
Speaker Two, my part, I will speak on
…..Slides 8-18 to explain Stark Laws and Anti-kickback Statute and how the
law differ
Speaker Three, will speak on
…..Slide 19-22 to speak about corporate integrity agreement and
compensation agreement
Speaker Four, will conclude
…..Slide 23-25 with answering the specific question for reference
3. By
Speaker One
THE ROLE OF A COMPLIANCE OFFICER
FOR LAYMAN ORGANIZATON HOSPITAL
SYSTEM (LOHS)
4. The role of compliance officer
The health compliance officer has critical role in
healthcare institutions.
They are mandated in the creation of the
compliance committees to ensure that the health
standards are followed with a disciplinary
directive which are well known to anyone
They are also concerned with solving problems of
individuals who have been sanctioned.
Mandated to act as a liaison between
management and the board of directors thus
playing a critical role in making decisions on the
kinds of policies the institution is going to take
(Mifsud, 2014).
5. What are your duties as a
compliance officer?• Duties of a compliance officer include, but
are not limited to implementing the standards
that will reflect compliance with the Office of
Inspector General’s (OIG) and enforcing the
policies for the daily operation of an
organization.
• When developing a compliance plan for a
medical practice, there are seven fundamental
standards of an effective compliance program
that reflect the principles of the Office of the
Inspector General’s (OIG)
• The seven fundamental standards
according to Reding (2013) include:
(Reding, 2013).
6. 1. Ethics and Procedures: these include risk analysis of medical
coding, medical record, medical documentation, billing services and
physician practices for patient evaluation and management (E/M).
2. Designating Responsibility: mainly falls on the administrator to
educate other employees, updating physicians’ licensure, and reviewing
physician practice for standard of care
3. Train and Educate Employee: requires compliance education for all
staff for continuing education.
4. Monitor and Audit: Requires an infrastructure for the patient privacy,
the privacy of health record for E/M code and CPT Code.
5. Anonymous Communication Lines System: having a systems for
reporting misconduct, abuse, and fraudulent activity.
6. Responding and Enforcement with Disciplinary Action: a
process for investigating noncompliance to the standards of care for a
sanction or a termination for violation of procedures, standards, rules and
laws.
7. Conducting a Dialogue: the purpose of conducting a dialogue is to
“narrow down limitation or deficiency in the organization operations” that
can be used to improve guidelines for an effective communication an
organization (Krisco 1999).
The Seven Fundamental Standards By
(OIG):
7. Type of case report to the Board
Of Directors (BOD)
The type of case for reporting is the Halifax, a public health system on Florida’s east
coast, paid $85 million to the Department of Justice after a federal judge ruled that
contracts between Halifax and its medical oncologists violated the Stark Law (Sigo,
2014). The Stark Law forbids a hospital from billing Medicare for certain services
referred by physicians who have a financial relationship with the hospital. In addition
to the $85 million, Sigo states that the hospital entered a corporate integrity
agreement,” obligating itself to undertake certain reforms and to have federal health
care claims reviewed for the next five years.” for a debate to create a new bill/law
9. What is the Stark Law?
The Stark law is named for United States
congressman, Pete Stark, who sponsored the initial bill
(Stark, 2013). Stark law is a set of United States
federal laws that prohibit physician self-referral.
The law governs physician self-referral of
Medicare and Medicaid patients for financial link,
specifically a referral of a Medicare or Medicaid to an
entity providing designated health services (DHS) if
the referring physician or his family member has a
financial relationship with the entity (e.g, a physician
cannot refer a Medicare patient to a hospital where his
or her spouse is a surgeon) It is a violation of the law
if a physician or an immediate family member of the
10. Continuation for what is the Stark Law?
The Stark law prohibits the institution from
billing Medicare and Medicaid or third party or
some other institution for the provided service
due to self-referral.
It implemented in stages as Stark II & III.
Stark II when the intermediate family
member of the physician has financial links or
tie to a particular organization for self-referral.
Stark III deals with malpractices in the
healthcare sector with self-referral practices of
doing each other a favor.
11. Who does the stark law pertain to
exactly?
The law pertaining to the physicians who refer
Medicare and Medicaid patients for specific
services or designated health services for
having a financial relationship or referring
patients for doing a favor. Physician self-referral
according to Stark (2013),
is the practice of a physician referring a
patient to a medical facility in which he has a
financial interest, be the ownership, had
investment in the organization, or a
structured organization for compensation
arrangement.
12. Agencies providing the Stark laws
Many federal agencies are responsible for the
provision of Stark law;
these include the Department of justice, the
Department of health and human services, and
the Center for Medicare & Medicaid Services
However, patient protection act and affordable
care act contact for eligibility provided
amendments for other agencies by the state, the
state of Maryland has Healthcare connection for
the affordable care act.
13. What is Anti-Kickback Statute
(AKS)?
AKS is a criminal law that prohibits the exchange or offer to exchange of
anything value in effort to induce or for a reward to referral
Medicare/Medicaid patient for health care services. It is a criminal offense
to privatize or trade federal health care program (Medicare or Medicaid)
for financial gain. Knowingly and willfully referral the Medicare/Medicaid
patient for health care business is considered fraud and abuse of federal
health care program.
The AKS is a law passed by the American Congress, by which it is illegal
for all types of healthcare providers –physicians included –to intentionally
and consciously take bribes with Federal healthcare programs (e.g., using
generic drug for brand name, using federal supplies or resources for
Medicare/Medicaid for a specialist)
According to Kusserow (1991) the Medicare and Medicaid anti-kickback
stature “makes it a crime to knowingly and willfully offer, pay, solicit or
receive reimbursement in exchange for the referral of federal programs
for a business (p49).
It forbids any recommendation or arrangement for the requesting of
any service paid by a federal health care scheme.
It can also mean that, accommodating payments for referrals not
from Medicare or Medicaid transaction is as against the law for
14. The videos by Ryan et.al (2011) and Rabin (2014) tell
the difference between Stark Laws and Anti-kickback
stature.
Stark Law Anti-Kickback Statute
Stark Law is typically part of settlements stemming from
federal health care program investigations. In exchange for
the establishment of the CIA finding of false claim, the OIG
will not take actions excluding the provider and/or entity
from participation in federal health care programs such as
Medicare or Medicaid.
15. How does Stark Law differ from the
Anti-Kickback Statute?
Differ in terms of:
prohibition
penalties,
Exceptions
federal health
programs
Referrals
items/services,
intent,
16. This video by Holland & Hart LLP (2015)
explain the consequences for violating the
either the stark law or the anti-kickback statute
17. Explaining the differencesProhibition: the Anti-Kickback Statute prohibits offering,
paying, soliciting, or receiving anything of value to reward
referrals of Federal health care program for doing business.
The Stark law prohibits physicians from referring patients for
designated health services or to an entities with which the
physician has a financial relationship.
Penalties: the Anti-Kickback Statute include criminal
offense, civil liability, and ethics violation/misconduct
combined for penalties; anti-kickback statute is the punishment
for violating standards and breaking the rules. The Stark Laws
carry only civil penalties for ethical violation or the violating of
standards (OIG, n.d.).
Exceptions: voluntary safe harbors are allowed in the
Anti-Kickback Statute for not all misconduct or unethical
behaviors break the law.
Whereas the Stark Laws carry mandatory exceptions for
violation of standards/ethics.
18. Continue with Explaining the
difference
Federal Health Programs: the Anti-kickback statute
applies to all programs. The Stark law applies to only
Medicaid and Medicare physicians self-referral practice
Referrals: the Anti-Kickback Statute prohibits referrals
from anyone. The Stark law prohibits referrals from physicians
Items or services: the Anti-Kickback Statute prohibits any
items or services. The Stark Law prohibits designated health
care services
Intent: for the Anti-Kickback Statue, unlawful intent has to
be demonstrated for making profit by unlawful means such as
overcharging for procedure or receiving overpayment from
doing favors, an intent to gain financially by unlawful action
or violating ethics to receive bribe for participating in the
event such as, physicians self-referral practices.
The Stark Laws have no intention to violate standard although
intend to deceive or damage for advantage is considered a
19. By
Speaker Three
Can the board of directors be held
personally liable for Stark and/or Anti-
Trust violations?
20. Corporate integrity agreement
In violation of the Anti-Kickbacks statute for corporate
liability. An agreement can be negotiated with the
provider of the health care or even within the
organization itself.
According to Finegan (2006) the criminal action “can
only be prosecuted by the government.” It is part of the
corporate strategy to examine case for false claims of
the statutes; The OIG admits not to exclude the
provider or any health care facility from taking part in
the federal health care program (p. 625).
Agreement which is negotiated with the provider of the
health care as part of the settlement strategy from
false claims of the statutes.
What is a corporate integrity
agreement?
21. Compensation agreement
The payment sum compensated to the physician based
on the employment accord must be steady with the fair
market worth of the services offered.
The agreement must be presented in writing .
reimbursement under the agreement ought to be set in
prior if the employer will want the general’
What is a Compensation agreeme
22. The board of directors
That any case violated under the two laws that is; the
Stark and the Anti-Kickback Statue the board of
director will be held personally liable for violations if
found to have assisted or participated in procurement
and arrangement of deals with the physicians.
They need to understand that going against the set
standards is the crime.
It is better for them to avoid such transaction because
the penalties are very high.
They should be role models to physicians,
Also they should organize seminars with physicians to
offer tips on the importance of the Stark and Anti-Trust
What the Boards of directors need to
know to avoid personal liability?
24. Was a representation of the Stark
law aim to resolve the false claims
act?
YES
False Claim Act allegations by CIA for a violation of federal
health care programs is a barred/expelled of an institution, a
closed down healthcare institution. The False Claims Act, also
called the "Lincoln Law") is an American federal law that
imposes liability on persons and companies (typically federal
contractors) who defraud governmental programs. It is the
federal Government's primary litigation tool in combating fraud
against the Government 31 U.S.C 3279- FALSE CLAIMS (United
States Code, 2006).
A corporate integrity agreement (CIA) is a “contractual
agreement between the Office of Inspector General (OIG) of
the U.S. Department of Health & Human Services, to allow an
25. References
Mifsud, M (2014). The possible role of the Chief Ethics and Compliance Officer in Maltese Financial
Institutions (Master’s thesis, University of Malta)
Stark, P. (2013). Stark Law
Sigo, S. (2014). Daytona Beach, Fla., Health System Settles DOJ, Whistleblower Case. Bond
Buyer, 1(34164), 1.
Finegan, S. (2006). The False Claims Act and Corporate Criminal Liability. Qui Tam Actions, Corporate Integrity
Agreements and the Overlap of Criminal and Civil Law. Penn St. L. Rev., 111,625
Krisco, K. H. (1999). Leadership and the Art of Conversation. Conversation as a Management Tool.
Conducting a dialogue, pp93-94. Jaico Publishing House,
Kusserow, R. P. (1992). The Medicare & Medicaid Anti-Kickback Statue and the Safe Harbor
Regulations—what’s next? Health Matrix, 2, 49.
Kusserow, R. (2013). Best Practices for an MCO Negotiating a Corporate Integrity Agreement. Managed
Care Outlook, 26(16), 6-8.
United States Code. (2006). Sec. 3729 - False claims Edition, Supplement 5, Title
31 – MONEY AND FINANCE