Compliance Program Implementation and Ethical Decision MakingHealth care is one of the most heavily regulated major industri

Compliance Program Implementation and Ethical Decision Making
Health care is one of the most heavily regulated major industries in the United States. Leaders are challenged to stay current and to comply with federal, state, and local laws and their associated regulations. Health care organizations are also responsible to meet industry standards. In some cases, payers equate meeting industry standards with achieving and maintaining accreditation. In fact, many payers consider accreditation a minimum condition of participation. In addition, individual licensure and certification requirements establish basic expectations for health care leaders’ professional conduct.

In summary, health care leaders are responsible to:

Meet ethical, personal, professional conduct, certification, and licensure expectations.
Comply with local, state, and federal health care and human resources laws.
Provide evidence of compliance with existing regulations and scan the field for emerging regulations.
Identify and meet appropriate accrediting body standards (for example, The Joint Commission’s National Patient Safety Goal standards).
As an individual’s health care leadership career advances, so does the corresponding level of accountability. Not knowing the laws or regulations is not an excuse for not complying with them.

This assignment allows you to demonstrate your knowledge of and skills relating to compliance concepts and governmental and regulatory agencies that oversee health care service delivery, billing, and general operations. You will also have the opportunity to apply the components necessary to initiate and maintain an effective compliance program. Finally, you will consider relevant human resources laws that may pertain to your compliance recommendations.

Preparation
You already are familiar with HIPAA but you may want to conduct independent research to enhance your knowledge. Consult the Health Care Administration Undergraduate Library Research Guide for additional guidance on how to conduct research using credible sources.

Continue your role of an early careerist in risk management and quality improvement at one of Vila Health’s community-based hospitals. You are working on a team-based initiative under the supervision of the Vila Health chief compliance officer. Your role is to assist in addressing a specific compliance risk regarding a breach of privacy and potential HIPAA violation. A Vila Health employee has disclosed—without prior written authorization—a patient’s protected personal health information.

Here is the information the team has collected to date about the privacy breach and potential HIPAA violation:

A Vila Health supervisor instructed an employee to obtain pre-authorization for an upcoming surgical procedure for a patient.
The Vila Health employee submitted confidential, protected health care information about the patient to the insurance company.
The Member Services Representative at the insurance company contacted the Vila Health supervisor.
The insurance company representative indicated that it cannot discuss the matter without prior written consent from the patient.
As part of the team exploring the privacy breach, you must prepare a workplace brief with authoritative, evidence-based references to support your work.

Instructions
For this assignment, you will create a workplace brief rather than an academic paper. Use the Compliance Program Implementation and Ethical Decision-Making Template given in the resources to write your brief.

Be sure to address all of the following in your brief.

Background
A short paragraph of no more than five or six sentences describing the known details about the privacy breach/HIPAA violation.

Problem Summary: Privacy Breach/HIPAA Violation
Summarize the relevant health care compliance concepts that apply to this privacy breach/HIPAA violation. Be sure to consider the following:

Federal, state, and local laws and associated regulations.
Disclosure.
Human resource concepts and laws.
Industry and accrediting body standards.
Seven Essential Elements of an Effective Compliance Program
Recalling your readings on the seven essential elements of an effective compliance program as determined within the Federal Register, apply each of the seven essential components of an effective health care compliance program to this HIPAA breach.

Privacy Breach Consequences
Provide a synopsis of the consequences for an individual leader, other internal health care organization stakeholders, and the health care organization for failing to take immediate actions to address a privacy breach. At a minimum, be sure to consider all of the following in your synopsis:

Patient safety.
Financial losses.
Employment status.
Individual and organizational violations of the law.
Legal consequences.
Civil liability.
Evidence-Based Recommendations
Construct evidence-based recommendations to resolve the HIPAA-related privacy breach. You also may want to include relevant information related to:

Human resource laws.
Professional codes of ethical conduct or standards.
Previous case precedents.
Current alleged health care legal violations.
Tip: Visit the Health Information Privacy website from the unit readings and explore the links on the site.

Ethical Decision-Making Framework for Health Care Leaders
Describe steps in a health care industry-approved ethical decision-making framework as one of your concluding recommendations.

Tip: Review Nelson’s 2015 article, "Making Ethical Decisions," from the Unit 3 readings.

Conclusion
Write a paragraph that summarizes the following:

Key concepts.
The importance of compliance.
Best practices to monitor for future quality improvements.
Short list of resources.
Note: Be sure to cite all resources using current APA format.

Additional Requirements
Your assignment should meet the following requirements:

Written communication: Use the Compliance Program Implementation and Ethical Decision-Making Template given in the resources. Your workplace brief must be clear, concise, well organized, and free of errors in grammar, punctuation, and spelling. The title page, citations, and references must be in current APA format.
Length: 4–6 typed, single-spaced pages, including the reference page.
Font and font size: Times New Roman, 12 point.
Title page: Develop a descriptive title of 5–15 words. It should stir interest yet maintain professional decorum. Ensure that your title page conforms to current APA format.
References: Include a minimum of six current, authoritative citations and references in current APA format.
Please review the Compliance Program Implementation and Ethical Decision Making Scoring Guide so that you understand how your faculty member will evaluate your work. Submit your assignment as a Word document.