Please use the references provided to answer. APA format in text citations.
Please use the references provided to answer. APA format in text citations.
Question 1 – Corporate Documents for compliance
In the Law of Health Care Administration, 9th Edition. Read:
Ch. 12 Taxation of Healthcare Institutions (pages 459 – 487) (ATTACHED)
Part 1: Critical Analysis of the Law
Evaluate the laws listed and explain how it applies to corporate risk. Evaluate the legal risks and consequences that can arise for failing to comply with the laws that govern corporate practices.
Non-Profit Tax Law
Evaluate the corporate document from the list below. Indicate the type of risk the corporate document will mitigate and how you would use it.
Corporate Code of Ethics
Review and discuss the legal and other issues in the The Tracks We Leave, Chapter 10 Failed Hospital Merger: Richland River Valley Healthcare System (ATTACHED). How would an Enterprise Document Management (EDM) system limit corporate compliance risk and the problems? How would an Enterprise Document Management (EDM) system prevent problems? Be specific and demonstrate understanding of the risks and how the compliance tool can be used specifically to control the risks.
Tip: Demonstrate analysis by doing the following in responding to the Ch 10 Failed Merger: (1) explain the legal risk in the scenario (2) discuss the enterprise document management (EDM) system and how it applies to limit contract risk and prevent problems in the scenario. Be specific!
Part 2: Strategic Compliance with the Law
You are an administrator in a very busy clinic in the same managed care organization (MCO) as the local hospital. Five of your providers (Dollar Docs) have office space in the hospital and they regularly refer to a nearby home health agency including five they own. The Dollar Docs give you data from their practice in order for you to prepare an SEC report each year. You find out they have been “inflating” numbers to show even more profit than they have actually earned. They also refuse to provide charity care for those who come into for services they provide.
What laws (from the list in part 1 for your group) does this arrangement violate? Why? What are the consequences of the violation(s)?
State Incorporation Laws
Non-Profit Tax Law
Sarbanes Oxley Law (SOX)
Create an action plan with three actions you could take to correct the problem including the specific compliance strategy selected.
References
Showalter, S. (2020). The law of healthcare administration. (9th ed.). Health Administration Press. Chapter 5 (pages 176 – 177, 187 – 189), Chapter 12 (pages 459 – 469), Chapter 13 (pages 491, 495 – 498, 500, 502), and Chapter 15 (pages 571-572, 576 -579, 580 – 584, 588 – 590)
Perry, F. (2020). The tracks we leave: Ethics and management dilemmas in healthcare. (3rd ed.). ACHE Management Series. Chapter 4 (pages 45 – 63) and Chapter 10 – Failed Hospital Merger: Richland River Valley Healthcare Systems (pages 149 – 159)
Legal Risk Analysis (4:59)
HHS OIG Guidance (6:34)
Starting a Non-Profit: Compliance Basics (3:28)
Question 2 – Medicaid & Information Blocking
Part 1: Critical Analysis of the Law
Medicaid is a joint federal-state plan with funding from the federal government and state implementation.
Evaluate the role of state waivers in Medicaid. Compare and contrast two chosen different types of waivers. What are the state consequences of not meeting waiver requirements?
How could these waivers impact a long-term care organization?
State the specific legal risks related to Medicaid waivers. Discuss the COSO framework for internal controls and evaluate how it could be used to meet Medicaid waiver requirements. Be specific and demonstrate understanding of the risks and how the compliance tool can be used specifically to control the risks.
Part 2: Strategic Compliance with the Law
You work for a small managed care organization (MCO) “Splendid Healthcare” that owns a hospital and two provider clinics in. Your MCO just received notice that it will be subject to an HHS OIG evaluation of your electronic health information (EHI) practices because there was a complaint that your organization was engaged in information blocking because you did not release information to the state Medicaid office when they requested it. Honestly, your technology is out of date and you can’t transfer encrypted EHI to meet the state’s request.
Name and describe and give the code section that gives Medicaid the right to access your EHI. Name and describe and give the code section that gives the HHS OIG have the right to access your medical records to evaluate information blocking. (Give the legal source of the right)
Discuss information blocking requirements and exceptions. How do these apply to this situation? What could you do to bring your EHI up to date so that you don’t face an information blocking complaint in the future?
Answer this question.
What management actions would you take to work effectively with HHS OIG to avoid information blocking problems in the future?
References
Showalter, S. (2020). The law of healthcare administration. (9th ed.). Health Administration Press. Chapter 2 (pages 38 -40, 46-47, and 52-56)
Perry, F. (2020). The tracks we leave: Ethics and management dilemmas in healthcare. (3rd ed.). ACHE Management Series. Chapter 19 (pages 291-308)
50th Anniversary of Medicare and Medicaid: 50 Years, Millions of Healthier Lives (3:37)
Medicare and You: Understanding Your Medicare Choices (3:29)
HHS OIG Guidance (6:34)
Question 3 – Cybersecurity
Read In the Tracks We Leave, 3rdEd. Ch. 9 Information Technology Setback: Heartland Healthcare System (ATTACHED)
Part 1: Critical Analysis of the Law
Evaluate HIPAA security requirements for a security risk assessment (SRA). Name and describe the law and give a code section.
How would you complete a security risk assessment that meets HIPAA security requirements? Outline it.
What physical, administrative, and technical safeguards would you recommend to keep data secure?
Evaluate HIT audits as a compliance tool. Describe an audit process you recommend that would meet the following criteria.
The audit is fair and unbiased and free from conflict of interest (1-2 points).
The audit results are effectively communicated to senior levels of the organization (1-2 strategies).
There is a process in place to correct any problems identified in the audit (1-2 actions).
Describe HIPAA privacy requirements for mental health and HIV patients, What management actions would you take to ensure compliance with HIPAA mental health privacy requirements?
Review and discuss the legal risks and other risks in the situation described in The Tracks We Leave: Chapter 9 Information Technology Setback: Heartland Health care System. How could a (1) strong HIT audit system and (2) strong compliance officer serve to prevent the situation described in Ch 9 ? Evaluate how the (3) HIMSS Code of Ethics would apply in this situation. Be specific and demonstrate understanding of the risks and how the compliance tool can be used specifically to control the risks.
Part 2: Strategic Compliance with the Law
You work for a large managed care organization (MCO) that includes 5 hospitals, 25 providers clinics, 1 health insurance company, and 10 pharmacies. The MCO is using electronic health records (EHR). Your organization is not using 2015 CEHRT. Your organization has been subject to medical identity theft through 3 recent cyberattacks that compromised the data of 2,000 patients. The cyberattacks all used a known vulnerability with poor data encryption during data transfer and poor security on the patient portal. All cyber-attacks removed the encryption or security safeguards to obtain patient data. The breach included a list of 20 HIV patients whose HIV status was being reported to the state as part of infectious disease reporting.
Evaluate what you need to do to respond to the cyberattack. How does it apply to this scenario? Recommend a cyberattack response. Your response should include:
Methods to secure stolen data and mitigate harm (two).
Actions to correct the problem that allowed for the cyberattack (two).
Evaluate the breach notification requirements under HIPAA. How does it apply to this scenario?
What breach notice actions do you recommend? (1-2) When do they need to be completed?
What actions would you take to bring the organization back into compliance after the breach?
References
Showalter, S. (2020). The law of healthcare administration. (9th ed.). Health Administration Press. Chapter 9
Perry, F. (2020). The tracks we leave: Ethics and management dilemmas in healthcare. (3rd ed.). ACHE Management Series. Chapter 9
Security 101: Security Risk Analysis (8:06)
Question 4 – Employee Evaluation
Read In The Law of Health Care Administration, 9th Ed, read: Ch. 7 Liability of the Health Care Institution.
Read The Tracks We Leave Ethics and Management Dilemmas in Healthcare, 3rd Ed.: Ch. 8 Nurse Shortage: Metropolitan Community Hospital
Part 1: Critical Analysis of the Law
Evaluate and discuss the requirements of the following law. Give the code citation. How does it apply to employee management? What does a manager need to do or not do to comply with it?
Sexual Harassment
Evaluate the following tool for compliance in employee evaluation. How would it limit legal risk related to employee evaluation? Discuss the pros and cons of it.
Corrective action policies and checklists
Part 2: Strategic Compliance with the Law
Evaluate the scenario in Ch. 8 Nursing Shortage: Metropolitan Community Hospital.
What are the legal risks? What are risks specific to staff negligence and liability?
What would management compliance tools (one) and processes (one) be incorporated in the organization to prevent this problem?
Assume there is a nursing shortage. What employee retention tools(one) and processes(one) would you incorporate to improve nursing retention in this scenario and minimize the likelihood of a negligence lawsuit? Be specific!
References
Showalter, S. (2020). The law of healthcare administration. (9th ed.). Health Administration Press. Chapter 7
Perry, F. (2020). The tracks we leave: Ethics and management dilemmas in healthcare. (3rd ed.). ACHE Management Series. Chapter 8 (pages 117-130) Nurse Shortage: Metropolitan Community Hospital
Vicarious Liability for Torts of an Agent (3:17)
https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0197
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