This week, we will learn about various governmental compliance and reporting requirements such as the False Claims Act and Anti-Trust Laws. These and other laws are important to understand from a health care administration and leadership perspective. For example, if an organization inaccurately codes services that have been provided to patients, whether knowingly or unknowingly, it can be considered submitting false claims under the False Claims Act. Anti-trust laws explicitly prohibit practices such as price-fixing and, what is called customer allocation in a specific healthcare market. You will need to conduct some research on these and other laws and regulations as you complete the Activity (memo) Assignment this week. As you do your research, be certain that you seek sources that review laws specific to health care versus business practices in general. Please be certain to keep your memo to 4 pages or less. Memos longer than 4 pages (excluding references) will be returned for revision.
Overview
In this module, you explored the importance of documentation in government compliance and reporting. When assisted by technology, documentation becomes easier to capture and maintain, as well as less prone to errors, which in turn improves the patient experience.
This activity will help you describe how technology supports regulatory compliance in healthcare. It also enables you to explain how regulation, fraud, and abuse impact operations and patient care.
Scenario
You work within a healthcare organization as the director of quality, and your chief compliance officer has asked you to create a memo to be distributed to the entire organization. They have asked that the memo focus on how an organization can better manage risk to the revenue cycle and healthcare reimbursement by examining ways to reduce fraud, waste, and abuse.
Directions
Create a memo to assess how the following laws and regulations can help a healthcare organization reduce fraud, waste, and abuse and thereby manage risk to the revenue cycle and reimbursement. Also, recommend strategies and technology to help an organization abide by the laws and regulations. Refer to the following laws and regulations to guide your response:
- False Claims Act
- Physician Self-Referral Law
- Anti-Kickback Statute
- Anti-Trust Laws
You may refer to the “Activity Reading” resource in the module resources section to better understand how a memo is structured. If you need writing support, access the Online Writing Center through the Academic Support module of your course.
Specifically, you must address the following rubric criteria:
- False Claims Act: Analyze the impact of the False Claims Act on the organization’s reimbursement, coding, and strategic planning. Consider the following questions to guide your response:
- What are the provisions of the False Claims Act?
- What penalties could an organization face for violating the Act?
- Physician Self-Referral Law: Analyze the impact of the Physician Self-Referral Law on a healthcare organization’s reimbursement, revenue cycle, and strategic planning. Consider the following questions to guide your response:
- What are the features of the Physician Self-Referral Law?
- How does this law help prevent fraud and abuse in healthcare?
- Anti-Kickback Statute: Analyze the impact of the Anti-Kickback Statute on healthcare reimbursement and referrals. Consider the following questions to guide your response:
- How is the Anti-Kickback Statute different from the Physician Self-Referral Law?
- What kind of financial penalties would be attracted by the violation of this statute?
- Anti-Trust Laws: Analyze the impact of the Anti-Trust Laws on a healthcare organization’s financial performance and strategic planning. Consider the following questions to guide your response:
- What are the premises of the Anti-Trust Laws?
- How do the Anti-Trust Laws help prevent fraud and abuse in healthcare?
- Recommendations: Recommend strategies and technology to reduce operational risk and promote operational efficiencies by integrating the regulations that prevent fraud, waste, and abuse. Consider the following questions to guide your response:
- What measures can you take to incorporate the provisions of the False Claims Act and the Anti-Trust Laws?
- What process changes will help the organization comply more easily with the Physician Self-Referral Law and the Anti-Kickback Statute?
All the claims in your deliverable should be evidence based. Your citations should be from your independent search for evidence (not from the textbook or module resources) of credible sources and be current within the last five years. You are required to cite a minimum of two sources, at least one of which should be separate from your own research. Refer to the IHP 630 Library Guide located in the Start Here section of the course for additional support.
Please review carefully and stay with four pages no more than four pages, as you can read the instructions above.
