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Description Healthcare operates in a highly regulated environment to ensure quality and safety of patient care and compliance with standards of business conduct. The Patient Protection and Affordable Care Act of 2010 (ACA) requires healthcare organizations that participate in federal healthcare programs such as Medicare and Medicaid to maintain a compliance program. Scenario: The Board of Directors of Healing Hands Hospital (HHH) is aware of the government’s increasing oversight of healthcare organizations for compliance with regulations. The Board has initiated a review of the hospital’s compliance program to determine whether any changes need to be made. Task: Provide a 3-5 page report with information about healthcare compliance programs. Based on the research, which includes the following: Discuss the 7 elements of a compliance program and explain why each one of the 7 is important to patient care. HEALTH CARE COMPLIANCE PROGRAM TIPS The Seven Fundamental Elements of an Effective Compliance Program 1. Implementing written policies, procedures and standards of conduct. 2. Designating a compliance officer and compliance committee. 3. Conducting effective training and education. 4. Developing effective lines of communication. 5. Conducting internal monitoring and auditing. 6. Enforcing standards through well-publicized disciplinary guidelines. 7. Responding promptly to detected offenses and undertaking corrective action. Five Practical Tips for Creating A Culture of Compliance 1. Make compliance plans a priority now. 2. Know your fraud and abuse risk areas. 3. Manage your financial relationships. 4. Just because your competitor is doing something doesn’t mean you can or should. Call 1-800-HHS-TIPS to report suspect practices. 5. When in doubt, ask for help. What is the role of the compliance officer and the role of the compliance committee? Choose 1 business function regulation and 1 clinical function regulation from the following list: Business function: The following are some business function regulations you can choose from: False Claims Act Stark Law Anti-Kickback Statute No Surprises Act (patient billing) Clinical function: The following are some clinical function regulations you can choose from: Health Insurance Portability and Accountability Act (HIPAA) Health Information Technology for Economic and Clinical Health (HITECH) Act Emergency Medical Treatment and Labor Act (EMTALA) Patient Safety and Quality Improvement Act (PSQIA) For each of the 2 regulations, respond to the following: Discuss how the regulation impacts the function of the organization. Which departments of the hospital are responsible for complying with the regulation? What are possible areas of concern for the organization if it is not in compliance with the regulation? Provide references to support the information discussed in the report. The following is are resources that can help: References Health Care Fraud Prevention and Enforcement Action Team, Office of Inspector General. (n.d.). Health care compliance program tips. https://oig.hhs.gov/documents/provider-compliance-training/945/Compliance101tips508.pdf U.S. Department of Health and Human Services, Office of Inspector General. (2023). General compliance program guidance. https://oig.hhs.gov/documents/compliance-guidance/1135/HHS-OIG-GCPG-2023.pdf

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