Group 3/HHS OIG Compliance Protocol

In the Law of Health Care Administration, 9th Ed. read:

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• Ch. 15       Fraud Laws and Corporate Compliance

Part 1:  Critical Analysis of the Law

1. Evaluate      the legal risks and consequences that can arise for failing to comply with      the laws that govern fraud and abuse. Evaluate one of the      following laws.

1.  

• False       Claims Act (FCA)
• Antikickback       Statute (AKS)
• Physician       Self-Referral Law (Stark law)

1. Evaluate one element      of the HHS OIG compliance protocol elements from the list below.  For      the element chosen assess how protocol indicates the type of risk it will      mitigate, and how you would use the element.

• Implementing written policies, procedures, and standards of conduct
• Designating a compliance officer and compliance committee
• Conducting effective training and education
• Developing effective lines of communication
• Conducting internal monitoring and auditing
• Enforcing standards through well-publicized disciplinary guidelines
• Responding promptly to offenses and taking corrective action

1. How would  a comprehensive compliance program that adopts the entire HHS OIG protocol      limit fraud and abuse risk?   How would a comprehensive  compliance program prevent the problems in The Tracks We Leave, 10 Failed  Hospital Merger: Richland River Valley Healthcare System?  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 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 where they enjoy free rent from the hospital. This makes it easy for the providers to send their patients to the hospital for additional needed services.  The Dollar Docs also regularly refer to a nearby home health agency including five agencies they own.

1. What laws      (from those your group was assigned to evaluate) does this arrangement      violate? Why? What are the consequences of the violation(s)?
2. Create an      action plan with three actions you could take to correct the problem      including the specific compliance strategy selected.