28 Sep Compliance Program Implementation and Ethical Deci
Compliance Program Implementation and Ethical Decision-MakingIntroductionHealth 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: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 assessment allows you to demonstrate your knowledge of and skills relating to compliance concepts, governmental and regulatory agencies which 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 which may pertain to your compliance recommendations.Demonstration of ProficiencyBy successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:InstructionsIn this assessment, you are assuming the role of an early careerist in risk management and quality improvement at one of Vila Health’s community-based hospitals. Vila Health is a medium-sized system of health operating facilities in Minnesota and Wisconsin. 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 about the privacy breach and potential HIPAA violation to date. 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 further discussion of the matter without prior written consent from the patient is prohibited.As part of the team exploring the privacy breach, you will prepare a workplace brief with authoritative, evidence-based references to support your work.PreparationYou are already familiar with HIPAA but may want to conduct independent research to enhance your knowledge. Consult this resource for additional guidance on how to conduct research using credible sources: Health Care Administration Undergraduate Library Research Guide.InstructionsThis is a workplace brief rather than an academic paper. Download the Compliance Program Implementation and Ethical Decision-Making Template [DOCX]. Be sure to address all of the following in your brief:BackgroundInclude a short paragraph of no more than five or six sentences describing the known details about the privacy breach and HIPAA violation.Privacy Breach—HIPAA ViolationSummarize the relevant health care compliance concepts that apply to this privacy breach and HIPAA violation. Be sure to consider the following:Seven Essential Elements of an Effective Compliance ProgramApply to this HIPAA breach the seven essential components of an effective health care compliance program, as determined within the Federal Register.Privacy Breach ConsequencesProvide a synopsis of the consequences for an individual leader and for other internal health care organization stakeholders for not taking immediate actions to address a privacy breach. At a minimum, be sure to consider all of the following in your synopsis:Evidence-Based RecommendationsConstruct evidence-based recommendations to resolve the HIPAA-related privacy breach. You may also want to include relevant information related to:For help in identifying appropriate evidence-based recommendations, you may want to visit some of the authoritative sources, such as the DOJ/OIG, CMS/HHS, et cetera, listed under the suggested resources for this assessment.Ethical Decision-Making Framework for Health Care LeadersDescribe an ethical decision making framework as one of your concluding recommendations. Tip: You may want to use the ACHE’s ethical decision-making framework:ConclusionWrite a paragraph that summarizes the following:Additional Requirements
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