Managing Legal Compliance in the Health Care Industry


Author: George B. Moseley III,Lecturer in Health Law and Management Department of Health Policy and Management Harvard School of Public Health Boston Massachusetts George B Moseley III

Publisher: Jones & Bartlett Publishers

ISBN: 1449639658

Category: Business & Economics

Page: 582

View: 5175

The pressures are mounting for healthcare organizations to comply with a growing number of laws and regulations. With the passage of the Affordable Care Act, sophisticated compliance programs are now mandatory and the penalties for noncompliance are more severe. Increasingly, those who are trained in the fundamentals of healthcare laws and regulations and the complexities of designing and running compliance programs will be in high demand. Managing Legal Compliance in the Health Care Industry is a comprehensive resource that will prepare you to build and manage successful compliance programs for any healthcare service or industry. In three sections, this unique title first examines all the key laws and regulations with which healthcare organizations must comply. In section two, the author explores in detail the seven essential ingredients for a good compliance program. In the final section, the book explains how the compliance program must be adapted to the special needs of different types of healthcare organizations. Designed for administrators and legal counsel in health care organizations, as well graduate-level students in programs of public health, health administration, and law, Managing Legal Compliance in the Health Care Industry is filled with highly practical information about the ways that legal violations occur and how good compliance programs function. Key Features: -Examines in detail the current laws and regulations with which all types of healthcare organizations must comply -Explores the seven essential ingredients for a good compliance program -Looks at compliance programs within twelve different types of healthcare organizations -References real-world cases of fraud and abuse -Includes Study Questions and Learning Experiences in each chapter that are designed to encourage critical thinking -Accompanied by a Navigate Companion Website that offers an interactive glossary, a list of current compliance events, downloadable documents, and a reading list.

Managing Health Care Business Strategy


Author: George B. Moseley III

Publisher: Jones & Bartlett Learning

ISBN: 1284081109

Category: Medical

Page: 500

View: 8070

Managing Health Care Business Strategy is the definitive textbook on strategic planning and management for healthcare organizations. It offers all the basic information on strategic planning and management within the unique context of organizations concerned with the delivery and financing of health care. It does this by noting the singular strategic environment in health care, explaining the special procedures and options available to health care organizations, and providing real-life examples in the form of case studies. It includes not only a description of the basic multi-step process of creating and then managing a strategic plan, but also a detailed look at the role played by the key business functions (finance, marketing, human resources, information technology, and law) as well as specific strategic options (merger/acquisition, reorganization, joint venture) and some of the popular tools for analyzing strategic situations (balanced scorecard, Six Sigma, SWOT).

Healthcare Information Privacy and Security

Regulatory Compliance and Data Security in the Age of Electronic Health Records


Author: Bernard Peter Robichau

Publisher: Apress

ISBN: 1430266775

Category: Computers

Page: 194

View: 818

Healthcare IT is the growth industry right now, and the need for guidance in regard to privacy and security is huge. Why? With new federal incentives and penalties tied to the HITECH Act, HIPAA, and the implementation of Electronic Health Record (EHR) systems, medical practices and healthcare systems are implementing new software at breakneck speed. Yet privacy and security considerations are often an afterthought, putting healthcare organizations at risk of fines and damage to their reputations. Healthcare Information Privacy and Security: Regulatory Compliance and Data Security in the Age of Electronic Health Records outlines the new regulatory regime, and it also provides IT professionals with the processes and protocols, standards, and governance tools they need to maintain a secure and legal environment for data and records. It’s a concrete resource that will help you understand the issues affecting the law and regulatory compliance, privacy, and security in the enterprise. As healthcare IT security expert Bernard Peter Robichau II shows, the success of a privacy and security initiative lies not just in proper planning but also in identifying who will own the implementation and maintain technologies and processes. From executive sponsors to system analysts and administrators, a properly designed security program requires that that the right people are assigned to the right tasks and have the tools they need. Robichau explains how to design and implement that program with an eye toward long-term success. Putting processes and systems in place is, of course, only the start. Robichau also shows how to manage your security program and maintain operational support including ongoing maintenance and policy updates. (Because regulations never sleep!) This book will help you devise solutions that include: Identity and access management systems Proper application design Physical and environmental safeguards Systemwide and client-based security configurations Safeguards for patient data Training and auditing procedures Governance and policy administration Healthcare Information Privacy and Security is the definitive guide to help you through the process of maintaining privacy and security in the healthcare industry. It will help you keep health information safe, and it will help keep your organization—whether local clinic or major hospital system—on the right side of the law.

Healthcare Fraud

Auditing and Detection Guide


Author: Rebecca S. Busch

Publisher: John Wiley & Sons

ISBN: 1118240251

Category: Business & Economics

Page: 352

View: 8212

An invaluable tool equipping healthcare professionals, auditors, and investigators to detect every kind of healthcare fraud According to private and public estimates, billions of dollars are lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud, Second Edition provides tips and techniques to help you spot—and prevent—the "red flags" of fraudulent activity within your organization. Eminently readable, it is your "go-to" resource, equipping you with the necessary skills to look for and deal with potential fraudulent situations. Includes new chapters on primary healthcare, secondary healthcare, information/data management and privacy, damages/risk management, and transparency Offers comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans Examines the necessary background that internal auditors should have when auditing healthcare activities Managing the risks in healthcare fraud requires an understanding of how the healthcare system works and where the key risk areas are. With health records now all being converted to electronic form, the key risk areas and audit process are changing. Read Healthcare Fraud, Second Edition and get the valuable guidance you need to help combat this critical problem.

The Stark Law Explained

A Comprehensive Guide for the Health Care Industry, Attorneys and Compliance Professionals


Author: Daniel Melvin

Publisher: Createspace Independent Publishing Platform

ISBN: 9781497437586


Page: 274

View: 3153

The riddles of the Stark Law have become increasingly difficult to solve. Thousands of pages of agency discussion and interpretation, judicial decisions, government and defense briefs, and commentary have tried to decode those riddles. The product of years of research and hands-on legal practice, this book provides a comprehensive and in-depth Stark Law resource that will give readers working in or with the health care industry the keys to decode this riddle, including: executives administrators attorneys compliance professionals clinicians accountants valuators business consultants regulators The main body of the book avoids "legalese" to explain the law in plain English. A Glossary of Acronyms is also included for readers new to the area. Much more than a primer, however, the book also provides detailed discussion and analysis for the reader looking for a more nuanced and comprehensive treatment. This book is both a teaching tool and reference guide to one of the most important, and complicated, statutes in the current environment of increased government scrutiny of health care regulatory compliance.

Managing Medical Devices within a Regulatory Framework


Author: Beth Ann Fiedler

Publisher: Elsevier

ISBN: 0128041927

Category: Technology & Engineering

Page: 380

View: 8253

Managing Medical Devices within a Regulatory Framework helps administrators, designers, manufacturers, clinical engineers, and biomedical support staff to navigate worldwide regulation, carefully consider the parameters for medical equipment patient safety, anticipate problems with equipment, and efficiently manage medical device acquisition budgets throughout the total product life cycle. This contributed book contains perspectives from industry professionals and academics providing a comprehensive look at health technology management (HTM) best practices for medical records management, interoperability between and among devices outside of healthcare, and the dynamics of implementation of new devices. Various chapters advise on how to achieve patient confidentiality compliance for medical devices and their software, discuss legal issues surrounding device use in the hospital environment of care, the impact of device failures on patient safety, methods to advance skillsets for HTM professionals, and resources to assess digital technology. The authors bring forth relevant challenges and demonstrate how management can foster increased clinical and non-clinical collaboration to enhance patient outcomes and the bottom line by translating the regulatory impact on operational requirements. Covers compliance with FDA and CE regulations, plus EU directives for service and maintenance of medical devices Provides operational and clinical practice recommendations in regard to regulatory changes for risk management Discusses best practices for equipment procurement and maintenance Provides guidance on dealing with the challenge of medical records management and compliance with patient confidentiality using information from medical devices

Essentials of Healthcare Compliance


Author: Shelley C Safian

Publisher: Cengage Learning

ISBN: 111179944X

Category: Medical

Page: 448

View: 2655

Essentials of Health Care Compliance provides you with the knowledge and skills necessary to understand how a formal compliance program is implemented at a health care facility. Managing several staff members and keeping a health care practice compliant with federal, state, and local statutes and regulations is a challenging job. Real-world examples and the author's hands-on approach will help you visualize yourself on-the-job, using the knowledge you have gained from this book to meet these challenges. Important Notice: Media content referenced within the product description or the product text may not be available in the ebook version.

Hospitality Law

Managing Legal Issues in the Hospitality Industry


Author: Stephen C. Barth,David K. Hayes

Publisher: John Wiley & Sons

ISBN: 0471464252

Category: Business & Economics

Page: 427

View: 2451

Reliable advice to help hospitality managers prevent legal problems and avoid litigation. Is an unhappy restaurant guest legally entitled to a refund for food she ate? Is a hotel required to replace money that a guest claims was taken from his room? Can a hospital food and beverage director legally accept a holiday gift from a vendor without threatening her employment status? "Hospitality Law, Second Edition" provides readers with answers to these questions and more. Packed with interactive exercises as well as up-to-date legal information specific to the hospitality industry, "Hospitality Law" benefits students by emphasizing preventive legal management and effective decision-making. This "Second Edition" gives students and managers background on safety and security requirements, disputes with customers, hiring and firing employees, liabilities associated with serving alcohol, and much more, including: New coverage of legal issues in travel and tourism, including those associated with transportation, travel agents, tour operators, gaming, mixed-use, and timeshare propertiesNewly added real-world legal case summaries that illustrate the practical application of hospitality laws in actual hospitality operations. Each case summary features a "Message to Management" that gives the reader a clear explanation of the impact of the decision on best practices, as well as preventative measures managers can take to limit exposureNew coverage of legal issues related to amusement parks and the Internet booking phenomenonNew "International Snapshots" offering insights from practicing attorneys and other professionals regarding differences between U.S. and international laws related to hospitalityUpdated Web exercises and guidance for researching on the Internet Encouraging readers to think critically about legal concepts related to hospitality, "Hospitality Law, Second Edition" is an indispensable part of every hospitality manager's education.

Managing Relationships with Industry

A Physician's Compliance Manual


Author: Steven C. Schachter,William Mandell,Scott Harshbarger,Randall Grometstein

Publisher: Academic Press

ISBN: 0080559557

Category: Psychology

Page: 310

View: 5120

Now more than ever, doctors are being targeted by government prosecutors and whistleblowers challenging the legality of their relationships with drug and device companies. With reputations at stake and the risk of civil and criminal liability, it is incumbent upon doctors to protect themselves. Managing Relationships with Industry: A Physician’s Compliance Manual is an indispensable resource for doctors, professional societies, academic medical centers, community hospitals, and group practices struggling to understand the ever changing law and ethical standards on interactions with pharmaceutical and device companies. It is the first comprehensive summary of the law and ethics on physician relationships with industry written for the physician. Authored by a former state Attorney General, Harvard Medical School Professor, health care lawyer and professor of ethics, Managing Relationships approaches the topic from a balanced and reasoned perspective adding to the on-going national dialogue and debate on the proper limits to medicine’s relationship with industry. The first complete and up-to-date summary and analysis of the law and ethics on physician-industry relationships Focuses on major enforcement actions and whistleblower lawsuits and the lessons learned for physicians Provides options and guidance for maintaining compliant relationships and avoiding traps for the unwary Covers both drug and device company relationships Summarizes the types of industry relationships that are necessary and productive and those that are harmful and abusive Details the law and ethics for each type of relationship including gifts, off-label uses and marketing, CME, speaker’s bureaus, free samples, grants, consulting arrangements, etc. Includes sample contracts for permissible consulting and CME speaker engagements

Patient Care Case Law


Author: George D. Pozgar

Publisher: Jones & Bartlett Publishers

ISBN: 1449604587

Category: Business & Economics

Page: 680

View: 804

In today’s litigious environment, where high-stakes negligence suits plague the health care industry, it is imperative that health care professionals understand their rights and responsibilities under the law and the legal ramifications of their actions. Patient Care Case Law: Ethics, Regulation, and Compliance is a unique compendium of case studies that provides a foundation for that understanding. The broad variety of case studies covered in this reference is organized around the patient’s progression through the health system, from admission to discharge. The text features chapters on patient rights, the screening and assessment process, diagnosis, treatment, universal protocols, discharge planning, and follow-up care. Additionally, chapters on employee and patient safety, human resources, and criminal acts round out the content. Each legal case presented includes a review of the facts, the issues related to the health care industry, and the court’s ruling and rationale for its decision. Patient Care Case Law: Ethics, Regulation, and Compliance features: • Appendices on the U.S. Code of Federal Regulations Chapter 42 for hospitals, Medicare/Medicaid certification, and assessment of quality care • A summary case written as a “closet drama” • Discussion questions for each case presented • Descriptive citations providing useful additional information • A list of suggested websites to aid further research • Accompanying resources for instructors: TestBank and PowerPoints

Encyclopedia of Health Care Management


Author: Michael J. Stahl

Publisher: SAGE Publications

ISBN: 1452265240

Category: Medical

Page: 664

View: 5357

The topic of health care management has escalated to one of the most widely discussed and debated topics in the health care industry, MBA programs, and in the field of medicine in general. In the 1980s, the industry was relatively stable and the need for combining business acumen with medicine was less than today. However, as we enter the 21st century, the need for applying business and management skills to the health care industry is stronger than ever. This Encyclopedia covers every topic a medical professional, institutional administrator, or MBA student would need to know about the business of health care. Key Features * Over 600 entries * More than 160 expert contributors from the fields of medicine, public health, business * Tables on medical degrees, medical specialties, medical organizations, health care acronyms, medical legislation * Unites the business and medical worlds, and spans the academic, corporate, and governmental arenas Topics Covered Accounting and Activity-Based Costing / Economics / Finance / Health Policy / Human Resources / Information Technology / Institutions and Organizations / International Health Care Issues / Legal and Regulatory Issues / Managed Care / Marketing and Customer Value / Operations and Decision Making / Pharmaceuticals and Clinical Trials / Quality / Statistics and Data Mining / Strategy

Essentials of Physician Practice Management


Author: Blair A. Keagy,Marci S. Thomas

Publisher: John Wiley & Sons

ISBN: 111842932X

Category: Medical

Page: 592

View: 9205

Essentials of Physician Practice Management offers a practical reference for administrators and medical directors and provides a comprehensive text for those preparing for a career in medical administration, practice management, and health plan administration. Essentials of Physician Practice Management is filled with valuable insights into every aspect of medical practice management including operations, financial management, strategic planning, regulation and risk management, human resources, and community relations.

Engineering a Learning Healthcare System:

A Look at the Future: Workshop Summary


Author: Institute of Medicine,National Academy of Engineering

Publisher: National Academies Press

ISBN: 0309120640

Category: Medical

Page: 340

View: 6450

Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system--one that increasingly is more effective, more efficient, safer, and higher quality--is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.

Compliance Management: A How-to Guide for Executives, Lawyers, and Other Compliance Professionals

A How-to Guide for Executives, Lawyers, and Other Compliance Professionals


Author: Nitish Singh Ph.D.,Thomas J. Bussen

Publisher: ABC-CLIO

ISBN: 1440833125

Category: Business & Economics

Page: 262

View: 655

This practical guide shows how to build an effective compliance and ethics program that will lower a business's risks and improve productivity. • Offers a step-by-step guide to creating and managing an effective compliance program • Showcases the latest best practices in a world of ever-changing regulations • Identifies the importance of developing and maintaining a corporate culture of "doing the right thing" and shows how ethical training can improve compliance • Features interviews with and best practices from top compliance executives, judges, Department of Justice attorneys, and Archer Daniels Midland informant Mark Whitacre • Provides easy-to-understand overviews and recommendations for complying with specific laws

Legal and Ethical Aspects of Health Information Management


Author: Dana C. McWay

Publisher: Cengage Learning

ISBN: 1305686322

Category: Medical

Page: 512

View: 1458

Understanding the complex legal and ethical principles that govern health information management is more important than ever. To help you successfully navigate these legal issues, LEGAL AND ETHICAL ASPECTS OF HEALTH INFORMATION MANAGEMENT is revised, updated, and expanded, providing the opportunity to focus on law and ethics as they relate to HIM. Key topics include the role of social media in health care, expansion of existing materials on e-discovery, compliance, completeness of the health record, breaches of confidentiality, and much more. Features include enrichment activities, mapping to CAHIIM standards, and interactive quizzing and case studies to help develop practical application and high-level problem solving skills. Written by a seasoned HIM professional and lawyer, LEGAL AND ETHICAL ASPECTS OF HEALTH INFORMATION MANAGEMENT, 4th Edition provides a complete solution for understanding the legal and ethical concerns that safeguard health care information today. Important Notice: Media content referenced within the product description or the product text may not be available in the ebook version.

The Compliance Officer's Handbook


Author: Robert A. Wade,Alex J. D. Krouse,Alex Krouse

Publisher: Hcpro, a Division of Blr

ISBN: 9781615693498

Category: Medical

Page: 154

View: 1009

The Compliance Officer's Handbook, Third Edition, gives compliance officers everything they need to take charge of a healthcare compliance program, whether they are new to the field or seasoned professionals who want to incorporate the latest strategies. Packed with legal insights from two experts on the latest OIG regulations, this handbook delivers tools, practical examples, and interpretations to build and maintain programs consistent with best practices for risk assessment, HIPAA compliance, training, monitoring, and auditing for compliance, and a host of other organizational responsibilities. ... The new edition includes: A new, in-depth chapter interpreting HIPAA regulations, including compliance with the authorization and notification requirements related to the privacy, security, and breach notification rules. A comprehensive chapter detailing critical issues for the compliance officer: establishing, monitoring, and documenting fair market value and commercial reasonableness between referral sources to avoid violating the Stark Law and Anti-Kickback Statute, or the False Claims Act. The following new forms: Income Guarantee Monthly Report, Community Need Checklist, Employment Justification Analysis Form, and Non-Monetary Benefit Tracking Form.

Legal and Ethical Essentials of Health Care Administration


Author: George D. Pozgar

Publisher: Jones & Bartlett Publishers

ISBN: 9781449694340

Category: Business & Economics

Page: 383

View: 6224

Rev. ed. of: Legal essentials of health care administration / George D. Pozgar; legal review, Nina M. Santucci. c2009.

Health Care Supply Chain Management


Author: Gerald (Jerry) R. Ledlow,Karl Manrodt,David Schott

Publisher: Jones & Bartlett Learning

ISBN: 1284123626

Category: Health & Fitness

Page: 400

View: 9478

Ledlow BCC Supplies currently account for up to 45% of a healthcare organization’s annual operating expense. The supply chain ensures that the technology of care is available to the health care professional at the right time, at the right place and in sufficient quantity and quality for superior health outcomes for patients within the health system. As such, a clear understanding of the workings of the healthcare supply chain is vital to successful healthcare management today. Health Care Supply Chain Management examines supply chain management within the unique context of healthcare services delivery. The authors, with over 60 years combined experience in healthcare administration, supply chain, and academia, examine the critical topics of sourcing, logistics, security and compliance, purchasing, storage and inventory management, distribution, vendor management, as well as future challenges in health care. Students of health administration, public administration, public health, nursing and other allied health professions will learn the most current and effective methods for the management of the supply chain that will contribute to success in the delivery and financing of healthcare services. Key Features: • Offers an overview of the elements of the healthcare supply chain • Examines both the operational and the strategic aspects of supply chain management • Includes a discussion of the integration of the supply chain with the clinical delivery of care • Provides a sound basis of knowledge for students so that healthcare supply chain improvements can be achieved for the mutual benefit of the healthcare industry

Health Law and Compliance Update

2018 Edition


Author: John E. Steiner

Publisher: CCH

ISBN: 9781454884293

Category: Law

Page: 462

View: 2947

The 2018 Health Law and Compliance Update, now in its 15th year, continues a publishing tradition that features national experts who address key developments in health care delivery, payment, and compliance. The authors include practical advice and analytical tools for use in organizational compliance programs, in addition to timely and thorough analysis of many substantive topics. The 2018 Edition includes detailed coverage and expert insights on the following topics: Risk Management, Internal Controls, and Regulatory Enforcement Artificial Intelligence and the HIPAA Compliance Programs Legal Compliance in Using Biospecimens in Research Statistical Sampling: Use and Techniques Including RAT-STATS The Increasing Importance of Data Analytics in Health Care Compliance The 340B Program: Under the Microscope Section 501(r) Likely to Stay, Even if the Affordable Care Act May Not Recent Prosecutions of Doctors and Other Health Care Professionals Under the Travel Act Fraud and Abuse