Healthcare compliance refers to the continuous process of meeting legal requirements, professional and ethical standards by the healthcare organizations, professionals and providers. Healthcare facilities and providers are expected to develop processes, procedures and policies that govern their conduct and at the same time train their employees on the same. The main areas of compliance include; getting accreditations from relevant bodies like Joint Commission, patient care, reimbursement, billing and so forth (Smith, n.d.).
Examples of law, regulation and guidance documents that health care facilities and providers must adhere to are; Anti-kickback laws, safe harbor regulations and antibody tests guidance. These statutes, regulations and guidance documents are meant to prevent fraud, abuse, unethical behavior, waste and other negative actions in health care operations (Strategic Management Services, 2018).
Anti-kickback laws
Safe harbor regulations
Defines what is not considered as a violation of Anti-kickback laws. The basic idea in these regulations is that payments and business transaction between referring parties be carried out within the fair market value. For example, investors in a health care facility should not be defined by the number of patients they refer in a health facility or provider. Rental equipment and spaces should be determined by the fair market value. There should be no inducement to influence the pay or the benefits that one gets from a health care facility (The American Speech-Language-Hearing Association, n.d.). But, these regulations seem to be giving health care professionals a loophole to exploit patients and the federal government programs. For instance, heath professionals may be referring patients to facility they have personal interests with since the pay from the government programs, though determined by the fair market value, is steady.
Guidance documents
Are documents that explain internal polices of what should be done. For example, as heath facility started to test individuals SARS-CoV-2, the virus that causes COVID-19, Center for Disease Control and Prevention developed an interim guidance document on how antibody tests should be interpreted and how the results should be used. For instance, the test results should not be used to group people in discriminative categories. No one should be denied health care services because of her condition (CDC, 2020).
Healthcare compliance
For a health care facility to meet legal requirements and avoid legal implications several things must be put in place. One, policies, standards of conduct and procedures to be implemented must be written down. This is to enable the parties concerned to have a place they can regularly refer what is expected of them. Two, employees must be continuously trained on what the law requires of them (Wilensky, 2020). Three, there should be a position for a chief compliance officer who should be responsible for ensuring legal requirements and other standards are met in the organization. Also, organizations should respond swiftly to cases of violation with corrective measures so as to avoid repetition of a similar case.
Examples of law, regulation and guidance documents that health care facilities and providers must adhere to are; Anti-kickback laws, safe harbor regulations and antibody tests guidance. These statutes, regulations and guidance documents are meant to prevent fraud, abuse, unethical behavior, waste and other negative actions in health care operations (Strategic Management Services, 2018).
Anti-kickback laws
These law mostly applies to Medicaid and Medicare programs. They prevent paying, receiving, offering and soliciting something in order to refer patients to a heath facility or provider. They also stop health care facility from corrupting government officials so as to generate federal health care contracts. The laws are civil and criminal by nature and therefore if a health care facility is thought to have violated them, it must be proofed without reasonable doubt that it happened (Strategic Management Services, 2018).
Safe harbor regulations
Defines what is not considered as a violation of Anti-kickback laws. The basic idea in these regulations is that payments and business transaction between referring parties be carried out within the fair market value. For example, investors in a health care facility should not be defined by the number of patients they refer in a health facility or provider. Rental equipment and spaces should be determined by the fair market value. There should be no inducement to influence the pay or the benefits that one gets from a health care facility (The American Speech-Language-Hearing Association, n.d.). But, these regulations seem to be giving health care professionals a loophole to exploit patients and the federal government programs. For instance, heath professionals may be referring patients to facility they have personal interests with since the pay from the government programs, though determined by the fair market value, is steady.
Guidance documents
Are documents that explain internal polices of what should be done. For example, as heath facility started to test individuals SARS-CoV-2, the virus that causes COVID-19, Center for Disease Control and Prevention developed an interim guidance document on how antibody tests should be interpreted and how the results should be used. For instance, the test results should not be used to group people in discriminative categories. No one should be denied health care services because of her condition (CDC, 2020).
Healthcare compliance
For a health care facility to meet legal requirements and avoid legal implications several things must be put in place. One, policies, standards of conduct and procedures to be implemented must be written down. This is to enable the parties concerned to have a place they can regularly refer what is expected of them. Two, employees must be continuously trained on what the law requires of them (Wilensky, 2020). Three, there should be a position for a chief compliance officer who should be responsible for ensuring legal requirements and other standards are met in the organization. Also, organizations should respond swiftly to cases of violation with corrective measures so as to avoid repetition of a similar case.
