Group 3/HHS OIG Compliance Protocol
In the Law of Health Care Administration, 9th Ed. read:
- Ch. 15 Fraud Laws and Corporate Compliance
Part 1: Critical Analysis of the Law
- 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.
- False Claims Act (FCA)
- Antikickback Statute (AKS)
- Physician Self-Referral Law (Stark law)
- 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
- 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.
- What laws (from those your group was assigned to evaluate) does this arrangement violate? Why? What are the consequences of the violation(s)?
- Create an action plan with three actions you could take to correct the problem including the specific compliance strategy selected.