Regulatory Compliance, Healthcare Law, and Ethics

Regulatory Compliance, Healthcare Law, And Ethics
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Regulatory Compliance, Healthcare Law, And Ethics
Introduction/Background Information
Corporate integrity programs play a central role in enhancing legal compliance and ethical practice within an effectively-managed healthcare organization. Upright healthcare organizations should consider the potential of their staff to commit fraud, abuse, or illegal conduct. That said, healthcare organizations must demonstrate commitment to ensuring high ethical practice thresholds and compliance principles to create a moral respectability image. This report evaluates the University of Maryland Medical System (UMMS) regulatory compliance and healthcare laws framework, healthcare ethics, and diversity measures and provides relevant conclusions and recommendations.
Regulatory Compliance and Health Care Law
Federal, State, and Local Laws, Regulations, and Guidelines
For this discussion, this report will consider selected federal, state, and local regulations, laws, and guidelines central to UMMS’s business conduct standards. UMMS should respect the False Claims Act (FCA), the federal government’s tool for the war against abuse and fraud. According to FCA, UMMS cannot knowingly submit fraudulent or false claims to be reimbursed by the federal government and decrease or avoid a duty to reimburse funds to the national government. The Criminal False Claims Act is a distinct federal law that institutes a criminal offense tag on any false claims. If convicted for this offense, UMMS would be required to pay $500,000 or twofold the false claim amount in fines, whichever is more significant. The antikickback statute also applies to UMMS. In this law, the federal government can penalize the healthcare facility for any fraudulent act involving Affordable Care Act healthcare programs or other health benefits programs funded via insurance premiums or otherwise (Showalter, 2017). Maryland Medicaid Fraud Law is a Maryland-enacted regulation similar to the federal FCA, providing for civil and criminal measures when the organization submits fraudulent or false claims to the Medicaid health plan. Under this state law, it is a crime for UMMS to willfully or knowingly take action to swindle the Medicaid plan in healthcare services reimbursement or delivery (Chrencik et al., n.d.).
Patient safety would be maintained through guidelines and regulations requiring the healthcare organization to deliver high-quality healthcare to clients and per professional standards safely. The Medical System’s primary goal is to furnish high-quality healthcare services to patients per medical orders issued by facility physicians or any other authorized healthcare professional based on each patient’s needs. The healthcare organization should uphold safe patient care practices by fostering an organization-wide safety culture. For example, spaces and buildings must be sustained to protect visitors, staff, and patients (Chrencik et al., n.d.). In addition, equipment employed to furnish health services must be effective, safe, and working properly.
Corporate Compliance Program
UMMS’s industry of operation is characterized by heightened regulation and a multifaceted business environment. The organization maintains a team of policy and compliance experts with the industry-wide experience to effectively help the medical system comply with the rules mentioned above. The UMMS compliance is anchored on practices to track, appraise, and act on federal regulations impacting technology, business operations, program compliance, and physician reimbursement. Additionally, UMMS’s robust compliance program benefits practices, including all areas of Maryland Primary Care Program engagement, including support for financial tracking and reconciliation processes, book of evidence (BOE), program documentation and audit defense, quarterly reporting, and application (University of Maryland Medical System, 2022). Concerning conflicts of interest (financial relationships disclosure), the Medical System’s staff and non-staff within leadership positions must avoid conflicts between the organization and their personal interests (Chrencik et al., n.d.).
Health Care Ethics and Diversity
UMMS Code of Ethics
UMMS’s code of ethical conduct incorporates different dimensions, including respect for persons, patient privacy rights, integrity and honesty, patient care responsibilities, upholding personal ethics, avoiding conflicts of interest, and integrity in research endeavors. Regarding respect for persons, UMMS requires that the staff treat each other with utmost dignity and respect in interactions, irrespective of an individual’s degree, station, religion, disability, illness status, sexual orientation, age, or race. Secondly, UMMS’s professional practice and care basis should be anchored on patient information and communication confidentiality. Integrity and honesty are anchored based on the organization’s effective professional-professional, teacher-student, and physician-patient relationships. The ethical duty to provide high-quality patient care guides the organization in maintaining a sense of responsibility for its medical care delivery and practice (Lee et al., 2020). The organization mandates its professionals to avoid conflicts of interest that could undermine their practice and delivery of services. For example, healthcare professionals must avoid accepting patient care or referral kickbacks. Regarding the requirement to uphold personal ethics, the Medical System must respect each individual’s ethical principles and beliefs. In this scenario, the healthcare staff must inform patients and their immediate families about the available treatment options according to acceptable nursing care and medical standards. Integrity in research entails adhering to institutional, federal, and ethical regulations governing clinical research using animals or human subjects and using patient data for research objectives (Lee et al., 2020).
Health Care Ethical Committee
The Healthcare Ethics Committee (HEC) structure should be interdisciplinary and encompass members of diverse professional dimensions and clinical care disciplines (nurses, physicians, allied medical professionals), and incorporate a scaled-up array of social aspects (e.g., social workers and ethicists). The role of nurses, ethicists, and physicians with deep interest and training in healthcare includes demonstrating and guiding ethical practices within the organization (Hester & Schonfeld, 2012). Social workers help with consultation on individual contexts, including developing relevant procedures and policies, providing community and staff education, advocating for policy and legal reforms, and resolving conflicts within the facility (Allen, n.d.). Critical care specialists should be part of the committee to address ethical concerns emanating from acute care units. Leadership is a crucial dimension of the HEC, and thus the committee chairperson is a vital position to consider. The role of the chair is to act as the committee’s de facto face, including guiding the mission and constructing meaningful agendas during meetings. Some HECs include the hospital’s legal team or risk management representative; others might comprise the healthcare organization’s administration. Legal teams, risk managers, and facility administrators aim to be objective in their discussions while attempting to establish the best solutions to challenging situations or complex policies from a more composed dimension (Hester & Schonfeld, 2012). In addition, Hester and Schonfeld argue that the healthcare organization’s administration might offer legitimacy to the HEC deliberations and influence resource allocation into decisions and implementation endeavors (2012).
Ethics and Compliance Training Program
Introduction
Ethics and compliance training programs constitute a crucial component of UMMS’s operations. Rather than emphasizing the identification and mitigation of abuse and fraud, as well as adherence to federal, state, and local regulations, the course has e...