MHA 598 Module 3 Case REGULATORY COMPLIANCE, HEALTH CARE LAW, AND ETHICS

REGULATORY COMPLIANCE, HEALTH CARE LAW, AND ETHICS Assignment Overview You are halfway through the course and your capstone project. That is a milestone of which to be proud. In this section of your project, you will be researching laws, regulations, guidelines, and specifications relevant to the business processes of your organization/facility. Case Assignment Regulatory Compliance and Health Care Law Regulatory compliance in health care is all about a health care organization's adherence to laws, regulations, guidelines, and specifications relevant to its business processes. Complete an extensive review of federal, state, and local laws, regulations, and guidelines relevant to the business processes of your organization/facility. Prepare an executive summary of federal, state, and local laws, regulations, and guidelines applicable to your organization/facility. Be sure to identify how patient safety will be maintained. Corporate Compliance Program (Showalter, 2017, pp. 569-572) Using the outline created in the Module 2 Discussion and the feedback received from your colleagues, develop a comprehensive document outlining the Organizational Policies and Procedures for your organization/facility. Health Care Ethics and Diversity Using the outline created in the Module 2 Discussion and the feedback received from your colleagues, develop a comprehensive Code of Ethics for your organization/facility. Design a health care ethical committee. Identify members. Distinguish the roles and responsibilities of the committee. Develop an Ethics and Compliance Training Course for your organization. Your training should be health care-based but specific to your organization. Be creative. Your training should be interactive and provide a setting to ask questions (i.e., gamifications or possibly role play to provide a platform for scenarios to be presented and feedback provided). Your course should include the following components: Introduction Course Description Course Objectives Evaluate the Relationship between Ethics and Cultural Competence Relevance of culture to health care and the social determinants of health Ethical implications for lack of cultural competence Section 2. Compliance and Ethics Overview Compliance Defined Ethics Defined Goals & Purpose Advantages of Training Section 3. Components of Ethics and Compliance Ethics Compliance Leadership Example/Tone Fraud and Abuse High Risk Activities Section 4. Investigations Investigations and Penalties Discuss two payment programs that are relevant to your organization (i.e., The Deficit Reduction Act or The Medicaid Integrity Program State/Federal Sentencing Guidelines Federal False Claims Act Section 5. Reporting Activities That Should be Reported Rights of Employees Provide a summary or detailed (descriptive) plan of implementation. In addition, provide a timeline of when employees will complete training upon employment, setting of the course, and your plan to incorporate each piece into the training. The training should be the same for all employees and include training materials. Conclusions and Recommendations Bring this section to a close and provide 2 or 3 recommendations for your organization based on the information researched and identified. Assignment Expectations Conduct additional research to gather sufficient information to justify/support your analysis. Case papers should be at least 5 pages, not including the title and reference pages. (At this point, you should have at least 15 pages; at least 5 pages for Module 1, 5 pages for Module 2, and 5 pages for Module 3.) Support your paper with peer-reviewed articles with at least 5 references. (At this point, you should have at least 15 references; at least 5 references for Module 1, 5 references for Module 2, and 5 references for Module 3.) Use the following link for additional information on how to recognize peer-reviewed journals: Angelo State University Library. (n.d.). Library guides: How to recognize peer-reviewed (refereed) journals. Retrieved from https://www(dot)angelo(dot)edu/services/library/handouts/peerrev.php You may use the following source to assist in formatting your assignment: Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from https://owl(dot)english(dot)purdue(dot)edu/owl/resource/560/01/ For additional information on reliability of sources, review the following source: Georgetown University Library. (n.d.). Evaluating internet resources. Retrieved from https://www(dot)library(dot)georgetown(dot)edu/tutorials/research-guides/evaluating-internet-content This assignment will be graded based on the content in the rubric. ======================= Module 2 Discussion: Hello Everyone once Again, The organization/facility is called Simpton Healthcare, located in Jacksonville, Florida, is a non-profit healthcare organization that operates as a general healthcare facility providing both inpatient and outpatient services. Rights and Obligations of Patients: .. Clearly defined patient rights encomPASS informed consent, respectful treatment, and confidentiality, among others. . There are clear obligations for patients, such as following treatment plans, providing accurate information, and respecting the dignity of staff and other patients. (Association of American Hospitals, 2020). 2. Quality Improvement and Assurance: . Implementation of protocols to ensure ongoing quality enhancement, including data analysis, feedback mechanisms, and routine audits. . Protocols for addressing and resolving patient complaints in order to maintain service delivery and care at a high standard. As of 2021, the Centers for Medicare & Medicaid Services. 3. Health Information Administration: . Policies that guarantee the availability, confidentiality, and integrity of patient health information in accordance with HIPAA requirements. . Criteria for the precise and punctual recording of patient interactions, medical interventions, and additional pertinent data. (2019, HealthIT.gov) 4. Prevention and Control of Infections: . Infection prevention and management protocols, including isolation precautions, hand hygiene, and sanitation procedures, within the healthcare facility. . As mandated by law, there are protocols for monitoring and reporting communicable diseases to local health authorities (2020, Centers for Disease Prevention and Control). 5. Preparedness and Response to Emergencies: . Strategies to manage medical emergencies, natural disasters, and other critical circumstances in a manner that safeguards the health and safety of patients, employees, and guests. . Training programs should equip staff with the skills and knowledge necessary to respond to emergencies effectively. (2018) Federal Emergency Management Agency. 6. Ethical Conduct and Professionalism: . A code of ethics that specifies the professional conduct and expected behavior of every staff member, with an emphasis on honesty, integrity, and regard. . Protocols for dealing with ethical quandaries and conflicts of interest, encomPASSing systems for notifying authorities of ethical issues and resolving them,. (Association of American Physicians, 2021) 7. Financial and billing integrity: . Policies that guarantee precise and transparent invoicing procedures encomPASS activities such as insurance coverage verification, appropriate documentation of rendered services, and adherence to billing regulations. . Methods for auditing financial transactions, identifying and preventing instances of fraud, waste, and invoicing practice abuse. As of 2020, the Centers for Medicare & Medicaid Services 8. Safety and Security: . Contingency planning for the protection of patients, staff, and visitors, including emergency response protocols, access control, and surveillance systems. . Staff education programs regarding emergency evacuation routes, safety procedures, and the reporting of suspicious activities or security violations. (Administration of Occupational Safety and Health, 2019) 9. Competence in Culture and Diversity: . Dedication to delivering care that is culturally sensitive and equitable to a heterogeneous patient population while also demonstrating reverence for unique beliefs, values, and practices. . Training initiatives aimed at augmenting the cultural competence of personnel and fostering cognizance and comprehension of the ramifications of cultural variances on the provision of healthcare. (2019, The Joint Commission) 10. Community Collaboration and Engagement: . Approaches to community engagement, including partnerships with community organizations, health education initiatives, and outreach programs. . Methods of collaborating with local authorities and other stakeholders to enhance access to healthcare services for underserved populations and address public health issues. (Agency for Research and Quality in Healthcare, 2020) The Organizational Code of Ethical Conduct for Simpton Healthcare 1. Introduction and Objective: . A Declaration delineating the significance of ethical behavior in the provision of healthcare services and its capacity to foster confidence among community members and the organization (Smith et al., 2023). 2. Core Values: . Identifying fundamental principles that govern the conduct of the entire workforce, including integrity, comPASSion, respect, and excellence (Jones & Brown, 2022). 3. Professional Standards: . The American Medical Association (2021) holds the following criteria for determining professional conduct: integrity, openness, responsibility, and compliance with pertinent legislation, regulations, and professional codes of conduct. 4. Patient Care and Privacy: . A dedication to delivering care that is centered around the patient, upholding principles of dignity, respect, and empathy while safeguarding patient privacy and confidentiality throughout all communications and interactions (Health Insurance Portability and Accountability Act, 1996). 5. Autonomy and informed consent: . The right to patient autonomy and the ability to make well-informed decisions regarding their healthcare are upheld, which includes the dissemination of transparent and comprehensible information regarding treatment alternatives, associated risks, and benefits (Beauchamp & Childress, 2019). 6. Conflict of Interest: . Principles for Recognizing and Handling Conflicts of Interest (Office of Inspector General, 2020). This includes disclosing financial interests, professional relationships, and any other potential conflicts that could undermine objectivity or impartiality. 7. Data Security and Confidentiality: . Responsibilities include safeguarding the privacy and security of patient health information in accordance with HIPAA regulations and company policies concerning the gathering, retention, and dissemination of sensitive information (U.S. Department of Health & Human Services, n.d.). 8. Professional Relationships: . The Joint Commission (2021) expects staff, patients, families, and other healthcare professionals to engage in collaborative and respectful exchanges, thereby cultivating an environment that promotes trust, cooperation, and reciprocal assistance. 9. Adherence to Non-Discrimination and Cultural Competence: . A dedication to delivering fair and culturally sensitive healthcare that is devoid of any form of bias or prejudice, including but not limited to disability, race, ethnicity, religion, gender, sexual orientation, or religion (The National Academies of Sciences, Engineering, and Medicine, 2016). 10. Research and Innovation: . Ethical behavior in research endeavors encomPASSes the safeguarding of research participants' rights, compliance with ethical principles, and open disclosure of results to preserve the credibility and soundness of research conclusions (World Medical Association, 2018). 11. Reporting and Accountability: . Protocols for disclosing ethical issues, misconduct, or organizational policy violations; additionally, systems for addressing, resolving, and holding accountable those responsible for unethical conduct (American Nurses Association, 2020). 12. Ongoing education and Improvement: . Foster a culture of ethical consciousness, introspection, and continuous improvement among personnel through a dedication to continuous education and training regarding ethical concerns and optimal methodologies in healthcare ethics (Kaplan et al., 2020). 13. Community Engagement and Social Responsibility: . Fostering involvement with the community in order to comprehend and resolve their healthcare requirements, thereby making a positive contribution to societal welfare and advocating for social justice and equity in the provision of healthcare (World Health Organization, 2010), References: . American Hospital Association. (2020). Patient rights & responsibilities. Retrieved from https://www(dot)aha(dot)org/center/legal-issues/patient-rights . Centers for Medicare & Medicaid Services. (2021). Quality improvement. Retrieved from https://www(dot)cms(dot)gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs . HealthIT.gov. (2019). Health information management. Retrieved from https://www(dot)healthit(dot)gov/topic/health-it-health-information-management . Centers for Disease Control and Prevention. (2020). Infection control. Retrieved from https://www(dot)cdc(dot)gov/infectioncontrol/index.html . Federal Emergency Management Agency. (2018). Emergency preparedness and response. Retrieved from https://www(dot)ready(dot)gov/ . American Medical Association. (2021). Code of medical ethics. Retrieved from https://www(dot)ama-assn(dot)org/delivering-care/ethics/code-medical-ethics-overview .Centers for Medicare & Medicaid Services. (2020). Billing and payments. Retrieved from https://www(dot)cms(dot)gov/Medicare/Billing . Occupational Safety and Health Administration. (2019). Safety and health topics. Retrieved from https://www(dot)osha(dot)gov/safety-health-topics .The Joint Commission. (2019). Advancing effective communication, cultural competence, and patient- and family-centered care. Retrieved from https://www(dot)jointcommission(dot)org/standards/ . Agency for Healthcare Research and Quality. (2020). Community engagement. Retrieved from https://www(dot)ahrq(dot)gov/ Colleagues Response: ( my name is Beckyleon in the response) Each statement begins by defining specific ethical principles or standards related to healthcare practices, such as privacy and confidentiality, and respect for patients and their families. The ethical code of conduct premise underscores the foundational importance of defining specific ethical principles, sourcing guidance from reputable authorities (Beckyleon Ehumadu), addressing a comprehensive scope of ethical considerations (Samantha Roby), and emphasizing continuous improvement in ethical awareness and practices (Shawn O’Toole) within healthcare settings. Beyond facilitating guidance of beliefs and values, this synthesis highlights the crucial role of ethical guidelines in influencing behavior, promoting accountability, and fostering a culture of ethical consciousness and continuous learning to address evolving challenges in healthcare ethics effectively. Many statements emphasized the importance of ongoing education, training, reflection, and continuous improvement in ethical awareness and practices among healthcare professionals and their organizations. This reflects a commitment to developing a culture of ethical consciousness, learning, and adaptation to changing ethical issues and problems in healthcare. Ethical values and beliefs are fundamental components that emanate from an organization's code of ethics (Martínez, 2021). At the core of a well-constructed code of ethics are clear standards and expectations that outline expected ethical behavior and decision-making processes for all individuals involved with the organization, including employees, leaders, and stakeholders. This shapes the ethical culture within the organization and prioritizes values/beliefs under an umbrella of integrity, honesty, respect, and fairness while holding all employees accountable to unified standards. Moreover, the code of ethics acts as a guiding framework, providing concrete guidelines, principles, and best practices to assist individuals in navigating complex ethical dilemmas and challenges that may arise in their roles (Martínez, 2021). By aligning with the organization's mission, vision, and goals, the code of ethics ensures that ethical values and beliefs are integrated into the fabric of organizational activities, policies, and practices, ultimately contributing to positive outcomes for stakeholders. Reference Martínez, C., Skeet, A. G., & Sasia, P. M. (2021). Managing organizational ethics: how ethics become pervasive within organizations. Business Horizons, 64(1), 83–92. Retrieved from https://doi(dot)org/10.1016/j.bushor.2020.09.008