Health care compliance. Health, Medicine, Nursing Research Paper

Health Care Compliance
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Health Care Compliance
Healthcare compliance is a government strategy that aims at ensuring that patients receive the necessary, safe, quality, efficient, and effective medical care in all hospitals (Russell et al., 2018). Healthcare compliance involves following a set of rules and regulations that are set explicitly for the healthcare industry. Compliance protocols include patient safety, privacy, and ensuring that medical institutions do not overcharge their patients. However, healthcare protocols vary in different states within the United States of America. As Russell et al. (2018) illustrated, healthcare compliance gives patients the confidence to check into a hospital and receive the treatment they deserve. Also, the agreement gives them the confidence to share their personal information with medical professionals since they are aware of the hospital's privacy protocols. UPMC Children's Hospital of Pittsburgh has to follow the stipulations of compliance agencies to ensure that they continue being the leading medical institution in providing quality care for children, teens and young adults throughout the state of Pennsylvania (Russell et al., 2018).
Healthcare compliance agencies help organizations such as UPMC to follow the growing need to follow government regulations that ensure patient safety, privacy, storage of patient information and protection of the well-being of medical staff at the organization (Shah et al., 2015). The enforcement of state legislation runs under the Office of the Attorney General, while federal laws are under the Office of the Inspector General in the U.S. Department of Health and Human Services. As illustrated by Nunes, Rego and Brandao (2009), the various organizations and governing agencies that ensure that UPMC complies with the requirements of both federal and state laws include:
The U.S. Department of Health and Human Services (HHS)
HHS is a government agency under the Office of the Inspector General in the USA that ensures the protection of patients' privacy, provision of quality medical services and reduction of fraud in healthcare organizations (Nunes, Rego and Brandao, 2009) . The department also ensures that hospitals comply with federal healthcare laws and set programs. The Healthcare Information Portability and Accountability Act (HIPAA) of 1996 stipulate standards in the healthcare industry and provide a process for the protection and handling of patient health history. Under the Department of Health and Human Services, the Health Information Technology for Economic and Clinical Health Act (HITECH), through its implementation in 2009, addresses the sharing of electronic health records (EHR). HITECH with HIPAA ensures that medical facilities protect patient information and allows HHS to carry out periodical audits and penalty adjustments. Any institution that does not comply with these regulations is liable to a fine of up to $1.5 million (Nunes, Rego and Brandao, 2009).
The Emergency Medical Treatment and Labor Act (EMTLA) under HHS ensures that all American citizens can receive emergency medical services irrespective of their medical insurance cover or ability to cater to the services (Russell et al., 2018). EMTLA provides that all the allow Medicare can give patient emergency services, including screening and stabilizing treatment incase of abrupt health issues. The Patient Protection and Affordable Care Act (ACA) ensures that organizations charge a reasonable fee for medical services. Also, ACA outlines quality and service efficiency programs such as the Medicare Shared Savings Program for establishing Accountable Care Organizations (ACOs). Together with the association of physicians, healthcare institutions, ACOs keep the cost of healthcare within a manageable limit and enhance patient results, which ensures that patients pay for value instead of service (Nunes, Rego and Brandao, 2009).
Centers for Medicare and Medicaid Services (CMS)
As indicated by Nunes, Rego, and Brandao (2009), the CMS, under the U.S. Department of Health and Human Services (HHS), holds the responsibility of administering Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The administration of all these programs involves a series of compliance protocols and reimbursement strategies that medical institutions have to follow. CMS also includes the Electronic Health Record (EHR) incentive programs, which provides regulations that ensure organizations are in lin with HITECH standards in the handling of patient information. The 2015 Me...