Managing Legal Compliance in the Health Care Industry is a comprehensive text that prepares students for this increasingly critical field in health care administration. In three sections, this unique title first examines all the key laws and regulations that health care organizations must comply with. In section two, it explores in detail the seven essential ingredients for a good compliance program. In the final section, the book explains how the compliance program must be adapted to the special needs of different types of health care organizations. Designed for graduate level students in programs of public health, health administration, and law, the text is filled with highly practical information about the ways that legal violations occur and how good compliance programs function. Key Features: - Examines in detail the current laws and regulations with which all types of health care organizations must comply - Explore the seven essential ingredients for a good compliance program - Looks at compliance programs within twelve different types of health care organizations - References real world cases of fraud and abuse - Includes Study Questions and Learning Experiences in each chapter that are designed to encourage critical thinking

Managing Legal Compliance in the Health Care Industry is a comprehensive resource that will prepare you to build and manage successful compliance programs for any healthcare service or industry. In three sections, this unique title first examines all the key laws and regulations with which healthcare organizations must comply. In section two, the author explores in detail the seven essential ingredients for a good compliance program. In the final section, the book explains how the compliance program must be adapted to the special needs of different types of healthcare organizations."--Pub. desc.

The Health Care Compliance Professional's Manual is one of the most vital, long-standing, and best known resources in the world of health care compliance. It has all the tools you and your compliance team need to plan and execute a customized compliance program. This new edition is filled with industry best practices, sample forms, policies, procedures, and much more to save you time and comply with federal standards. The Health Care Compliance Professional's Manual will help you to: Use OIG publications and Federal Sentencing Guidelines to plan and execute a customized compliance strategy that meets tough federal standards and minimizes enforcement risks Oversee physician compensation and referrals Perform risk assessments using matrixes with step-by-step instructions to pinpoint areas that pose compliance and operational risks Draft compliance policies that form the foundation for a strong compliance program Build a strong infrastructure reinforced by industry best practices Create an effective education and training program that instills in employees the importance of legal compliance Implement a privacy and security plan that ensures patient information is protected Stay up-to-date on the latest legal and state and federal regulatory requirements affecting your facility, in areas such as HIPAA, EMTALA, fraud and abuse, reimbursement, privacy, security, patient safety, and clinical research Study for CCB(R) Certification in Healthcare Compliance (CHC) Packed with tools to make your job easier and more efficient, The Health Care Compliance Professional's Manual will provide: Practical coverage of federal and state laws governing your facility Insight into helpful federal standards on effective compliance programs Step-by-step guidance on implementing a sound compliance program Examples of common risk areas and how to handle them Time savings and peace of mind from sample policies, checklists and forms from members of the American Health Law Association (AHLA) The Health Care Compliance Professional's Manual will help you protect your company if violations do occur: Learn how to apply auditing, monitoring, and self-assessment techniques for conducting internal investigations Discover how to successfully follow the OIG's voluntary disclosure program to resolve overpayment problems and avoid exclusion from Medicare Find out how to enter into a corporate integrity agreement to settle with the federal government and mitigate FCA-related penalties Document your compliance efforts so you leave a protective paper trail that shields you from liability And much more Previous Edition: Health Care Compliance Professional's Manual, Second Edition ISBN: 9781543813265 SKU: 10071961-7777

Authored by experts with years of health care compliance experience, this new edition integrates changes in regulation, trends in enforcement, and the reasoning of the courts to help you navigate emerging and unsettled areas of compliance risk, such as self-disclosure obligations, risks associated with opioid use, and the impact of statistical sampling.Highlights of this edition include:All new glossary of health care compliance terms, including key statutes, acronyms, governing agencies, and moreExpanded civil monetary penalty and exclusion authorities under 2017 final rulesDiscussion of core elements of compliance programs for Medicare Advantage Plans and Part D Plans as established by federal regulationsExpanded whistleblower protections under federal and state law, false claims based on lack of medical necessity, materiality after Escobar, and recent enforcement activityExpanded discussion of determinations of medical necessity, CMS review of medical necessity terminations, consequences, and appeals processesRecent health information privacy and security developments, including new guidance, risks associated with innovative technologies, and trends in Health Insurance Portability and Accountability Act (HIPAA) enforcement activityNew chapters:Chapter 1, Glossary of Key TermsChapter 10, The Relationship between Enforcement and ComplianceChapter 17, Health Care Civil Rights and Nondiscrimination Under Section 1557 of the Affordable Care ActChapter 19, Behavioral Health

Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.

An indispensable resource for doctors, community hospitals, and group practices struggling to understand the law and ethical standards on interactions with pharmaceutical and device companies, this title is the first summary of the law and ethics on physician relationships with industry.

Now more than ever, doctors are being targeted by government prosecutors and whistleblowers challenging the legality of their relationships with drug and device companies. With reputations at stake and the risk of civil and criminal liability, it is incumbent upon doctors to protect themselves. Managing Relationships with Industry: A Physician's Compliance Manual is an indispensable resource for doctors, professional societies, academic medical centers, community hospitals, and group practices struggling to understand the ever changing law and ethical standards on interactions with pharmaceutical and device companies. It is the first comprehensive summary of the law and ethics on physician relationships with industry written for the physician. Authored by a former state Attorney General, Harvard Medical School Professor, health care lawyer and professor of ethics, Managing Relationships approaches the topic from a balanced and reasoned perspective adding to the on-going national dialogue and debate on the proper limits to medicine's relationship with industry. - The first complete and up-to-date summary and analysis of the law and ethics on physician-industry relationships - Focuses on major enforcement actions and whistleblower lawsuits and the lessons learned for physicians - Provides options and guidance for maintaining compliant relationships and avoiding traps for the unwary - Covers both drug and device company relationships - Summarizes the types of industry relationships that are necessary and productive and those that are harmful and abusive - Details the law and ethics for each type of relationship including gifts, off-label uses and marketing, CME, speaker's bureaus, free samples, grants, consulting arrangements, etc. - Includes sample contracts for permissible consulting and CME speaker engagements

Healthcare IT is the growth industry right now, and the need for guidance in regard to privacy and security is huge. Why? With new federal incentives and penalties tied to the HITECH Act, HIPAA, and the implementation of Electronic Health Record (EHR) systems, medical practices and healthcare systems are implementing new software at breakneck speed. Yet privacy and security considerations are often an afterthought, putting healthcare organizations at risk of fines and damage to their reputations. Healthcare Information Privacy and Security: Regulatory Compliance and Data Security in the Age of Electronic Health Records outlines the new regulatory regime, and it also provides IT professionals with the processes and protocols, standards, and governance tools they need to maintain a secure and legal environment for data and records. It’s a concrete resource that will help you understand the issues affecting the law and regulatory compliance, privacy, and security in the enterprise. As healthcare IT security expert Bernard Peter Robichau II shows, the success of a privacy and security initiative lies not just in proper planning but also in identifying who will own the implementation and maintain technologies and processes. From executive sponsors to system analysts and administrators, a properly designed security program requires that that the right people are assigned to the right tasks and have the tools they need. Robichau explains how to design and implement that program with an eye toward long-term success. Putting processes and systems in place is, of course, only the start. Robichau also shows how to manage your security program and maintain operational support including ongoing maintenance and policy updates. (Because regulations never sleep!) This book will help you devise solutions that include: Identity and access management systems Proper application design Physical and environmental safeguards Systemwide and client-based security configurations Safeguards for patient data Training and auditing procedures Governance and policy administration Healthcare Information Privacy and Security is the definitive guide to help you through the process of maintaining privacy and security in the healthcare industry. It will help you keep health information safe, and it will help keep your organization—whether local clinic or major hospital system—on the right side of the law.

Regulatory Compliance in the Healthcare Industry: Navigating the Complexities" is a comprehensive guide that equips healthcare professionals with the knowledge and strategies needed to ensure compliance with regulatory requirements. Authored by experts in healthcare compliance, this book covers key topics such as patient privacy, data security, quality of care and compliance program development. Real-world case studies, best practices and practical tools make this book an essential resource for healthcare professionals, compliance officers and administrators seeking to navigate the intricate landscape of regulatory compliance and promote ethical practices in the ever-evolving healthcare industry.