From The List Below Choose One Topic Related To Financial Management ✓ Solved

From the list below, choose one topic related to financial management in health care organizations. Include a cover page and a list of references at the end of the paper in APA Format. Paper will be double spaced and be 4-5 pages in 12 point New Times Roman font. TOPICS · False Claims Act · Physician Self-Referral Act (Stark Law) · Anti-kickback Statute · Civil Monetary Penalties Law · Exclusion Authorities · Tax Exemption (Non-profit Hospitals) · Anti-trust & Accountable Care Organizations · Deficit Reduction Act The assignment is to be written in clear, concise narrative. All sections in the outline for Assignment #2 are required.

Outline: Must use the headings from the outline below in your paper and the paper must be in narrative form not outline or bullet format. A penalty will be deducted from paper if underlined headings not used in your paper. 1. Name of the Law and or laws: State the official title of the federal and/or state law, the statute and section number. Must be either a federal statute or state statute and you must cite both if applicable.

Thus if there is both a federal and state law that covers your subject picked then you must cite both. Do not assume that there is just a federal and or state law. In most cases there is both a federal and state law. You must use the laws cited in this section throughout the rest of the paper. 2.

Management’s Financial Responsibilities: What are the health care organization’s responsibilities under this financial management statute you stated above? Provide a comprehensive discussion of three (3) specific responsibilities under the financial management statute. State specifically after each responsibility where this responsibility is stated in the federal or state law . Describe the appropriate behavior and expectation. Include the citations and source of documents describing the organization’s responsibilities.

3. Consequences for Ethical or Legal Breach : Discuss in general the civil and criminal consequences from the law. Then identify from the news, three (3) specific case examples of health care organizations or health care providers found guilty of a legal or ethical breach relative to the law you have cited in first part of paper. Identify the specific legal and/or ethical breach and the penalties assessed to the health service organizations and/or individuals found guilty of violating the law or ethics [provide citation of law]. At the end of each case, discuss in detail whether you agree or not with the decision and why.

Bring in the facts of the case to support your comments. Students should use a minimum of three (3) documented specific examples retrieved from the print media. 4. HCO Management’s remedial steps to reverse the non-compliance organizations : Describe in detail three (3) specific management actions or remedial steps you would take to ensure the financial management in the health care organization meets or exceeds the federal law or state law relative to the requirements of the law you cited above. Discuss specifically how each of the three management actions specifically meets or exceeds the specific federal or state law you cited.

Note: These actions may include specific uses of technology, procedures, human resource training, and other management tools. However these action steps must be within the control of a manager. 5. Conclusion: Summary your findings above 6. Reference List [ APA Format] The paper must be: · Late penalties: See Course Syllabus. · Be sure and use the underlined headings found in the outline below in your paper.

Paper must be in narrative format not outline or bullets. · Double spaced and be 4-5 pages in 12 point New Times Roman font. · Include a cover page [not counted as a page] which should have student name and title of your paper [Provide a short name for the legal responsibility the specific health care organization has for one type of patient right in a specific setting ] · A the end of the paper a list of references in APA Format [not counted as a page] · Be prepared using word-processing software and saved with a .doc, .docx, or .rtf extension. No pdf. · Be uploaded to your Assignments Folder by 11:59 p.m. EST on the due date. · The paper is to be posted in Assignment #2 drop box. · Must cite to the source for all your facts in the text of your paper in APA format.

Example of an in text citation: (Ernst, & Young, 2000 p14). Example of source cited on Reference page: References Healthcare Financial Management Association (U.S.), Ernst, & Young. (2000). Health care system reform: A provider perspective : survey results. Westchester, Ill.: Healthcare Financial Management Association. THE ORGANIZATION I HAVE SELECTED The Division of Family & Children Services (DFCS) is responsible for welfare and employment support, protecting children, foster care and other services to strengthen families (Georgia.gov).

The agency for which I will develop my strategic plan will be with the Georgia Division of Family & Children Services (DFACS). It is a regional agency and I selected for my capstone because it is my desire to affect change in the area of child abuse and neglect. This is an area of familiarity, as I have had the opportunity to volunteer at one of their offices while stationed in Georgia. My strategic plan will be developed from the perspective of social change. I chose to focus on this perspective for my strategic plan because there is always room for improvement and to also continually lower the percentage of child maltreatment that occurs in the state of Georgia.

This agency investigates reports of child abuse; finds foster and adoptive homes for abused and neglected children. Reference: Department of Human Services. Retrieved from:

Paper for above instructions

Introduction

The healthcare industry operates within a complex regulatory framework that encompasses a multitude of laws designed to ensure ethical practices. One significant piece of legislation in this context is the Federal Anti-Kickback Statute (AKS), which was enacted as part of the Social Security Act and is identified in Section 1128B(b) (42 U.S.C. § 1320a-7b). This law prohibits the exchange of inducements in the form of payment or compensation aimed at influencing the referral of services reimbursed by federal healthcare programs, including Medicare and Medicaid. The Anti-Kickback Statute is crucial for maintaining the integrity of the healthcare system and prevents financial impropriety that could harm patients and inflate healthcare costs (U.S. Department of Justice, 2021).

Management’s Financial Responsibilities

Under the Anti-Kickback Statute, healthcare organizations (HCOs) have distinct responsibilities to ensure compliance with legal regulations. Firstly, HCOs must establish and enforce a compliance program, which includes regular training for all employees and stakeholders about the provisions of the AKS (U.S. Department of Health and Human Services, 2020). This responsibility is a direct reflection of Section 1128B(b)(1), which outlines the need for internal controls to detect and prevent fraud.
Secondly, HCOs must adequately screen and vet potential vendors and referral sources to assess compliance with the AKS. This mandates a thorough background check of referral sources, which should adhere to ethical standards and regulatory guidelines (Centers for Medicare & Medicaid Services, 2022). This responsibility is implicitly supported by the statute, which discourages business arrangements that could be construed as violative of the AKS.
Lastly, healthcare organizations must implement transparent documentation processes for all transactions involving payments or compensations to ascertain that these do not violate the AKS. Both the nature of the transaction and its necessity for patient care should be documented to show compliance (American Health Lawyers Association, 2021). Section 1128B(b)(2) states that engage in the illegal provision of payoffs or kickbacks for services is a federal offense—making transparent documentation essential to demonstrate legal compliance.
These responsibilities reflect a commitment to ethical financial management, which is critical in the contemporary healthcare landscape.

Consequences for Ethical or Legal Breach

The potential consequences of breaching the Anti-Kickback Statute can be severe, involving both civil and criminal penalties. Civil penalties can include fines that may reach up to ,000 per violation and potential exclusion from federal healthcare programs, while criminal charges could lead to imprisonment for up to five years for knowingly and willfully violating the law (U.S. Department of Justice, 2021).
Three case examples illustrate the grave implications of violating the AKS. In United States v. HealthSouth Corp., the healthcare provider settled for 5 million after allegations arose that executives engaged in kickback schemes (U.S. Department of Justice, 2014). The penalties reflect the heavy costs associated with unethical behavior within healthcare management. I agree with this decision because it upheld a strong deterrent against future violations.
A second case is United States v. Amedisys Inc., where the provider faced a million settlement due to allegations of incentivizing referrals, which could lead to excessive billing for unnecessary services (U.S. Department of Justice, 2017). This decision was appropriate, given the need to ensure a balance between profit-making motives and patient welfare.
Lastly, in U.S. v. Abbot Laboratories, the company was fined .68 billion for offering kickbacks to healthcare providers in exchange for promoting its drugs (U.S. Department of Justice, 2012). This case exemplifies the severe financial repercussions for ethical lapses and serves as a cautionary tale concerning the profitability of pharmaceutical interventions.
These examples underline the necessity for stringent adherence to the AKS, as breaches not only damage the financial standing of HCOs but also erode trust in the healthcare system.

HCO Management's Remedial Steps

To reverse or mitigate non-compliance with the Anti-Kickback Statute, managers at HCOs can take several strategic steps. Firstly, establishing a comprehensive compliance training program that includes regular updates about the changes in regulations is crucial. Training should be mandatory for all staff to understand the ramifications of the AKS and recognize potentially harmful arrangements (U.S. Department of Health and Human Services, 2020). This step exceeds basic compliance as it fosters an organizational culture that prioritizes ethical standards.
Secondly, utilizing technology-driven solutions, such as automated compliance monitoring tools, can bolster an organization’s ability to detect potential kickback arrangements before they develop into serious infractions. These systems can flag suspicious transactions or relationships that may violate the AKS, enabling proactive management (Healthcare Financial Management Association, 2021).
Lastly, forming an ethics and compliance committee within the organization can further ensure that policies related to the AKS are continuously evaluated and updated to reflect the best practices in the industry (American Health Lawyers Association, 2021). This committee should regularly report to leadership on compliance status and areas of concern related to AKS, thus emphasizing its crucial role in upholding the integrity of the healthcare organization.
By implementing these measures, HCOs can work to not only meet but exceed the regulatory requirements established by the Anti-Kickback Statute.

Conclusion

The Anti-Kickback Statute serves as a fundamental regulatory framework that safeguards against unethical financial practices in healthcare. The responsibilities of healthcare organizations and the severe consequences of operational breaches encapsulate the statute's importance. Through proactive and strategic management actions, HCOs can mitigate risks associated with compliance failures and build ethical organizational cultures. These efforts are essential not only for the financial health of organizations but also for maintaining public trust in the healthcare system.

References

American Health Lawyers Association. (2021). Understanding the Anti-Kickback Statute. Retrieved from https://www.healthlawyers.org/
Centers for Medicare & Medicaid Services. (2022). Guidance on Compliance Programs. Retrieved from https://www.cms.gov/
Healthcare Financial Management Association. (2021). Managing Compliance in Healthcare Organizations. Retrieved from https://www.hfma.org/
U.S. Department of Health and Human Services. (2020). Compliance Program Guidance for Individual and Small Group Physician Practices. Retrieved from https://oig.hhs.gov/
U.S. Department of Justice. (2012). Abbott Laboratories to Pay .68 Billion Criminal and Civil Settlement. Retrieved from https://www.justice.gov/
U.S. Department of Justice. (2014). HealthSouth Corporation Agrees to 5 Million Settlement. Retrieved from https://www.justice.gov/
U.S. Department of Justice. (2017). Amedisys Inc. to Pay Million to Resolve False Claims Act Allegations. Retrieved from https://www.justice.gov/
U.S. Department of Justice. (2021). Anti-Kickback Statute. Retrieved from https://www.justice.gov/
U.S. Government Accountability Office. (2018). Health Care Fraud: Actions Needed to Improve Medicare Program Integrity. Retrieved from https://www.gao.gov/
Fraud Enforcement and Recovery Act of 2009. (2009). Public Law No: 111-21.