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Regulation / Accreditation my discussion topic: Corporate Compliance…
Regulation / Accreditation
my discussion topic:
Corporate Compliance Program
understanding and application of the role regulation and accreditation has in the health care industry
multiple regulations and regulatory / accreditation bodies in the health service industry
apply the assigned concept
Pick a hospital: nursing home
discuss how you would mitigate a challenge that these regulations / regulators / accreditation pose to your selected environment.
Gospin, D. E., & Yeung, L. R. (2014). Compliance Program Effectiveness: Do You Really Need Outside Counsel, and How Does That Relationship Work?. Journal Of Health Care Compliance, 16(3), 21-26.
Chibbaro, M. J. (2000). Making Corporate Compliance Programs Work. Hfm (Healthcare Financial Management), 54(5), 60.
effective organizational infrastructure
consequences of not establishing CCP
Harrington, C., Stockton, J., & Hooper, S. (2014). The Effects of Regulation and Litigation on a Large For-Profit Nursing Home Chain. Journal Of Health Politics, Policy & Law, 39(4), 781-809. doi:10.1215/03616878-2743039
studies to compare the impact of regulatory actions and litigation
on nursing home chains
did not comply
with California’s nurse staffing standards
violations of
federal quality regulations,
Federal law requires nursing homes to meet federal quality standards in
order to receive funds for either Medicare and/or Medicaid.
what impact state regulatory actions and
class action litigation had on a large for-profit nursing home chain’s
compliance with nursing home staffing and quality regulations.
negative financial impact
Civil litigation had more impact on the chain than the regulatory oversight
Skilled Healthcare Group’s California facilities and parent company
Chibbaro, M. J. (2000). Making Corporate Compliance Programs Work. Hfm (Healthcare Financial Management), 54(5), 60.
Why healthcare organization created it?
minimize risk of wrongful behavior
reduce fines that result from gov audit
adhere to federal gov recomm.
3 primary reasons
keep non-compliant events from happening
ensure organization is the first to learn about a non-complaint
reduce negative consequence from external investation
Reasons for establishing
effective organizational infrastructure
who created it
Healthcare organization
Corporate Compliance Program
What is the program?
Who is responsible? various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, to encourage the development and use of internal controls to monitor adherence to statutes, regulations, and program requirements.
When do manager need to be aware of this?
Where is this program operated?
Why should manager care?
Who was involved? Healthcare providers
What happened?Compliance and reporting
When did it take place? Violating a regulations
Where did it take place?
Why did that happen?
Undetected weaknesses