Legal of Aspects of healthcare final

Legal Aspects of Healthcare
Name:
Institution:
Abstract
The healthcare industry is a highly managed institution by the federal government because it determines the economic, social, and political success of the society. As a result, several rules and regulations have been formulated to govern the running of the institutions within this industry for purposes of achieving affordable care. However, fraudulent activities have emerged ever since concerning the federal health care payments. Physicians can overcharge the government or provide under-quality products, which is a culpable act under the false claim act. Moreover, inflating charges for inpatient and outpatients services for personal gains can occur during hospital service delivery. Therefore, the government through various departments instituted fraud and abuse regulations to help curb this menace and ensure that the citizens receive what is due to them. Significant statutes that relate to healthcare include the False Claim Act, exclusive authorities, the stark law, anti-kickback laws and civil monetary penalties. These statues ensure that service delivery is offered with honesty and vigilance at the healthcare facilities.

Legal Aspects of Healthcare
Scenario Questions
Revenue Sources and Tax Implication
The institution is facing several issues because of revenue sources including health insurance exchanges, bed capacity, lack of physicians, reimbursement cuts, changing donor preferences and employee relations.

The available covers that most of the patients in the community are using lead to lower reimbursement. As a result, we are forced to absorb the extra costs, which are leading the organization to bad debts. Further, we are having issues signing patients up for the new covers because the plans are not as favorable. The society needs to be educated about the need for insurance covers to achieve the intended target of covered people in the society. High deductibles have also laid a great burden on the institution.
Because of these cost issues, we have been unable to expand our bed capacity, which is affecting our service delivery process. Further, we are short in terms of qualified personnel to deal with the rising number of patients. As a result, we are losing patients to other facilities in the area, which has dire effects on our reimbursement cuts. The only viable solution is to hire profit practitioners to deal with the needs of the society. However, by taking this step we will risk being banned from the tax exemption program and ultimately reduce the access of care in our facility due to the high costs that our services will be charging at to cover the new expenses.
Lastly, our financial sources have evolved over the last few years. Although the use of philanthropy practices as opposed to fundraising has helped us acquire large sums of money, the focus of donors is changing. Therefore, we need to come up with groundbreaking ideas to keep the donors at our side. Luckily, we do not have tax implications this financial year, which is good for us.
Risk Management
The key issues that I need to analyze in the institution to ensure that the hospital is free from legal liability include:
Financing and Insurance Claim Management
Clinical Research
The Human and Psychological Health Care
The Emergency Preparedness
The Tax Liability Issues
Physicians Availability
Employee Relations-Layoffs
The institution must operate within the set laws and regulation to avoid fraudulent activities when handling insurance claim issues. Further, the mandatory federal regulations are to be followed to limit the chances of facing lawsuits for the individuals as well as the institution (Karuppan, Dunlap & Waldrum, 2016). For instance, the use for profit physicians can cause the hospital to be banned from tax exemptions stipulated for community-owned facilities. Therefore, the facility needs to request for more personnel from the local government to avoid this problem in the future. The number of stakeholders needs to be limited to the minimum to reduce the cost of operations. These costs can be used to further community programs that will encourage donors to invest in the facility.
To reduce the legal liability of the hospital, the access to the lobby needs to be regulated to ensure that the hospital is not culpable for accidents that happen in the lobby on another person’s charge. Limiting the access to the lobby will ensure that the institution has full control of that area and provide the institution with a better opportunity of managing hospital acquired infections. Educating the staff about the various claims and the proper management of federal healthcare payments will also help to reduce the legal exposure of the institution. Importantly, the facility must sign compliance forms indicating that they are upholding the ethical and legal principles as stipulated by the various statutes that affect healthcare.
The history of Anglo-American legal system and its relation to healthcare
The American law is meant of four sub-segments including the constitution, statutes, administration regulations, and judicial decisions. None of the segments of the government or the law is considered more powerful in the United States. The written law has existed in the world since time immemorial and the first written regulation were those done by Hammurabi. A code of operation that is famous for its eye-for-an-eye practice. The code included everyday guidance for the people at the time including marriage, inheritance, and criminal procedure practices. The Anglo-American has embraced this aspect of writing rules and regulations meant to govern the society in various documents. The constitution, for instance, is the written law of the nation that guides the functioning of public and privately owned organizations and individuals.
The conquest of Norman in England is what gave birth to the Anglo-American law, as we know it today. The law is meant to protect the citizens from harm by ensuring that people do not practice revenge and blood feuds when faced with a dispute. The law allows people to take their grievances to courts or use other alternatives such as arbitration to deal with personal disputes. The Anglo-American law embodies the private and the public law effective for serving the diverse needs of the society.
The Anglo-American law has considerable effects on the healthcare industry of the United States of America. The industry is one of the most regulated to ensure health communities. Both the public and private law standards govern the operation of healthcare facilities. Every decision made by a practitioner of an administrator has legal implications. However, the emergence of Affordable Care Act has changed many legal facets affecting the healthcare industry.
Chapter Questions
Several factors motivate the healthcare industry to uphold the programs aimed at compliance and corporate ethics. First, the health care industry is one of the highly regulated industries in the United States. The organizations within the industry have clearly set mandates; therefore, upholding these programs ensures that an organization remains operational within the industry. Further, the existence of audit reports by an external auditor mandates the organization uphold the programs to ensure that misconduct is corrected before it gets to the higher offices and risks the loss of operational license. Moreover, organizations follow these principles and the programs assigned by the government to avoid lawsuits and the closure of the business (Karuppan et al., 2016). Designated compliance officer in healthcare organizations is also one of the factors causing the facilities to adhere to the programs and ethical principles.
Several fraudulent behaviors can occur in hospital operations concerning federal health care payments. Physicians can overcharge the government or provide under-quality products, which is a culpable act under the false claim act. Moreover, inflating charges for inpatient and outpatients services for personal gains can occur during hospital service delivery. It is important to note any misbehavior in relation to federal healthcare payment carries long sentences and punishments. Further, people have been accused of artificial acquisition where one fortifies the Medicare quotes for personal reasons. In some situations, physicians can prevent eligible people from registering to a Medicare program, which is also categorized under false claim (Field, 2007). Performing unnecessary surgical procedures to a Medicare or Medicaid patient, authenticating payment of services from an imaginary patient as well as receiving overpayment for services when the patient has already passed on are some of the fraudulent activities that can exist in the healthcare industry.
Significant statutes that relate to healthcare include the False Claim Act that prevents individuals from selling shoddy products to or overcharging government. Secondly, the statutes include the stark law that prevents physicians from referring Medicare and Medicaid patients to facilities in which the physician has some gain, as well as the anti-kickback laws that prohibit physicians and healthcare practitioners from taking monetary or material payments to offer favors to patients or other stakeholders in the industry. Civil monetary penalties and exclusion authorities also constitute the significant statutes that have a considerable effect on the healthcare industry. These statutes are enforced by various government organizations including the department of health, department of justice and center for Medicare and Medicaid among other responsible organizations. The affordable care act (ACA) has affected these statutes by eliminating and including clauses to the fraud and abuse laws to ensure that the United States government exposes all the fraudulent activities in the healthcare industry (Karuppan et al., 2016).
Kickbacks in the healthcare industry refer to the aspect of health care practitioner taking payoffs in monetary of material form to acquire certain programs for the patients. Kickbacks are considered fraudulent in the healthcare industry and many practitioners have faced lawsuits regarding kickbacks. The health ministry has formulated principles that prohibit people from taking payments or giving payments for whatever reason. Most of the times, kickbacks are given to acquire Medicare or Medicaid programs among other programs in the healthcare industry. Additionally, hospital superintended give and receive payments from each other for referring or receiving referrals from other organizations. Self-referrals refer to the aspect of patients choosing the services they want to take without consulting anyone. Moreover, the patients can choose the physician they want to see in hospitals where that service is allowed (Field, 2007). The self-referral services are limited; therefore, the patient must have adequate knowledge about which services allow self-referrals and those that do require a patient to follow the due process.
The stark law is a provision in the health care industry that prohibits physicians from referring patients to institutions in which the patient has a financial gain or some other benefits. If the physician or a family member owns the facility, the physician has a level of investment in the facility or the physician has a compensation plan with the facility, it causing a conflict of interest. The law mostly affects Medicare and Medicaid patients (Pozgar & Santucci, 2016). A physician become legally liable if he or she refers such a patient to an organization offering designated health services (DHS). Physician self-referral services affect the normal running of health care organization and raise the cost of care to unbearable states. The stark law has banned referrals to institutions that offer clinical services. The stark law serves similar but not the same services with the anti-kickback laws. It has three segments including stark (I), stark (II), stark (III). The first provision prohibits referrals for clinical services, the second provision provides exceptions to some of the clinical services and the third one revises the combination of both to bring a substantial and operational law.

References
Field, R. (2007). Health care regulation in America: complexity, confrontation, and compromise. Oxford New York: Oxford University Press.
Karuppan, C., Dunlap, N. & Waldrum, M. (2016). Operations management in healthcare: strategy and practice. New York, NY: Springer Publishing Company.
Pozgar, G. & Santucci, N. (2016). Legal aspects of health care administration. Burlington, MA: Jones & Bartlett Learning.