Course list

Working in compliance surrounding health care law, especially in an organizational context, isn't always simple. It involves coordinating many people — delegating roles, assigning tasks, and assembling and maintaining different types of expertise. It is necessary to understand multiple and occasionally overlapping systems like federal and state laws, statutes and regulations, and sometimes state or federal constitutional obligations. Most health care organizations have developed entire programs or departments that are focused on compliance, and that will be the focus in this course.

Throughout this course, you will explore various laws and regulations that health care organizations are required to follow in order to meet compliance obligations. Since there are many ways you could unintentionally fall out of compliance, you will discover strategies for averting risk by anticipating key areas of concern. By examining the consequences of noncompliance, you will recognize how such violations can be costly. As you uncover seven myths about health care compliance, it will be clear that laws and regulations apply to all organizations.

While you are not required to do so, we recommend consulting credible sources that are maintained by professional compliance groups such as the Health Care Compliance Association. Other compliance materials that may be useful are issued by the Department of Justice, the Office of Inspector General within Health and Human Services, and the Centers for Medicare & Medicaid Services. These will complement the materials on compliance and compliance programming covered in this course.

Healthcare organizations and their compliance departments spend a significant amount of time focusing on interactions with individuals. These diverse groups include everyone from patients to human research participants, along with many others, and these interactions necessitate different types of consent to do things like successfully provide service, obtain and use information, and engage in research activities. Throughout this course, you will explore some of the obligations that apply to healthcare organizations regarding these interactions with individual people.

To meet compliance standards, it is critical to keep a patient's health information private. Within the course, you will engage with tools designed to assure the capture of all the elements of a patient's informed consent, including consent to treatment, obtaining and disclosing information, and consent to participate in research. Various types of law apply in this context, including common law as well as federal and state statutes. As you progress, you will develop skills to distinguish among the various types and purposes of patient consent. You will also examine ways to protect this information once it is captured, not only by enforcing HIPAA regulations but by preventing potential exposure like a data breach or cyberattack.

Many medical advances have been made through research with human subjects, sometimes at a cost to the patients. You will also examine examples of unethical research and how recent guidelines have been put in place to avoid the misuse of human subjects. You will also discover how such special protections of patients include children. Organizations need to stay abreast of requirements surrounding consent and personal information, particularly as technology and the medium of interaction evolve over time. This course will help you to do just that.

Hospitals in the United States — especially private hospitals — have an unpleasant history of refusing to treat patients who are perceived as being unable to pay their bills. To address these issues, Congress passed a statute called the Emergency Medical Treatment and Labor Act, or EMTALA. The purpose of the statute is to provide for universal rights regardless of ability to pay or citizenship and to ensure screening for an emergency or labor. As a statutory right, EMTALA acts to reinforce our healthcare system by ensuring critical access to all.

In this course, you will explore the duty that healthcare organizations have to screen and treat patients in the emergency room setting. You will examine what constitutes an emergency and what the penalties are for failing to meet EMTALA obligations. There are some instances when it is appropriate to transfer a patient to another healthcare facility; you will explore those requirements as well. You will also discover the infrastructure required to comply with these healthcare obligations and examine the costs of uncompensated care to the healthcare organization as well as the community at large.

While healthcare involves a noble mission, it is nonetheless a business, and just like any other business operation, there is a potential for fraud. In this course, you will focus on what are commonly called fraud and abuse laws. You will discover the legal protections for the doctor-patient relationships in state law, such as doctor-patient confidentiality, as well as the doctor's fiduciary duties to the patient. At the federal level, you will examine fraud and abuse statutes that carve out particular types of transactions with profit motives to penalize. These are transactions where providers submit false claims to the government for payment and where providers receive kickbacks in exchange for ordering care or making referrals.

As you progress, you will examine the liability your organization can face under the False Claims Act, including medical billing and physician contracting. You will also examine the definition of a kickback and the penalty for receiving one. In addition, you will explore safe harbors that allow practices that could be construed as anti-kickback violations but are protected from penalty because they could benefit a patient's healthcare overall.

Federal laws provide protections for patients based on particular characteristics such as disability, race, and sex, among others. These laws grew out of evidence of systemic discriminatory practices by healthcare institutions and, while they don't cover everything, they deter or penalize the most egregious of these discriminatory practices. In this course, you will explore specific federal protections and how they have been strengthened by additional legislation.

As you explore discrimination on the basis of disability, you will examine two key federal laws: the Americans with Disabilities Act, which has a wide scope, and the Federal Rehabilitation Act of 1973, which is narrower. Progressing through the course, you will examine discrimination on the basis of race, color, or national origin. You will also discover how Title VI of The Civil Rights Act and Section 1557 of the Affordable Care Act are the principle statutes designed to protect individuals. You will examine the penalties for healthcare practices that discriminate on the basis of sex, including gender identity, as covered under two principal laws: Title IX of the Education Amendments Act and Section 1557 of the Affordable Care Act.

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