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In: Operations Management

Compliance officers are found in virtually all health care organizations. Most hospitals have a dedicated compliance...

Compliance officers are found in virtually all health care organizations. Most hospitals have a dedicated compliance officer. Smaller organizations may designate one of the top administrative leaders as the organization’s compliance officer. Health plans also have compliance officers. Any organization that bills Medicare or Medicaid needs a compliance officer.

You will be interviewing a compliance officer for a health care organization and using that information to write a paper. The list of potential paper topics is:

Not reporting medication errors

Keeping these topics in mind, the questions you will need to ask when interviewing the compliance officer are:

What are your roles and responsibilities as the compliance officer?

What are the methods used for a patient to file a complaint?

How do you deal with civil versus criminal complaints?

What moves an internal compliance issue to have to be reported to law enforcement, CMS, or a health plan?

What are the most risk management issues for your organization?

What type of accreditation issues do you work on?

For this discussion, you will come up with additional questions to help you write your paper.

In your first post, list an additional three to five questions that you will plan to ask the compliance officer that you will interview. Focus on the roles of a compliance officer and what the compliance officer sees as possible trends in the future for that role. Review the HCCA website to view current resources about health care compliance issues.

Solutions

Expert Solution

Role and responsibilities of a Healthcare Compliance Officer:

  • Make a compliance committee to enforced the standards with disciplinary guidelines
  • To address issues concerning individuals
  • To conduct an internal investigation promptly, do take corrective actions
  • Report on above findings to the government
  • act as liaison between the board of directors and the government
  • educate employees and management on the rules of standards to be implemented in compliance programs

Methods used for a patient to file a complaint:

  • filing of a complaint may also be done ??by phone, fax or email or written
  • a complaint is submitted to a doctor or the management of a healthcare facility
  • Complainant can file another complaint, if not happy with the resolution of first one to the responsible administrative authority

How do you deal with civil versus criminal complaints in healthcare:

In criminal cases, only the federal or a state government (the prosecution) may initiate a case; which are further decided by a jury; punishment for serious (felony) charges often consists of imprisonment/ a fine paid to the government.

In civil cases, cases are initiated (suits are filed) by a private party (the plaintiff); further decided by a judge (though significant cases may involve juries); punishment almost always consists of a monetary award and never consists of imprisonment.

Most risk management issues in healthcare organization:

  • Cyber Risk- Cyber hacks and data breaches
  • Healthcare Infections
  • Complexity in Healthcare Reform/Physician Integration
  • Poor Emergency Preparedness
  • Challenges of Telemedicine

Additional three to five questions that you will plan to ask the compliance officer that you will interview:

  • Have educational qualifications as a Bachelor Degree in Business Administration with a focus on corporate law?
  • Aware of all standards in compliance program?
  • Knowledge of who is the authority to be reported in case of any violations and related procedure awareness?

keosha answered 1 year ago
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