Healthcare compliance laws
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Metropolitan Community College, Kansas City *
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0105
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Health Science
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Dec 6, 2023
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docx
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Uploaded by ProfessorKingfisher2276
Healthcare compliance laws
Many laws regulate the healthcare industry. While the following isn’t an exhaustive list of laws and
regulations, these are some important ones:
Health Insurance Portability and Accountability Act (HIPAA): Protects private patient information from
being shared without a patient’s knowledge or consent.
Health Information Technology for Economic and Clinical Health (HITECH) Act: HITECH expands the scope
of HIPAA and provides healthcare facilities with certain standards for using IT to implement electronic
health records (EHR).
Emergency Medical Treatment & Labor Act (EMTALA): This law was enacted to ensure the public can
access emergency treatment regardless of whether they can pay.
Patient Safety and Quality Improvement Act (PSQIA): This law was enacted to encourage the reporting,
discussion and resolution of patient safety issues. It also authorizes the Agency for Healthcare Research
and Quality to provide a database of Patient Safety Organizations (PSOs).
Anti-Kickback Statute: A statute that prohibits providers and organizations from receiving financial
incentives for a patient referral when the federal government may be charged for those services.
False Claims Act (FCA): Under the FCA, filing a false claim for federal program funds is illegal and
punishable with fines from $11,803 to $23,607.
These laws are in place primarily to protect patients and ensure that all individuals have equitable access
to healthcare in the U.S.
Who is responsible for healthcare compliance?
Everyone in a healthcare organization must adhere to the healthcare regulations established by the
government. It’s the responsibility of every professional to make sure they are acting ethically and per all
laws. Many healthcare organizations have a compliance officer, or a similar role, to help ensure the
facility is compliant.
Having someone in a designated role can help make it easier for a facility to coordinate or communicate
with government agencies or third-party organizations that maintain healthcare compliance standards.
Multiple government agencies and a not-for-profit organization are involved in maintaining compliance
programs:
Department of Health and Human Services (DHS): A federal agency focused on improving the health,
safety and well-being of every American.
Drug Enforcement Administration: A federal government agency tasked with combating drug trafficking
and distribution in the U.S., including prescription drugs.
The Joint Commission: A not-for-profit institution that introduced a standard for accreditation of
healthcare organizations in the U.S.
Office of the Inspector General: An office within the U.S. Department of Health and Human Services
whose mission is to protect the integrity of DHS programs through audits and investigations.
Food and Drug Administration (FDA): An entity that regulates the information that must be included and
disclosed on prescription drugs. The FDA also approves or disapproves prescription drugs to be used in
healthcare.
These entities can provide resources and guidance on any healthcare compliance issues you might
encounter.
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