282L group project PP
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School
Galen College of Nursing *
*We aren’t endorsed by this school
Course
282
Subject
Information Systems
Date
Feb 20, 2024
Type
pptx
Pages
8
Uploaded by giannafdamico
282L Spring 2023
Corporate Compliance &
HIPAA Confidentiality
Group 3 Members:
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Izzy B.
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Gianna D.
•
Rachel E.
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Jordyn K.
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Jaimie M.
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Tina R.
4 Objectives
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State what Medicare fraud is and list at least one example
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Verbalize how bribes and kickbacks violate corporate compliance rules
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Verbalize at least two ways to prevent patient information breaches in the hospital
•
List two penalties for violating HIPAA
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Corporate Compliance
State what Medicare fraud is and list at least one example
Deceiving the Government by billing Medicare for services and/ or supplies that was never received, double billing for services, using a individuals Medicare number without their knowledge and using it to submit false claims.
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Example: Mrs. Blake goes into her doctor's office for a cortisone injection which she is receiving for pain management every 6-7 weeks. She receives a call a few days after her last visit asking about her experience with the knee brace, she is now using, in addition to the injections. However, she has never been offered nor received a knee brace. Upon investigation she discovers her doctor has billed her for a knee brace not once but twice.
Corporate Compliance
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Verbalize how bribes and kickbacks violate corporate compliance rules.
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”Kickbacks"/ bribes violate corporate compliance by accepting or rewarding an individual who refer business to you. The referral process for Medicaid and Medicare has steps in place to properly refer clients to physicians. "In the federal health care programs, paying for referrals is a crime" ([42 U.S.C. § 1320a-7b(b)].
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Stark law: The physician self-referral law prevents physicians from referring indivisuals to receive health care servies which can be billed to Medicaid or Medicare in which the physician has a personal and/ or financial relationship with.
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Kickback statue: This statue covers the intent of both parties (the payer and the recipient) to be criminally penalized who offer and accept willful payments, nice trips, meals, travel ect in exchange for referrals. Violating this staue can result in jail time, fines and being excluded from being eligible to participate in federal health care programs.
HIPAA Violations/Confidentiality
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Verbalize at least 2 ways to prevent patient information breaches in the hospital.
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Before walking away from your computer, make sure the screen is locked for privacy
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Don’t talk about patient information with other nurses in the hallway
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Don’t leave any patient’s information exposed anywhere
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HIPAA Violations/Confidentiality
•
List 2 penalties for having a HIPAA violation
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Civil penalties include imprisonment and fines up to $50,000, per offense
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Nursing license may be revoked
References
What are the penalties for violating HIPAA?
(2023). Retrieved from ADA: https://www.ada.org/resources/practice/legal-and-regulatory/hipaa/penalties-for-violating-hipaa
Reporting Medicare fraud & abuse (2022). Retrieved from:
https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse
Office of inspector general. Retrieved from:
https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/