Amanda H. extended essay help biology the essay writing structure

The five elements pertaining to the establishment of a false claim under the False Claims Act are the government must establish that the claim submitted is false and that it was submitted knowingly, the government must establish that the person submitted the claim with actual knowledge, in deliberate ignorance, or with reckless disregard for the claim’s truth or falsity, the claim was against a department or agency of the United States and if the claim was material.

Privacy Standards were designed to accomplish the following three broad objectives: Define and limit the circumstances in which entities use and disclose PHI, establish certain individual rights regarding PHI and require covered entities to adopt administrative safeguards to protect the confidentiality and privacy of PHI. According to our textbook, the HIPAA Privacy Standards prohibit covered entities from using or disclosing individually identifiable health information that is or has been transmitted or maintained electronically.

This requirement is not limited to the record in which the information appears but applies to the actual information itself. Any information that has been transmitted by fax, telephone, computer, electronic handheld device is protected by the HIPAA Standards. Privacy Standards states that an individual has rights over their health information, including the right to request restrictions on certain uses and disclosures of their PHI, the right to inspect and copy their PHI, the right to amend their PHI, and the right to receive an accounting of disclosures of their PHI.

Covered entities must comply with the Security Standards with respect to e-PHI. Compliance requires the covered entity to ensure the confidentiality, integrity, and availability of all e-PHI the covered entity creates, receives, maintains, or transmits, protect against any reasonably anticipated threats or hazards to the security or integrity of such information, protect against any reasonably anticipated uses or disclosures of such information that are not permitted or required under the Privacy Standards and ensure compliance with HIPAA by its workforce.

Stark II laws prohibit physician referrals to entities in which the physician has a financial relationship. There are ten specific designated health services for which referrals by physicians who have financial relationships with the entity providing the designated health service that are prohibited.

According to our textbook, they are Clinical laboratory services, Physical therapy, occupational therapy, and speech-language pathology services, Radiology and certain other imaging services, Radiation therapy services and supplies, Durable medical equipment and supplies, Parenteral and enteral nutrients, equipment, and supplies, Prosthetics, orthotics, and prosthetic devices, Home health services and supplies, Outpatient prescription drugs and Inpatient and outpatient hospital services.

Basically, what this means is referrals are “prohibited between a physician and a hospital where a physician has an impermissible contractual relationship with a physician group that shares a parent entity with the hospital. ” Qui tam is an abbreviation of a Latin phrase that means “he who as well for the king as for himself sues in this matter. ” According to our textbook, Qui tam is a legal term for the mechanism in the Federal False Claims Act that allows persons and entities with evidence of fraud against federal programs or contracts to sue the wrongdoer on behalf of the government.

Qui tam actions are known as whistleblowers. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was established to set national standards to protect patient medical records and other personal health information and applies to health plans and those health care providers that conduct certain health care transactions electronically. HIPAA requires safeguards to protect the privacy of personal health information and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization.

HIPAA also gives patients rights over their health information, including rights to examine and obtain a copy of their health records and to request corrections. The Emergency Medical Treatment and Active Labor Act (EMTALA) requires all Medicare and Medicaid participating hospitals with an emergency department to provide appropriate medical screening to each patient requesting emergency care to determine whether the patient requires such care.

According to our text, EMTALA is referred to as the “antidumping law” because it prohibits hospitals from transferring an emergency patient to another hospital simply because of the patient’s inability to pay. The statuete requires the hospital to medically stabilize the patient regardless of their ability to pay and they are prohibited from posting payment information in the patient’s emergency room.

EMTALA also permits hospital staff to engage the patient in discussion regarding his or her financial or insurance information before conducting the medical screening examination and stabilization of the emergency condition. Compliance programs are systemic procedures instituted by an organization to ensure that the provisions of the regulations imposed by a government agency are being met.

The Office of Inspector General suggests the following for an effective compliance plan: Organize compliance materials, learn what laws and regulations govern its practices and put in writing the necessary steps for a high-level compliance officer to be certain that it obeys the law, appoint a high-level compliance officer who can insist the organization be compliant, employee education and systemic compliance training, development of effective lines of communication, consistent and continuous enforcement of compliance standards through well-publicized disciplinary standards, development of auditing and monitoring programs and development of mechanism for reporting detected violations.