University of Phoenix Medicare Abuse and Fraud Discussion

Description

*****As a health care manager, how do your operations decisions and legal and regulatory requirements impact each other? Provide examples.Include Refernce

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RESPONSE TO KATIE:….As a health care manager your operations decisions and legal and regulatory requirements impact each other greatly.You have to make decisions regarding your operations that align with the legal and regulatory requirements to avoid issues in the future that could be as large as breaking the law and could face severe penalties.Both teams should work together in tandem to ensure that all the regulations and legal requirements are being adhered to as well as ensuring that the facility runs smoothly and to the best of it’s ability.

As a health care manager operations decisions are important and you have to take everything into consideration, including budget, staffing, ordering needs, etc. this includes creating or helping to create policies and procedures. These policies and procedures must align with the regulatory compliance teams’ advice as to what ensures that legal requirements are being met.The staff must be properly trained on these policies and procedures. This ensures that both the patients and facility are protected from anything unlawful or against procedure occurring.

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RESPOND TO PROFESSOR : Great response, Katie! You made an excellent point that operational decisions and legal and regulatory requirements impact each other immensely. Operational decisions must keep legal and regulatory requirements as a fundamental foundation which guides the direction of the operational processes. Without compliance being the center of focus, the risk is drastically increased for an organization. Fines and other penalties, including loss of enrollment with Medicare/Medicaid, can result if non-compliance is identified.

Katie and/or All—See the information from CMS regarding fraud and abuse. According to CMS, what is the difference between “fraud” and “abuse”?

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