Purpose of A Healthcare Compliance Program

When it comes to healthcare, ethics and compliance aren’t simply legal requirements; they are critical components to quality and safe patient care too. Regardless of the specialty or size of the healthcare facility or practice, all the medical providers face concerns related to healthcare compliance.

Healthcare compliance is an ongoing process of legally abiding to professional and ethical standards that are applicable to the healthcare industry. Health care compliance requires effective development of policies, procedures, and processes in order to educate staff, define appropriate conduct, as well as to monitor that everyone adheres to set guidelines. A healthcare compliance program encompasses numerous areas including, patient care, billing, reimbursement, managed care, HIPAA, and OSHA.

The purpose of a healthcare compliance program is promoting organizational adherence to the applicable state and federal law, and also to the healthcare requirements of the private payer. An effective healthcare compliance program could help in detecting and preventing frauds, waste, and abuse. Compliance programs designed as per the Healthcarelaw Las Vegas helps establish a culture within the organization that promotes, detection, prevention, and resolution any conduct that doesn’t conform to the organization’s business and ethical policies, and the law. Compliance programs need to be articulate and must demonstrate the commitment of the organization to adhere to the law and the ethical standards.

A lot of commercial insurers require healthcare providers to have healthcare compliance programs at place, as an essential condition to be able to participate in their program. Medical providers that aren’t able to do so have greater risk of failing to participate in any healthcare program.

What Should You Do When Under Medicaid Investigation?

The moment that you realize that you or your organization is subject to a Medicaid investigation, you should talk to a healthcare lawyer or a Medicaid fraud defense lawyer as soon as possible, before you talk to any investigator. When you are under an investigation, always remember that “do-it-yourself” approach would be a wrong path. The way that a case is handled during the early stages would determine the overall outcome, and it would include the likelihood of whether any criminal charge would be filed against you. This is the reason why consulting a healthcarelawyer Las Vegas is so critical before discussing any matter with an investigator.

If you’re a health care practitioner and are subjected to Medicaid investigations, then you must avoid the following:

• Allowing anyone to remove or even review any document(s) or file(s) from your office or workspace unless and until they have a legal warrant.
• Discuss your case with anyone
•  Instruct your staff member(s) to lie
• Alter any document(s)

Such actions would compound your problems and would make your defense case even more difficult.

The chances of favorable outcome, in your case, would dramatically increase if your start your defense early on, especially when it comes to Medicaid investigations. The govt. authorities have invested already considerable resources and time in gathering the evidences and building case against you. The authorities are well ahead of game – therefore, the sooner your lawyer or defense team would get involved in this matter, the better would your chances get.

Tips to Help Onboard New Employees into Your Compliance Culture

The best way to getting the most out of employees is having them onboard into your compliance culture. Effective onboarding could be a really useful tool for healthcare compliance, and this is because integrating your healthcare compliance program into the onboarding process is one of the most effective ways of emphasizing the very importance of your program to the new employee and fully immerse the new hire into your healthcare compliance culture.

Onboarding presents the employer with an opportunity to indoctrinate the new employees into their compliance initiatives. An efficient and seamless way to make sure that full spectrum of your healthcare compliance program is properly understood as well as embraced right from the very beginning. Following are the crucial areas of any onboarding process where one could easily emphasize healthcare compliance program:

1. Hiring. Insert your compliance program directly into the hiring qualifications.

2. Orientation. Make your compliance program an integral part of orientation.

3. Warm welcome. Include the compliance in your company’s “welcome aboard” package.

4. Create onboarding folder. You could get your compliance officer put together an onboarding       folder for the new employees.

5. Training. Appoint mentor who has good knowledge of the compliance program, perhaps a person expert in healthcare law Las Vegas.

6. Get staff involved. You could make compliance program a part of the training, and also get the staff involved.

7. Expectations. You can include compliance program in the paperwork or the meetings regarding expectations that you have of the new hire.

How to Become A More Empowered and Responsible Patient?

Empowerment of patients can have many definitions; however, at the same time, most emphasis is often placed on the concept that the patients take active roles in one’s own disease management, while also supporting an active participation with constantly learning further about conditions and diseases as well as treatment options that are available to them at the moment.

Set Clear Goals

It is important to understand that the human body doesn’t necessarily reacts the same way that an individual might expect it to, suggests a healthcare lawyer Las Vegas. This is why it is better to set some treatment goals and further work towards goals that one has set. For instance, one may have to set a goal regarding swiftly healing the patients, while some may want to manage their conditions or disease, and further there are those who need to simply accept the disease or condition that they have and learn to cope with the situation.

Take Responsibility

Another important thing is realizing that one knows their own body better than others do. One must accordingly refer their resources and further use the knowledge to make much better decisions regarding treatment options. Additionally, it will be great if one could ensure that there is a health care compliance program in place, at the organization, so as to be clear how Medicaid investigation would be dealt with, if the situation arrives. And if a patient is finding it difficult to understand the various aspects of this process, they always have the option to seek the expert’s advice.

Legal Issues & Obstacles of Telemedicine

When it comes to the practice of telehealth or telemedicine, there are numerous legal obstacles, and the main one among those is licensure.

Healthcare providers, which include physicians or doctors, are licensed by the states. generally, their practice is often governed by the state where that are practicing physically (i.e. their ‘home state’) as well as the state where the patient is located (i.e. the ‘remote state’). For instance, if a California physician who specializes in cancer wants to offer consultation to a patient or patients in New York, then the physician needs to be licenses in California as well as in New York, both, as per healthcare law Las Vegas. Otherwise, New York city could find the physician who has California license guilty of practicing medicine in NY without NY license.

There are some states that have attempted to find a solution to this problem by forming a limited telehealth license for which the out-of state physicians and healthcare providers could apply. However, the problem is that this solution isn’t available in all the states.

In the other states, licensing law and healthcare compliance program allows the out-of state doctors to offer consultation to an in-state doctor regarding a given patient. Here, it is important to note that it isn’t the same thing as allowing an out-of state physician to provide their medical services to the in-state-patient remotely. Certain states also have reciprocity for the health care practitioners like nurses but not the same for physicians. Because there isn’t a national physician licensing, physicians are placed in potential legal perils and issues when they offer services to out-of state patients.

Tips to Become an Empowered Patient

Patient empowerment could have lots of definition, however, the most amount of emphasis is placed on the basic concept that patients are taking active roles in their individual disease management all the while supporting active participation with learning more about the diseases and conditions along with the treatment options available to them.

In order to become an empowered patient, one should do the following things:

Take Responsibility

One needs to realize that they themselves know their body a lot better than others, and they should accordingly refer to all the resources that at their disposal – from people to words printed – and they need to use this knowledge to make better decisions when it comes to treatment options. Also, it would be great if you make sure that there’s a healthcare compliance program at place, at the institution you are getting your treatment at, to ensure quality healthcare. And if one is having a hard time in understanding any of the aspects of the whole process, then they may seek advice from an expert in healthcare law Las Vegas.

Set Goals

One needs to understand the fact that our body does not react always the same way that one would expect it to, suggests an expert in healthcare law Las Vegas. It’s therefore better to set certain treatment goals and then work towards the goal that you set. For example, you may have had set a goal to swiftly heal, and an another person might just want to be able to manage his/her disease or condition, and there might be someone else who needs to just accept the condition that he/she is in and learn to better cope with all the new problems.

What Does A Healthcare Lawyer Do?

Healthcare law focuses primarily on the legislative, judicial, and executive rules & regulations governing the healthcare industry. The healthcare industry includes the hospitals, hospital systems, clinics, solo medical practitioners, and other healthcare providers such as nursing homes, acute care center, and psychiatric centers, pharmaceutical manufacturers, private and public insurers, etc. Some regulations that are relevant to the healthcare industry include, HIPAA, Stark, EMTALA, Anti-Kickback Statute, and other state privacy laws.

Healthcare lawyers generally represent the clients in the healthcare industry where cases are in connection with various general corporate matters such as corporate organizations, employee benefits, antitrust issues, tax, general contract negotiation, and capital financing. In addition to all this, healthcare lawyer Las Vegas often provide their advice on physician recruitments, medical staff relationship matters, and acquisition of healthcare practices. Healthcare lawyers provide guidance in relation with Medicaid investigations, Medicare fraud, payment issues, insurance regulation, HMO, health reform issues, and telemedicine. Finally, healthcare lawyers also address risk management, confidentiality, informed consent, and bio-ethical issues which include end-of-life decision-making, healthcare decision-making, and assisted reproduction.

Healthcare lawyers generally represent healthcare providers in front of state and federal agencies which regulate the healthcare industry. Healthcare lawyers assist healthcare providers in regards to various types of legal litigations, which include medical malpractice, Medicaid investigations, abuse and fraud claims, antitrust issues, intellectual property matters, breach of contract issues, real estate issues, labor & employment disputes, and Medicare and Medicaid reimbursements matters. A lot of healthcare lawyers often work for some of the other law firms which has departments specializing in healthcare law.