Compliance: Audits and Plans for Healthcare / Edition 1

Compliance: Audits and Plans for Healthcare / Edition 1

by Cherilyn G. Murer, Michael Murer, Lyndean Lenhoff-Brick
     
 

ISBN-10: 0070444625

ISBN-13: 9780070444621

Pub. Date: 08/28/1998

Publisher: McGraw-Hill Professional Publishing

Product Details

ISBN-13:
9780070444621
Publisher:
McGraw-Hill Professional Publishing
Publication date:
08/28/1998
Edition description:
BK&DISK
Pages:
238

Table of Contents

Preface v(4)
Acknowledgements ix
Chapter 1 Healthcare Compliance Today
1(12)
What Is Compliance?
1(1)
What Is a Compliance Program?
2(3)
Why Have a Compliance Program?
5(6)
Conclusion
11(2)
Chapter 2 The Laws of Compliance
13(24)
Introduction
13(2)
Civil Monetary Penalties
15(1)
Criminal Penalties for Acts Involving Medicare or State Health Programs
16(1)
The Anti-Kickback Provisions
17(4)
Anti-Referral Statutes
21(5)
False Claims Act
26(5)
Health Insurance Portability and Accountability Act of 1996
31(1)
Exclusion
32(1)
Examination and Treatment for Emergency Medical Conditions and Women in Labor
33(1)
Tax-Exempt Organizations
34(1)
Conclusion
35(2)
Chapter 3 Sentencing Guidelines
37(24)
Introduction
37(1)
Sentencing Before the Guidelines
38(1)
The Sentencing Reform Act of 1984
39(1)
Sentencing Guidelines for Individuals
39(1)
Sentencing Guidelines for Business Organizations
40(4)
Penalties Available Under the Federal Sentencing Guidelines
44(1)
Determining Fines Using the Guidelines
44(4)
Example of Determining Fines Under the Guidelines
48(1)
Departing from the Guideline's Recommended Fine
49(6)
Payment of the Fine
55(1)
Other Penalties Under the Guidelines
56(2)
The Guidelines Requirements for an "Effective" Compliance Program
58(2)
Conclusion
60(1)
Chapter 4 The Compliance Process--Conducting the Audit
61(14)
Introduction
61(1)
Methodology
61(2)
Initiation of the Audit
63(3)
Audit Results
66(1)
Use of Legal Counsel
67(1)
Conclusion
68(7)
Chapter 5 Designing the Compliance Program
75(30)
Introduction
75(4)
Action Steps for the Design of a Compliance Program
79(14)
Has an Effective Program Been Developed?
93(1)
Government and Other Model Compliance Programs
94(4)
Conclusion
98(7)
Chapter 6 In-House Compliance--The Role of the Compliance Officer
105(18)
Introduction
105(1)
The OIG Model Compliance Plan for Hospitals and the Role of the Compliance Officer
106(3)
Expressing the Compliance Vision Through the Compliance Officer
109(1)
Outlining Job Responsibilities
110(2)
Job Descriptions
112-121(9)
Chapter 7 Addressing Potential Violations of the Law
123(26)
Introduction
123(1)
Learning of Potential Violations
124(2)
Investigating Potential Violations
126(6)
Disclosing Violations
132(3)
The Office of Inspector General's Compliance Program Guidance for Hospitals
135(3)
The Office of the Inspector General's Model Compliance Plan for Clinical Laboratories
138(1)
Operation Restore Trust's Voluntary Disclosure Program
139(7)
Conclusion
146(3)
Appendixes 149(80)
A: Sample--Statement of Policy and Purpose 149(10)
B: Sample--Hospital Code of Ethics 159(2)
C: Sample--Addendum to Employee's Copy of Compliance Program and Code of Ethics 161(2)
D: Sample--Prospective Employee Form 163(2)
E: Sample--Training Form 165(6)
F: Sample--Oversight Committee Selection Criteria 171(2)
G: Sample--Compliance Checklist for Billing Department 173(2)
H: The Office of Inspector General's Model Compliance Plan for Hospitals 175(36)
I: The Office of Inspector General's Model Compliance Plan for Clinical Laboratories 211(8)
Acronyms and Abbreviations 229(2)
Glossary 231(2)
About the Authors 233(2)
Index 235

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