COM 410 Healthcare Regulatory Environment

Question: Write a report on regulatory environment in healthcare. Answer: The caregivers, management and the authority of Marcus Welby Hospital are responsible to maintain an integrated supply process with the help of the subsidiary companies. However, as per the identified discrepancy, the facilitating system of Durable Medical Equipments (DME) is facing some significant acts of violation within the activities. The three major concerns are offering premiums to the employees for each order of DME from the subsidiary company, offering rebates to patients who are using the equipments and paying agency personnel for assisting the patents while using the equipments. Through all these aspects the Subsidiary company and their salesman are the subject of directly accusation for their unethical mode of value exchange and for neglecting the legal boundaries of those kinds of actions (Clemente et al., 2018). From the corporate perspective the owners and the authority of the hospital have to be more careful about the business compliance and public service based regulations at the time of value exchange operation. It is the responsibility of any healthcare organisation or home health agencies to monitor all supply and value exchange activities from the employee level to the management level activities (Ghebleh, 2017). The acceptance of the any rebate or premiums as a beneficiary inducement should be monitored by the management and should be also taken under the urgent basis mitigation procedures. When it comes to the illegal referral and inducement, Physician Autonomy is not violated. Therefore, Physician Autonomy is in preferable situation. On the other hand, Clinical and Financial Integration has been violated in large scale. From offering premiums to the employees for each order of DME from the subsidiary company to offering rebates to patients who are using the equipments and paying agency personnel for assisting the patents while using the equipments, the corporate compliances have been breached. At the same time, Referral Fee Law is also violated. In public service operation like healthcare organisation, Payment for referrals is a ‘criminal offense’ (Pena, Larson & O’Connor-Barnes, 2016). Antitrust is ethical consideration that implies the shared values and vision of the organisation with each individual employee. Employees who have helped to conduct the crime of unethical inducement are the subject of Antitrust. Therefore, from the perspective of corporate ownership the authority should keep a strong and in depth monitoring system on the value exchange practice between the salesman and subsidiaries as well as between the patients and subsidiary. Hospital and physician groups from joint-venture partnership, has equal responsibilities to maintain the integrated supply management and facilitation system as well. It is the responsibility of any physician who involves in a home health agencies to effective report all supply and value exchange process from the employee level to the management level activities (Stowell, Schmidt & Wadlinger, 2018). However, physicians are not directly involved in the supply and repay of referral procedure. Therefore, in this scenario PHO does not directly influences the Corporate practice of Medicine negatively. At the same time, in Clinical and Financial Integration the ‘Doctors’ has a significant position as a part of healthcare provision. As mentioned earlier, since physicians are not directly engaged, they did not have the direct responsibility to control the supply and value exchange operation except the fraud reporting protocols (Schwartz et al., 2013). Therefore, doctors and physicians have the mixed or neutral responsibilities in the current scenario of breaching the Referral Fee Law for healthcare provision. Doctors, physician groups and caregivers should contribute to the patient-salesman interaction. Effective, fraud reporting system can prevent these unethical inducement activities to large extent. At the same time, the management has to take appropriate action to eliminate all the possibilities of these unethical activities. At the time of rebating the patients for using the equipments the caregivers and doctors can report the authority to take necessary action. At the same time, physicians can make the patients aware of the significance of these unethical rebates in a public service operation like healthcare (Pathria et al., 2017). They can also directly communicate with the salesmen asking for avoiding this activities and direct interaction with the patients. Through this Referral physician groups and caregivers can more emphasis on imposing the Referral Fee Law. Management Service Organisations (MSO) who are responsible to provide office management service and to act as negotiating agent with insurers/ employers based on the contract with the hospital have shown exceptional negligence in Clinical and Financial Integration by allowing the suppliers of MDE to special incentives to the caregivers for assisting the patients to using the equipments. Therefore, external office management service has also violated the Referral Fee Law by appreciating the workforce to maintain this unethical financial relationship with the salesmen of subsidiary company (Hamric, 2012). On the other hand responsible personnel who provide office management service and to act as negotiating agent with insurers/ employers can make the patients aware of the significance of these unethical rebates in a public service operation like healthcare. They can also directly communicate with the management board of the subsidiary company while making them aware of these misconducts in healthcare provision. In this scenario, Management Service Organisation of this healthcare facility is also the subject of accusation for antitrust issue. They have the direct responsibility to control the supply and value exchange operation except the fraud reporting protocols. Antitrust is ethical consideration that implies the shared values and vision of the organisation with each individual employee (Runciman, Merry & Walton 2017). However, they have failed to maintain the proper value exchange operation within the suppliers and the personnel of healthcare facility. The acceptance of the any rebate or premiums as a beneficiary inducement should be monitored by the management and should be also taken under the urgent basis mitigation procedures. As per the above discussion it can be said that, the facilitating system of Durable Medical Equipments (DME) is facing some significant acts of violation within the activities. The three major concerns are offering premiums to the employees for each order of DME from the subsidiary company, offering rebates to patients who are using the equipments and paying agency personnel for assisting the patents while using the equipments. It has been also found that from the corporate perspective the owners and the authority of the hospital have to be more careful about the business compliance and public service based regulations at the time of value exchange operation. At the same time, Management Service Organisations should directly communicate with the management board of the subsidiary company while making them aware of these misconducts in healthcare provision. On the other hand, Hospital and physician groups from joint-venture partnership, has equal responsibilities to maintain the integrated supply management and facilitation system as well. Moreover, all the responsible personnel and employees have to play individual role to eliminate these misconducts that violate the Referral Fee Law. Reference Clemente, S., McGrady, R., Repass, R., Paul III, D. P., & Coustasse, A. (2018). Medicare and the affordable care act: fraud control efforts and results. International Journal of Healthcare Management, 11(4), 356-362. Ghebleh, S. (2017). No VIP treatment: ACOs should not get waiver protection from the prohibition on beneficiary inducement. Vand. L. Rev., 70, 737. Hamric, A. B. (2012, March). Empirical research on moral distress: issues, challenges, and opportunities. In Hec Forum(Vol. 24, No. 1, pp. 39-49). Springer Netherlands. Pathria, A. K., Allmon, A. L., De Traversay, J., Ianakiev, K. G., Suresh, N., & Tyler, M. K. (2014). U.S. Patent No. 8,639,522. Washington, DC: U.S. Patent and Trademark Office. Pena, J. A., Larson, J. C., & O’Connor-Barnes, E. (2016). Parallel Investigations and Prosecutions in Anti-Kickback Cases Involving Healthcare Providers. US Att’ys Bull., 64, 47. Runciman, B., Merry, A., & Walton, M. (2017). Safety and ethics in healthcare: a guide to getting it right. CRC Press. Schwartz, R. L., Furrow, B. R., Greaney, T. L., Johnson, S. H., & Stoltzfus Jost, T. (2013). Health law: cases, materials and problems. West Academic Publishing. Stowell, N. F., Schmidt, M., & Wadlinger, N. (2018). Healthcare fraud under the microscope: improving its prevention. Journal of Financial Crime, (just-accepted), 00-00.

COM 410 Healthcare Regulatory Environment

Calculate the price
of
your order:

Basic features

On-demand options

Paper format

Guaranteed originality

Affordable prices

Best experts

Calculate the price of your order

Expert paper writers are just a few clicks away

COM 410 Healthcare Regulatory Environment

Calculate the price of your order:

Basic features

On-demand options

Paper format

Guaranteed originality

Affordable prices

Best experts

Calculate the price of your order

Expert paper writers are just a few clicks away

Calculate the price
of
your order: