A hospital must keep up to its charitable purpose by when planning incentives for recruiting physicians. Physicians may be recruited for various reasons such as to join the hospital’s medical staff and fill a gap in the community’s need for medical services. To help recruit these physicians, hospitals can offer incentives such as malpractice insurance for a limited period to these physicians, signing of bonuses (Gray, 1986). In addition, they can offer a mortgage guarantee on the physician’s home, a private-practice income guarantee, and financial practice start-up assistance.
It is important for a physician considering employment or currently employed in a hospital or private practice to understand their rights as an employee and as a member of the hospital’s medical staff. Also, they should understand the interplay between the two roles. As an employee of a hospital or private practice, the physician will often be governed by the terms of the employment agreement (Glandon & Morrisey,1986). Also, as a member of the medical staff, the physicians are often subjected to particular medical staff bylaws. The bylaws mainly govern the terms of a physician’s staff members and clinical privileges.
- Tax-exempt hospitals are required to oblige to the Affordable Care Act of 2010, which means that they will have new volumes of insured patients which will reduce the hospital bad debts and charity care.
- Tax-exempt hospitals are required to serve the general public, exclusively operate for educational, charitable and scientific reasons in order to qualify and maintain their tax-exempt status.
- Patient protection and affordable care act is also a compliance program for tax-exempt hospitals.
- Tax-exempt hospitals are also required to often determine new ways to justify their tax-exempt status, for example providing care at more cost to the Medicaid patients than reimbursement amount.
- Tax-exempt hospitals are also required to provide a community health needs assessment report to the IRS for tax auditing.
Every healthcare organization often engages in various administrative, and quality improvement activities in order to run its business. HIPAA privacy regulations often allow these health organizations to use a patient’s personal health information (PHI) for healthcare operations without the patient’s consent. For instance, a hospital can use and disclose a patient’s PHI to evaluate the skills, performance, and qualifications of a physician who is treating the patient.
HIPAA privacy rule often creates certain national standards to help protect patients’ personal medical records and other personal health information. As such, it gives patients more control over their health information or details. Moreover, HIPAA privacy rule often sets boundaries on the use and disclosure of an individual’s health records and information (Annas, 2003). Besides, it often holds violators of patients’ privacy rights accountable for their civil and criminal acts whenever they use the patients’ medical records and health information for illegal activities. Also, it establishes various guidelines and safeguards that healthcare providers must achieve to protect patients’ privacy rights.
The minimum necessary standard is the key protection of the HIPAA privacy rule. It based on the concept that a patient’s personal health information should not be used and disclosed when it is not necessary and appropriate to carry out a certain function (Guthrie, 2003). As such, it often requires covered entities to evaluate their practices and enhance safeguards in order to limit unnecessary use and disclose a patient’s protected health information and medical records.
The Anti-Kickback Statute is a criminal law that prohibits the solicitation, offer, and acceptance of any form of remuneration in the form of gifts, and cross-referrals to another party for the purpose of purchase, and reimbursing services under a federal health program. Safe harbors protect certain payments and business practices that hospitals and physicians engage in that could implicate from AKS criminal and civil prosecution. However, the safe harbors do not protect hospitals and physicians who make illegal referrals to healthcare providers and suppliers. Also, physicians can be targeted by the AKS when they decide what patients should use, which medical specialists they should see, as well as the health care services and supplies that they must receive.
When a health organization does not satisfy any safe harbors, various incidents may be encountered. As such, contractors, and suppliers may submit reports and complaints to the federal government about the health organization. Moreover, patients may make reports about fraud and abuse by their health care providers (Moseley III, 2013). Also, medical staff, physicians and other healthcare professionals may become unhappy with the health organization’s complain policies.
The purpose of a special fraud alert is to provide general guidance to the health care industry on violations of federal law. It also helps in identifying health care fraud schemes. The Office of the Inspector General (OIG) is likely to receive the copies of the special fraud alerts. OIG is subjected to the role of identifying and acting effectively on any fraud alerts.
Annas, G. J. (2003). HIPAA regulations-a new era of medical-record privacy?. New England Journal of Medicine, 348(15), 1486-1490. Retrieved from https://pdfs.semanticscholar.org/1b09/68a9e392383a770c8b40255f970600108f66.pdf
Glandon, G. L., & Morrisey, M. A. (1986). Redefining the hospital-physician relationship under prospective payment. Inquiry, 166-175. Retrieved fromhttps://www.jstor.org/stable/29771782?casa_token=WhH0qsyVrLEAAAAA:z7hUQf0A4i1HrU7PAU38MnM5GuiP_g5HvgJDD4sCClBe7tZnCfbX5fdsjPNODPtKmCgYrtq6_GPw2RxFS48SZwIRtL8R4N88SB0uKMc5F677VATapSrQxA&seq=1#metadata_info_tab_contents
Gray, B. H. (Ed.). (1986). For-profit enterprise in health care. National Academies. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK217920/
Guthrie, J. (2003). Time is running out-the burdens and challenges of HIPAA compliance: A look at preemption analysis, the minimum necessary standard, and the notice of privacy practices. Annals Health L., 12, 143. Retrieved from https://lawecommons.luc.edu/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=1252&context=annals
Moseley III, G. B. (2013). Managing Legal Compliance in the Health Care Industry. Jones & Bartlett Publishers. Retrieved from https://books.google.co.ke/books?hl=en&lr=&id=BmErAQAAQBAJ&oi=fnd&pg=PR1&dq=Managing+Legal+Compliance+in+the+Health+Care+Industry&ots=v0NjqOSj-J&sig=_2wXi07Clc6LCe1K_oq05KjLDMU&redir_esc=y#v=onepage&q=Managing%20Legal%20Compliance%20in%20the%20Health%20Care%20Industry&f=false