Corporate Compliance: A Necessity for Healthcare Leaders - Free Paper Sample

Introduction

Corporate compliance issues have been the leading headlines lately, with corporation leaders finding themselves in austere scrutiny. Due to the complexity of the healthcare system, knowledgeable directors who are dedicated are of great value in ensuring that the corporate compliance requirements are all met (Callender et al., 2017). These directors usually execute their oversight responsibilities in the challenging healthcare environment with the guidance of the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services as well as the American Health Lawyers Association (AHLA) (OIG, 2017). This paper will elucidate compliance issues for GoodHealth, Inc. by focusing on the type of penalties imposed, legal duty bleached, and reasons for self-reporting.

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Penalties from OIG

In the current case, GoodHealth, Inc., which is a multifaceted healthcare provider, has issues regarding procurement and safety of imagining equipment. As a result, OIG can impose penalties as stipulated in the 21st Century Cures Act, under the Civil Monetary Penalties Law (C.M.P.) (Ropes & Gray, 2019). Under this law, OIG can impose penalties in the form of amounts that range over $100,000 dollars per individual, as well as other additional damages amounting to three times the actual losses of the government for some dues (Ropes & Gray, 2019).

Additionally, OIG may as well decide to exercise its exclusion authority under the administrative federal health care program, which may be a critical threat to the awardees’ acts. Therefore, adding to monetary fines, GoodHealth, Inc. is also subject to additional penalties for noncompliance, which includes the entire facility of concern being fully excluded from participating in federal health programs that can go for several years as deemed by OIG. If there is an exclusion for good health, then Medicare and Medicaid would terminate paying for items or services that the health provider furnishes, orders, or prescribes.

Legal Duty Bleached

It is clear that the directors from GoodHealth, Inc. have breached their legal duty as the heads of the facilities. Under the provisions of A-0528, regarding the condition of participation for the radiologic services, the hospital facility is supposed to be maintaining or having available, diagnostic radiologic services (Transmittal, 2015). The legal provision also indicates that when the imaging services are provided, they are supposed to be in professionally approved standards in ensuring safety. Thus, the directors of the current health provider have breached this legal duty of ensuring that they offer professional imaging services in accordance with the U.S. Food and Drug Administration’s (F.D.A.) rules (Transmittal, 2015). Offering imaging services in the facilities without the equipment is a breach of legal duty.

Additionally, the federal law under operation vehemently prohibits physicians from referring to Medicare as well as Medicaid patients for specific health services where the physician has a possible financial interest. Almost all the states have the same prohibitions applying to all the privately insured. As for the case of GoodHealth, Inc., they use services from a staff radiologist, when they rent the imaging equipment. This action from the directors is anecdotal evidence of the breach of their legal duty.

Such actions are in the form of a typical referral arrangement that is entirely against the federal self-referral law. The OIG of the U.S. Department of Health and Human Services (H.H.S.) categorizes these types of arrangements as prospects to refer the physicians so as to bill as well as retain remuneration which is probably illegal under the federal law and antikickback statute (42 U.S.C. §1320a-7(b)) (Transmittal, 2015).

Reasons for Self-Reporting

There are several reasons why GoodHealth, Inc. should self-report or disclose to the OIG as a health care provider. OIG has always been advocating for reasons why dealing with Federal health care programs with integrity is crucial (Gerber, 2017). Any healthcare provider, supplier, or entity that is subjected to Civil Monetary Penalties is supposed to utilize the long-lasting Provider Self-Disclosure Protocol (SDP) (Patrice, 2013). Self-reporting is a civic duty that will enhance the obligation of the organization to take measures, to detect and prevent fraudulent activities. It will include instigating explicit measures and mechanisms in investigating and resolving cases of potential fraud that involve Federal health care programs.

The main reason to use this self-reporting protocol is to voluntarily disclose self-discovered evidence for the possibility of noncompliance or fraud issues (Patrice, 2013). This type of self-disclosure will give GoodHealth, Inc., a significant opportunity to avoid the costs as well as disruptions that are linked to government-directed investigations together with any civil litigation (Patrice, 2013). Additionally, it will be important for the organization to have a good faith self-report as a way of showing cooperation to the OIG’s review and resolution processes. Doing so will demonstrate that the organization has a robust as well as an effective compliance program (Patrice, 2013). Also, under the Civil Monetary Penalties Law (CMPL) and under section 1128J(d) of the Act, 42 U.S.C. 1320a-7k(d), self-reporting will help the organization to mitigate the possible exposure (Patrice, 2013).

Conclusion

GoodHealth, Inc., which is a complex healthcare provider, has issues regarding procurement and safety of imagining equipment. OIG will impose Civil Monetary Penalties or exclude the organization from federal health programs. The directors bleached safety and referral laws. The organization should self-report to avoid costs, show cooperation, and mitigate possible exposure.

References

Callender, A. N., Hastings, D. A., Hemsley, M. C., Morris, L., & Peregrine, M. W. (2017). Corporate Responsibility and Health Care Quality. A Resource for Health Care Boards of Directors. https://oig.hhs.gov/fraud/docs/complianceguidance/Corporate%20Responsibility%20and%20Health%20Care%20Quality%206-29-07.pdf

Gerber, S. (2017, August 15). To disclose or not to disclose, that is the question. National Law Review. https://www.natlawreview.com/article/to-disclose-or-not-to-disclose-question

OIG. (2017). Corporate responsibility and corporate compliance. A Resource for Health Care Boards of Directors. https://oig.hhs.gov/fraud/docs/complianceguidance/040203corpresprsceguide.pdf

Patrice, S. (2013). Updated OIG’s Provider Self-Disclosure Protocol. Office of Inspector General. https://oig.hhs.gov/compliance/self-disclosure-info/files/Provider-Self-Disclosure-Protocol.pdf

Ropes, & Gray, L. (2019). HHS OIG issues self-disclosure program guidance for research grants and contracts. Lexology. https://www.lexology.com/library/detail.aspx?g=990f49b1-9cf9-455c-902f-0968c848c5c7

Transmittal. (2015). Department of Health and Human Services, Centers for Medicare & Medicaid Services. Manual System. https://www.cms.gov/RegulationsandGuidance/Guidance/Transmittals/Downloads/R141SOMA.pdf