HCA 505: Legal and Ethical Issues in Healthcare

Course Description

This course provides a framework for analysis of legal and ethical issues in the provision of healthcare. This course is an overview of health law issues and includes the conceptual foundations for societal, institutional, and individual dilemmas in healthcare delivery and the legal aspects of clinical and financial decision-making. It covers government regulation including legal constraints, liability, negligence, patient rights, confidentiality, as well as, corporate and administrative responsibility. (3 credits)

Associated Program Learning Outcome(s)

#3 Explain the role of the administrator in upholding the legal, social, and ethical responsibilities in the healthcare organization as they relate to patient/client rights

Student Learning Outcomes (SLOs)

Students who successfully complete this course will be able to:

1. Perform an in-depth search and interpretation of the seven elements of a compliance program and the role of the OIG.
2. Formulate an enterprise-wide compliance-training program.
3. Demonstrate a working knowledge of the healthcare employee responsibilities in maintaining compliance in ethics in healthcare.
4. Discuss the elements of the False Claims Act, Anti-Kickback Statute, and Stark Law and formulate how these elements relate to the healthcare industry.
5. Explain Corporate Integrity Agreements and apply recent litigation in this area.
6. Create policy based on OIG sanction screening standards for hiring new employees, giving staff privileges to physicians and other healthcare professionals, and developing vendor agreements.
7. Analyze a Board of Director's fiduciary obligations for compliance and how the duty of care may be exercised in overseeing the organization's compliance system.
8. Demonstrate a working knowledge of the components of a healthcare risk management program by applying the principles to a given incident.
9. Demonstrate a working knowledge of the basic components of the HIPAA privacy and security regulations and promoting interoperability standards.
10. Examine regulations addressing identity theft, including medical identity theft.

Course Activities and Grading

Required Textbooks

Available through Charter Oak State College's Book Bundle

• Wade, Robert and Alex Krause. Compliance Officer's Handbook. 4th. HCPro, Inc., 2020. ISBN-13: 978-1-64535-030-9

Additional Resources

• Journal Articles and other course material, including primary websites, will be provided as required reading within the course.

Course Schedule

COURSE OUTLINE

A. Overview of the Compliance function in a healthcare organization

1. Corporate Compliance (Fraud and Abuse)
   1. Corporate Compliance Program (“the program”)
      1. The seven elements
         1. Establish standards and procedures
         2. Organization’s governing authority knowledgeable of program content and exercise oversight
         3. Exclude from authority personnel any person or organization who has engaged in illegal activities or conduct inconsistent with the program
         4. Provide education
         5. Ensure program is followed through monitoring and auditing activities
         6. Promote and enforce program through the organization
         7. If criminal conduct detected, take steps to appropriately respond
      2. Role of the Compliance Officer
      3. Managing the program
         1. Budgeting and staffing
         2. Conducting investigations
         3. Training and education
      4. Legislation, regulations and accreditation standards related to the program
         1. Federal False Claims Act
         2. Federal Anti-kickback Regulations
         3. Stark II
         4. EMTALA
         5. Acting under a Corporate Integrity Agreement
         6. Research Billing/ OHRP/IRB
         7. OIG Compliance Guidelines
         8. Employment Law Basics for Compliance Professionals
         9. ERISA Fiduciary Duties
         10. Conditions of Participation/ The Joint Commission
         11. Other
      5. Other Legal and Ethics functions
         1. Risk Management
            1. Risk management program
            2. Role of risk manager
            3. Conducting risk assessments
            4. Conducting investigations
         2. Privacy and security of protected health information
            1. HIPAA
            2. HITECH
            3. Role of Privacy Officer
            4. Conducting investigations
            5. Training and education
         3. Identity theft
            1. General vs. medical
            2. Red Flags Rule

COSC Accessibility Statement

Charter Oak State College encourages students with disabilities, including non-visible disabilities such as chronic diseases, learning disabilities, head injury, attention deficit/hyperactive disorder, or psychiatric disabilities, to discuss appropriate accommodations with the Office of Accessibility Services at OAS@charteroak.edu.

COSC Policies, Course Policies, Academic Support Services and Resources

Students are responsible for knowing all Charter Oak State College (COSC) institutional policies, course-specific policies, procedures, and available academic support services and resources. Please see COSC Policies for COSC institutional policies, and see also specific policies related to this course. See COSC Resources for information regarding available academic support services and resources.