11:53 Done Business Transactions Resource an... Date: Health care business The Law and Legal Risk Role of A question you A managerial situations Code Section requirements and Assessment Person who would ask the action you would Penalties for can be a resource person to take to comply non-compliance Low resource for help you better with the law with the Law Medium compliance know how to (Give reasons to ligh (Give comply with the support your (Give reasons to law action) reasons to support your support your choice) rating) 1. Your organization just hired State licensing a physician from out of state. law The physician will need to become licensed in your state of Maryland. As an administrator, you have been asked to oversee the process to ensure the physician obtains a valid Maryland license to practice medicine. 2. You were reviewing the Federal new physician contract and Antikickback see that the physician will be Statute (AKS) paid a flat salary with bonuses from the hospital for increasing hospital admissions. 3. Your managed care State organization (MCO) wants to Certificate of build a new hospital and 2 Need new rehabilitation centers in your state of Maryland. You are asked to spearhead the project. 4. You oversee the medical Federal False billing department. The Claims Act billing manager responsible (FCA) for day to day activities was Notice of out of the office for 6 months Overpayment on a disability leave. The Rules manager has just returned and discovered that the coders billed everything at the highest level of service whether there was documentation to support it or not during the 6 months the manager was gone. 5. Your hospital wants to Federal expand and buy out a Antitrust law physician group in a nearby Joint Venture town. The physicians would Guidelines become employees of your hospital. 75% of the physicians in your town and the nearby would be employed by your hospital when the venture is complete. 6. You are responsible for the Federal profit/loss statements for your Sarbanes budget area each month. The Oxley Vice President over your area Act (SOX) just asked you to "improve" Conflict of the numbers to show a profit Interest even though the numbers show a loss. You have been told that the VP owns 60% of the shares of stock for your public corporation. 7. You are an entrepreneur and State want to open up a home health Incorporation company in Maryland. You Law want to be incorporated unde Maryland law and operate as Home Care Inc. 8. You work for a family Federal practice physician clinic. Two Physician Self- of the physician owners are Referral Law also part owners of a nearby (Stark) durable medical equipment (DME) store and a clinical lab All physicians in the organization regularly refer patients to the DME store and clinical lab. 9. Your hospital is a non-profit Federal organization and doesn't pay Internal taxes. The billing company at Revenue your hospital just sent word Service (IRS) that it sent 50 unpaid claims to tax law collections. You wonder if this should be considered charity care instead. 10. You work for a large Federal health insurance company. Health The company wants to start a Insurance disease management program Portability and for its members by contracting Accountability with a national pharmaceutical Act (HIPAA) to run the disease management Busines program. Associate Regulations
