In recent years, there have been many developments in the medical health field that have made diagnosis more straightforward and faster. However, the improvements have created many chances of negligence and malpractices by healthcare officials that could adversely affect patients. Therefore, legal regulations must be put in place to ensure that healthcare practices are carried out in the right way and that patients are protected from exploitation. The government has put in place a set of rules, laws, and regulations to protect individual patients and healthcare providers. The set laws also give directives on healthcare professionals’ responsibilities and how well they should carry out the duties. Some of the legal issues addressed by the set laws by healthcare professionals include trust issues on confidentiality, medical negligence, informed consent, and integrity issues.
The antitrust issues
There are increasing cases of corruption and other unethical practices by health providers that have been reported over time. Therefore, the confidentiality of patients’ information is violated, which destroys the relationship and trust between the patients and healthcare providers. Thus, to solve the issue, the Accountable Care Organizations (ACOs) was formed to serve as a law that ensures quality in healthcare practices and reduces service costs for patients. Accountable Care Organizations comprise a group of health providers, doctors, and other medical officials who came together to provide improved and high-quality care to patients voluntarily. Also, the Health Insurance Portability and Accountability Act (HIPAA) was passed to ensure the protection of health information through the use of electronics. The act ensures confidentiality and integrity when transmitting medical records information and grants access to health data to authorized persons like healthcare providers. The Act was necessary as there were increased cases of unethical sharing of information related to a patient’s health. Thus, the regulation sets standards that guarantee the confidentiality and integrity of the health records. Other functions of the act include regulation of the disclosure of protected information through the covered entities, including health insurers and medical providers. The law enforcement on HIPAA ensures that the covered entities may only reveal information about patients after written consent, which helps avoid mistrusts.
False claims issues
Any fraud involving federal contracts or Medicare activities is considered illegal. Thus, the government put the False Claims Act in place, which allows the prosecution of healthcare officials that carry out any fraudulent activity related to their service. The activities that constitute a violation under the law include the presentation of a false claim for payment to the government. The Act also prohibits knowingly using a false record to avoid the obligation to pay money to the federal government. Furthermore, the Patient Protection and Affordable Care Act (PPAC) aims to fight fraud and ensure penalties for submission of false claims. The act, in 2012, stated that physicians must return any overpayments paid by the government within two months after discovering the mistake. Finally, the act put in place a whistle-blower, which initiates the actions to be taken against false claims on publicly disclosed information. Thus, these set acts and government regulations dictate how healthcare providers carry out their service to patients and ensure they receive the best care.
Healthcare administrators are likely to be faced with many risks in their work that may lead to adverse effects if not managed well. Some of the significant risks affecting the Medicare service include cyber threats and non-compliance threats. Technology is developing continuously and as it is implemented in the record-keeping and facility management activities. Recently, most facilities encourage electronic record-keeping rather than the regular paper works for easy and faster access to the information when needed. However, the electronically kept records face a threat from unauthorized personnel who may hack the system through cyber-crime. Cyber-crime can expose critical patient information and thus damage the facility’s reputation, and the patient may sue the healthcare providers. Therefore, healthcare providers should take care of electronically stored information by coming up with a system that prevents third-party access to unauthorized patient information. The safe measures to prevent cyber theft include creating firewalls and stronger passwords that can only be accessed by executive personnel. Also, managers can ensure security to critical information by shutting down all health-related systems when they are not in use and locking up doors to the computer labs. More so, managers should create awareness of cyber theft threats to the employees and train them on protective measures against cyber theft.
Compliance lapse is another significant risk that faces managers in healthcare facilities. There are many legal regulations that health providers are expected to conform to, such as the patient protection acts and false claims acts, and avoid legal issues with the government. Besides, many patients are currently aware of their rights under the various healthcare acts and are thus, more likely to report any mistreatment by health officials. Therefore, healthcare providers should be aware of all the laws related to their service and work hard to follow the regulations. The management is also expected to conform to non-healthcare business regulations in their facilities, such as the commission for equal employment and occupational safety of the health officials and other workers in the organization. Furthermore, managers should educate their fellow workers on the importance of compliance to avoid violation of the law and avoid non-compliance risks.