WK 3 Health Law, Ethics, and Policy
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Week 3
Criminal and Civil Law
In Week 2, you learned how laws are created. This week, the focus will be more specific to
criminal and civil law. In order to promote justice and fairness, laws are established to
punish certain behaviors in a consistent manner. In healthcare specifically, punishable
behaviors could include failure to provide a reasonable standard of care, deliberate actions
such as improper coding and billing for services provided, or failure to obtain consent for
medical procedures. Punishments include fines and/or imprisonment. Violations of
criminal law are public cases between the government and an individual or group (e.g.,
“The People vs…”). A criminal case can also arise from violations of administrative laws,
which are regulations established by government agencies. Criminal cases are commonly
known as either a felony—a serious crime requiring a minimum of a year of imprisonment
—or a misdemeanor, a less serious time requiring fines and time served up to one year.
Civil law pertains to disputes between one entity and another. The two major categories
in civil law are tort (harm done to others) and contract law. A tort can result from
intentional acts such as battery or fraud, or through unintentional and careless acts such
as negligence. A contract is an oral or written agreement between two or more parties.
Violations of contract law can occur from failing to uphold one’s part in an agreement,
otherwise known as a breach of contract. Civil cases can be initiated by private as well as
public parties (Annas, 1995; Erstad, 2018; Legal Information Institute, n.d.). It is becoming
more common for cases to involve both criminal and civil proceedings. The U.S.
Department of Justice began pursuing criminal investigations by paralleling civil
investigations in cases of corporate fraud. An example of a case where both criminal and
civil charges were sought is when Tenet Healthcare Corporation hospitals paid kickbacks
to Hispanic Medical Management for maternity referrals. The structure of the referral
process resulted in improper Medicaid eligibility determination and billing practices
(Schencker, 2015).
You learned in the first week that the organizational environment can either discourage or
encourage unethical actions—actions that could lead to civil or criminal sanctions.
Competent, ethical, and engaged chief executive officers (CEOs) are essential to
“developing a culture that fosters employee voice and upward communication” (Adelman,
2012, p. 133). Adelman (2012) asserts CEOs who prioritized consistent visibility and
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Books and Resources for this Week
Hamilton, E. C., Pham, D. H., Minzenmayer, A.
N., Austin, M. T., Lally, K. P., Tsao, K., &
Kawaguchi, A. L. (2018, January). Healthcare
delivery... Link
availability to employees encourage open communication and trust- and
relationship-building. CEOs are also key players in promoting a corporate culture of
continuous improvement that centers on the transparency of information, especially when it
comes to encouraging employees to share difficult information (Adelman, 2012). Therefore,
through fostering communication and a willingness to report adverse events and near-
misses in healthcare settings, executives can help create a culture that reduces the
likelihood of criminal and civil violations.
References:
Adelman, K. (2012). Promoting employee voice and upward communication in healthcare:
The CEO’s influence. Journal of Healthcare Management / American College of
Healthcare Executives, 57(2), 133–147. Annas, G. (1995). Medicine, death, and the criminal
law. The New England Journal of Medicine, 333(8), 527-530.
Erstad, W. (2018). Civil law vs. criminal law: Breaking down the differences.
Legal Information Institute: Cornell Law School. (n.d.). Criminal law.
Schencker, L. (2015). Tenet fraud probe signals feds' growing interest in criminal cases.
Modern Healthcare, 45(20), 14.
Be sure to review this week's resources carefully. You are expected to apply the information
from these resources when you prepare your assignments.
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Klaas, P. B., Herge, K. H., Klaas, K. M., Klaas,
J. P., & Larson, A. N. (2014). When patients
are harmed, but are not wronged: Ethics, law,
and... Link
Sale, J. A., & Weintraub, B. (2011). Emerging
trends in criminal healthcare law
enforcement: The Patient Protection and
Affordable Care Act... Link
Spraker, M. B., Fain, I. R., Gopan, O., Zeng, J.,
Nyflot, M., Jordan, L., ... Ford, E. (2017). Basic
original report: Evaluation of near-miss... Link
Office of the United States Attorneys. (n.d.).
Steps in the federal criminal process. U.S.
Department of Justice. Link
Week 3—Assignment: Recommend Strategies to Address
Alleged Negligence in a Healthcare Setting Assignment
Due July 7 at 11:59 PM
In Weeks 1 and 2, you read about the impact on an organization when it has a culture of
hiding allegations of misconduct, failing to respond to complaints quickly or at all, and not
addressing negligence or incompetence. As a healthcare executive, you want to avoid the
potential loss of trust, erosion of consumer satisfaction, and lowering employee morale
that results from a corporate culture that tolerates corruption.
You will write a memorandum to all department heads and other members of your
leadership and management team explaining the steps you would like to establish to
facilitate:
1. Safe reporting of incidents, adverse events, and near misses.
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2. Transparent investigation processes.
3. A recognition system for champions of organizational excellence.
Do not use real names. You can use fictional names or identify the members by titles only.
Table 2. Sample Memorandum
MEMORANDUM
TO: <Members of leadership and management team>
FROM: <Your name>, Chief Executive Officer
DATE: Month day, year
SUBJECT: Investigations of Negligence and Misconduct
<Enter your memo narrative here.>
Length: a minimum of 2 pages (not including title page and reference page).
References: Minimum 3 scholarly resources.