Healthcare Case Study

Background

Final Group Assignment

In general, this course considered areas of law separately, using examples to demonstrate how a legal issue might arise. The reality of health care, of course, is that issues do not arise discretely. Very often, conduct can raise legal concerns under more than one statute or regulation. Further complicating the situation, legal matters may be influenced by nonlegal issues related to human resources, management, organizational turf battles, and personality conflicts.

The purpose of this group final exercise is to animate the challenge of identifying issues and developing, implementing, and maintaining an effective compliance program under real-world conditions. Working with your colleagues, you will identify and recognize legal, ethical, and compliance issues, considering whether (and, if so, which) require remedial action.

Instructions

Read the hypothetical case study carefully. What are the legal and/or compliance issues raised by the hypothetical.

1. What law, regulation, or governance requirement/policy MAY have been violated? Consider among the following and explain why a potential violation may have occurred. (Choose and explain which ones apply to the case)

• Federal False Claims Act • Physician Self-Referral “Stark” Law • Federal Anti-Kickback Statute • Federal Tax-Exempt Law • Emergency Medical Treatment and Labor Act (EMTALA) • Health Insurance Portability and Accountability Act (HIPAA) • Antitrust Law • Good governance (e.g., Sarbanes-Oxley) • Organizational bylaws • Standards of conduct/conflicts of interest policy • Scope of practice laws, licensure, certification • Employment law, corporate liability

2. Which issues merit highest priority? Why?

3. Which issues would you recommend for further investigation? Why?

4. What, if any, further steps would you suggest (e.g., referral to inside/outside counsel, involvement of additional departments or individuals, revision of policies/procedures, termination of employment or contractual relationships, self-reporting to the government, internal audit, etc.)?

5. To the extent you believe there to be a legal or compliance-related issue, please recommend alternatives to the problematic program, policy, programmatic element/component, departmental or corporate structure, and/or relationship that you believe would not violate any laws. These alternative proposals do not require detail; however, and particularly where the offending program/policy is designed to increase access, improve quality, or reduce costs, the CEO and board will want to know that these ultimate goals can still be achieved if you are recommending. elimination or modification of existing activities.