Compliance Program Implementation and Ethical Decision Making

Prepare a workplace brief (8-10 double-spaced pages) to address a privacy breach that occurred in a health care organization. Include the consequences of failure to act and evidence-based recommendations for addressing the breach.

Introduction

Health care is one of the most heavily regulated major industries in the United States. Leaders are challenged to stay current and to comply with federal, state, and local laws and their associated regulations. Health care organizations are also responsible to meet industry standards. In some cases, payers equate meeting industry standards with achieving and maintaining accreditation. In fact, many payers consider accreditation a minimum condition of participation. In addition, individual licensure and certification requirements establish basic expectations for health care leaders’ professional conduct.

In summary, health care leaders are responsible to:

1. Meet ethical personal, professional conduct, certification, and licensure expectations.
2. Comply with local, state, and federal health care and human resources laws.
3. Provide evidence of compliance with existing regulations and scan the field for emerging regulations.
4. Identify and meet appropriate accrediting body standards (for example, Joint Commission’s National Patient Safety Goals standards).

As an individual’s health care leadership career advances, so does the corresponding level of accountability. Not knowing the laws or regulations is not an excuse for not complying with them.

This assessment allows you to demonstrate your knowledge of and skills relating to compliance concepts, and governmental and regulatory agencies that oversee health care service delivery, billing, and general operations. You will also have the opportunity to apply the components necessary to initiate and maintain an effective compliance program. Finally, you will consider relevant human resources laws that may pertain to your compliance recommendations.

Instructions

In this assessment, you are assuming the role of an early careerist in risk management and quality improvement at one of Vila Health’s community-based hospitals. Vila Health is a medium-sized system of health operating facilities in Minnesota and Wisconsin. You are working on a team-based initiative under the supervision of the Vila Health Chief Compliance Officer. Your role is to assist in addressing a specific compliance risk regarding a breach of privacy and a potential HIPAA violation. A Vila Health employee has disclosed—without prior written authorization—a patient’s protected personal health information.

Here is the information the team has collected about the privacy breach and potential HIPAA violations to date. A Vila Health supervisor instructed an employee to obtain pre-authorization for an upcoming surgical procedure for a patient. The Vila Health employee submitted confidential, protected health care information about the patient to the insurance company. The Member Services Representative at the insurance company contacted the Vila Health supervisor. The insurance company representative indicated that further discussion of the matter without prior written consent from the patient is prohibited.

As part of the team exploring the privacy breach, you will prepare a workplace brief with authoritative, evidence-based references to support your work.

Preparation

You are already familiar with HIPAA but may want to conduct independent research to enhance your knowledge. Consult this resource for additional guidance on how to conduct research using credible sources: Health Care Administration Undergraduate Library Research Guide.

Instructions

This is a workplace brief rather than an academic paper. Download the Compliance Program Implementation and Ethical Decision-Making Template [DOCX]. Be sure to address all of the following in your brief:

Background

Include a short paragraph of no more than five or six sentences describing the known details about the privacy breach and HIPAA violation.

Privacy Breach—HIPAA Violation

Summarize the relevant health care compliance concepts that apply to this privacy breach and HIPAA violation. Be sure to consider the following:

• Federal, state, and local laws and associated regulations.
• Disclosure.
• Human resource concepts and laws.
• Industry and accrediting body standards.

Seven Essential Elements of an Effective Compliance Program

Apply to this HIPAA breach the seven essential components of an effective health care compliance program, as determined within the Federal Register.

Privacy Breach Consequences

Provide a synopsis of the consequences for an individual leader and for other internal health care organization stakeholders for not taking immediate actions to address a privacy breach. At a minimum, be sure to consider all of the following in your synopsis:

• Patient safety.
• Financial losses.
• Individual and organizational violations of the law.

Evidence-Based Recommendations

Construct evidence-based recommendations to resolve the HIPAA-related privacy breach. You may also want to include relevant information related to:

• Human resource laws.
• Professional codes of ethical conduct and standards.
• Previous case precedents.
• Current alleged health care legal violations.

For help in identifying appropriate evidence-based recommendations, you may want to visit some of the authoritative sources, such as the DOJ/OIG, CMS/HHS, et cetera, listed under the suggested resources for this assessment.

Ethical Decision-Making Framework for Health Care Leaders

Describe an ethical decision-making framework as one of your concluding recommendations. Tip: You may want to use the ACHE’s ethical decision-making framework.

Conclusion

Write a paragraph that summarizes the following:

• Key concepts.
• Importance of compliance.
• Best practices to monitor for future quality improvements.
• Short list of resources.
  • Be sure to include all appropriate citations.

Additional Requirements

• Written communication: Use the Compliance Program Implementation and Ethical Decision-Making Template linked above. Your workplace brief needs to be clear, concise, well-organized, and generally free of errors in grammar, punctuation, and spelling. The title page, citations, and references need to be in the current APA format.
• Length: Approximately 8–10 typed, double-spaced content pages in Times New Roman, 12-point font, including the reference page. See the APA 7th Edition Example Paper [PDF].
• Title page: Develop a descriptive title of approximately 5–15 words. It should stir interest, yet maintain professional decorum. Ensure that your title page conforms to the current APA format.
• References: Include a minimum of six current, authoritative citations and references in the current APA format. See Evidence and APA for more information.
• Scoring guide: Please review the scoring guide for this assessment so that you understand how your faculty member will evaluate your work.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

• Competency 1: Analyze health care laws and regulations from a local, state, and federal level.
  • Summarize the relevant health care compliance concepts that apply to a HIPAA privacy breach.
• Competency 3: Assess the importance of continuous readiness in the health care organization.
  • Apply the seven essential elements of an effective compliance program to a HIPAA privacy breach.
  • Recommend evidence-based actions to address a HIPAA privacy breach.
  • Describe a health care, industry-approved, ethical decision-making framework.
• Competency 4: Explain how governing body and regulatory agency standards exercise oversight authority within a health care organizational setting.
  • Provide a synopsis of the consequences to individual leaders and other internal stakeholders of not addressing a HIPAA privacy breach.
• Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with the expectations of health care professionals.
  • Write a clear, concise, well-organized, and generally error-free workplace brief addressing a HIPAA privacy breach that is reflective of professional communication in the health care field.