This course identifies and describes the functions of the main regulatory bodies overseeing the healthcare financing and delivery systems in the United States and provides an introduction to the most significant regulatory schemes in the field of healthcare.
This course focuses on the laws intended to deter improper billing and reimbursement in the context of healthcare providers and explores when improper billing practices constitute fraud and abuse. The course examines the federal False Claims Act, the enforcement process and civil, criminal and administrative penalties for improper billing practices and billing fraud.
This course examines the laws regulating patient referrals, which include the Medicare and Medicaid Stark Law and the federal Anti-Kickback Statute. The course also reviews the federal False Claims Act insofar as that law applies in the context of referral practices.
This course examines the federal law that creates rights and duties relating to privacy of a patient’s health information, namely, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The course addresses who is regulated, the scope of patients’ rights, the duties imposed relating to safeguarding protected health information and providing notices of privacy practices and breaches and enforcement-related issues.
This course focuses on formal corporate compliance programs for healthcare providers and other healthcare organizations. The course identifies and describes elements of an effective program and discusses challenges involved in implementing such programs and the compliance responsibilities of corporate officials.
This course examines the different ways healthcare is paid for and delivered in the United States. It examines major health programs such as Medicare and Medicaid, as well as the health system changes prompted by the Affordable Care Act. The course also discusses common types of health insurance plans, current efforts in the realm of payment reform and value-based care and issues surrounding healthcare costs in the United States
This course examines a variety of laws and regulatory schemes bearing on the provision of healthcare. Topics include informed consent and medical negligence; the duty to treat and stabilize emergency medical conditions; treatment of minors; treatment of mental health conditions; the roles and responsibilities of a hospital’s medical staff, including effective professional peer review; hospital accreditation and patient safety initiatives; and issues related to post-acute care providers, telemedicine and clinical research.
This course focuses on the issue of capacity. It examines the ways capacity is defined and evaluated by legal professionals and estate planning tools used to handle potential capacity issues, including power of attorney, health care surrogates, living wills and trusts. The course also discusses the process by which an individual is found to be incompetent by a court through the guardianship process, including how a guardian or conservator is appointed and the rights or abilities of the guardian; and introduces some resources and techniques available to protect the assets and persons of incapacitated individuals, including children.
This course looks at the regulations and laws relating to licensure, accreditation and overall quality.