HSA 405 SU Healthcare Compliance Paper

Overview

This assignment will explore compliance issues with federal and state laws and regulations governing healthcare organizations, such as the Anti-Kickback Law, the False Claims Act, the Stark Law, credentialing, medical errors, and patient safety. It is important to understand healthcare compliance for the benefit of improving patient care. It is also important to promote adherence to applicable laws, payer healthcare requirements, and to protect the organization against fraud, waste, abuse, and other potential liabilities.

Instructions

Write a 2–3 page paper in which you:

Summarize one statute, one regulation, and one guidance document that impose compliance obligations on healthcare organizations.

Explain what healthcare organizations must do to comply with legal requirements.

Chapter 7
Social
Determinants of
Health and the
Role of Law in
Optimizing
Health
Chapter Overview
• Describes the meaning of “social determinants of health”
and the significance of social factors on individual and
population health
• Describes how law can create or perpetuate health-harming
social conditions
• Explains how law can be used to ameliorate health-harming
social conditions
• Explains how innovative interventions to improve health,
such as medical-legal partnership, can help address healthharming social conditions at the individual and population
levels
Background
(1 of 2)
• Health disparity—when one population group
experiences a higher burden of disability or illness
than another group
• Healthcare disparity—denotes differences in access
to healthcare services or health insurance, or in the
quality of care actually received
• Health equity—a situation in which everyone has the
opportunity to attain his or her full health potential
• As long as these disparities exist, a society cannot
achieve health equity.
Background
(2 of 2)
• Many factors contribute to health and healthcare
disparities, including:
– Individual behaviors, healthcare provider bias, cultural
expectations and differences, location and financing of
healthcare systems, social factors, and more
• Disparities appear through different lenses.
– Race, ethnicity, socioeconomic status, age, geography,
language, gender, disability status, citizenship status,
and sexual identity and orientation
Determinants of Health
• According to the Centers for Disease Control and
Prevention (CDC), determinants of health are “factors
that contribute to a person’s current state of health.”
• Biological factors—genetic mutation that could increase
chances of developing a disease (sickle cell anemia)
• Psychosocial factors—conflicts within one’s family that
may lead to stress, anger, and/or depression
• Behavioral factors—alcohol/drug use, smoking,
unprotected sex
• Social factors—conditions in which people are born and
that affect their daily lives and overall well-being as they
move through various stages of life
Defining Social
Determinants of Health
• Social determinants of health (SDH)—social
conditions into which people are born and that affect
their daily lives and overall well-being as they move
through life
– World Health Organization (WHO) defines SDH
as: “the conditions in which people are born, grow,
live, work and age”
– Centers for Disease Control and Prevention (CDC):
SDH are shaped by the distribution of money,
power, and resources at both local and national
levels
Types of Social Determinants
of Health
(1 of 2)
• Access to high-quality educational opportunities
• Access to medical care services
• Access to social media and other technologies
• Availability of community-based resources and
opportunities for recreational activities
• Availability of resources to meet daily needs
Types of Social Determinants
of Health
(2 of 2)
• Culture
• Language/literacy
• Public safety
• Residential segregation
• Social norms and attitudes
• Socioeconomic conditions
• Transportation options
The Link Between Social Determinants
and Health Outcomes
• While most diseases and injuries have multiple
causes, and while several factors and conditions
contribute to a single death, the overwhelming weight
of evidence demonstrates the powerful effects of
socioeconomic and related social factors on health.
Law as a Social Determinant
of Health
(1 of 2)
• The law can be used to design and perpetuate social
conditions that can have terrible physical, mental, and
emotional effects on individuals and populations.
• The law can be utilized as a mechanism through which
behaviors and prejudices are transformed into
distributions of well-being among populations.
Law as a Social Determinant
of Health
(2 of 2)
• Laws can be determinative of health through underenforcement.
• The law can be used to structure direct responses to
health-harming social needs that result from things like
impoverishment, illness, market failure, and individual
behavior that harms others.
Right to Criminal Legal Representation
Versus Civil Legal Assistance
• While the right to legal representation exists in
criminal matters, there is no right to a lawyer in
civil matters.
• Common civil legal matters involve immigration
status, domestic violence, disability law, family
law, housing needs, public benefits (e.g., Medicaid,
food stamps, Social Security), employment
disputes, and special education needs.
Combating Health-Harming Social Conditions
Through Medical-Legal Partnership
• Medical-legal partnerships function as a patient care
team that includes both medical and legal
professionals.
– A legal services attorney is embedded in a medical
care setting (hospital, community health center, etc.)
to address underlying social conditions that
negatively affect patient health but whose
remediation is outside the expertise of traditional
healthcare providers.