Description
Why is something already written in the law and code section?
The law and code section has a general reference to the law that applies. Use this general reference to find the specific law that applies. (Use the Common Health Laws document) Write the formal name of the law (the title) and write the code section for the law in the box.
For example, in the box to the right of scenario 1, it says “state licensing law”. The scenario is for the state of Maryland. Use your resources to find the Maryland state licensing law. Write the name of the law and its Maryland Code section in the box where it says “state licensing law.”
How do I cite and reference code sections?
Use the examples below, but fill in the proper code section numbers to cite the code.
-United States Code (U.S.C.) cite 42 U.S.C. 342 (2021)
-Maryland Code 23-41-1 (2021)
How do I know complete the risk assessment? How do I know if something is low, medium, or high risk?
Evaluate the risk by looking at the following factors.
Consequences. Consider all of the practical consequences of the situation. This includes poor clinical outcomes, legal liability, financial loss, reputational loss, and capacity loss such as a loss of use of technology. If the practical consequences are serious, then there is a higher risk of harm. If the practical consequences are low, then there is a lower risk.
Penalties. Consider the legal penalties or non-compliance. The more severe the penalties, the higher the risk. Lower penalties have a lower risk. Generally, criminal penalties can include jail or prison time so they will have higher penalties.
- Likelihood. How likely is it that the problem will arise? If this is a common problem that occurs frequently, then there is a higher probability and a higher risk. If this is something that doesn’t commonly occur there will be a lower probability and lower risk.
- Internal Controls. What internal controls are in place that would limit the likelihood that this would happen? If there are strong controls, this would lower the likelihood of a problem. In other words, if the company has a good policy, system, or protocol to ensure the situation is handled properly, the risk will be lower. If there are weak controls, then this would increase the likelihood of a problem. This often occurs when each manager makes there own decision on an issue.
- Overall Risk. Compare and contrast the risk assessment from the different areas to come to an overall risk assessment of high, medium or low.
- Be sure to support your risk assessment with reasons to support your conclusion. Write in complete sentences.
- For example, for the first scenario evaluate the risk of the physician licensing situation and give it a rate of low, medium, or high. Describe your reasons for the rating in simple complete sentences.
Do I need to support my risk rating?
Yes!
Give specific reasons to support your risk rating. Demonstrate your evaluation of the risk by including your supporting reasons.
What does it mean “A question you would ask the resource person to help you better know how to comply with the law”?
Underneath this section, write one question that would help you know what to do. The question should be something that the person you selected as the person as a resource could answer. For example, you wouldn’t ask a finance person a legal question or a clinical person a business question.
Keep in mind that good questions lead to good answers and poorer questions can leave you without the information you want. This is a chance to practice formulating good questions when you need help as a manager on the job. Tip: Avoid yes/no questions.
For example, if I selected the Medical Director as the person who would be my best resource, I might ask, “What steps did you take to become licensed in Maryland to practice as a physician?” Tip: Don’t select Medical Director as the role best able to help.
How do I decide on a managerial action to take to comply with the law?
Review risk management and legal compliance resources in the Classroom Law Library resources for Week 1 and Weeks 2 & 3/Business Transactions. Feel free to use any part of the Classroom law library any time. Also use the Compliance Library and its documents. The textbooks and other classroom resources are also good sources of information.
Evaluate the different strategies to determine which strategy best applies to each scenario. Consider both immediate actions and long-term system wide solutions. Select the action that you feel will be the strongest to control the risk as you have assessed it. Give reasons to support your choice. Tip: Don’t use the same management action for all the scenarios. Management actions should be specific the the scenario.
Describe your action. The best strategies are specific and actionable. Include reasons to support your actions, so that it is clear why you felt this was the best course of action.
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1
Business Transactions
Resource and Compliance Matrix
Name:
Date:
Health care
The Law and
Legal requirements
Risk
Role of
A question
A managerial
business situations
Code Section
and Penalties for
Assessment
Person who
you would
action you
can be a
ask the
would take to
Low
resource for
resource
comply with
Medium
compliance
person to help
the law
High
(Give reasons
you better
(Give reasons
(Give
to support
know how to
to support
reasons to
your choice)
comply with
your action)
non-compliance with
the Law
support your
the law
rating)
1. Your
State licensing Legal requirements
organization just
law
•
Having passed
High
Chief Medical
The failure to Officer
What are the
I would make
legal
a checklist of
2
hired a physician
Maryland
Naturopathic
comply with
CMOs
requirements
the legal
from out of state.
Statutes
Physician
the licensing
perform both
for practicing
requirements
The physician will
Health
Licensing
can lead to
physicist and
medicine in
that I need to
need to become
Occupations
Examination
incompetent
administrative
Maryland?
have for me to
licensed in your
(MD Health
(Timmons,
physicians
duties.
be licensed as
state of Maryland.
Occ Code §
2016).
which will
Compliance is
a physician in
As an
14-3A-02
an
Maryland
administrator, you
(2018))
to perform
poor clinical
administrative
(Timmons,
have been asked to
Code of
physical and
outcomes
duty Frakes,
2016).
oversee the process
Maryland
laboratory
Frakes, M.
M. (2013).
The action
to ensure the
Regulations
examinations for
(2013).
They know
helped me to
physician obtains a
(COMAR)
diagnostic
The penalties
what
be prepared
valid Maryland
(Maryland
purposes Frakes,
for non-
qualification
for
license to practice
10.32.21.08.
M. (2013).
compliance
the staff need
assessments,
medicine.
08 (2021))
are high
to have to
and interviews
There is a
provide the
Having a
•
Having the ability culminate in
Penalties
•
Imprisonment of
3
•
•
up to one year
high
standard
checklist, it
Fine, not more
likelihood of
medical care
would be easy
than $5,000
a serious
They update
for me to
Both penalty and
problem
the staff about
know what
fine
happening
the new health
requirements I
(Timmons,
regulations
have met, and
2016).
and ensure that
which ones I
they are
have not met.
followed
2. You were
Federal
reviewing the new
Antikickback
physician contract
Legal Requirements
High
State Medicaid Is being given
Following
Not to make false
The
Department
bonuses by the
compliance
Statute (AKS)
statements (Patel
consequences personnel
hospital to
program
and see that the
United States
& Sherer, 2016).
are
This personnel
increase
The programs
physician will be
Code (42 U.S.
Not to make false
damaging.
knows the
hospital
provide
paid a flat salary
Code §
statements
There will be
transactions
admissions
guidance to a
with bonuses from
1320a–7b)
regarding the
poor clinical
that can lead
violate
physician that
•
•
4
the hospital for
Code § 1320a-
operation or
outcomes,
to violation of
Antikickback
will help them
increasing hospital
7b
condition
and the
the
Statute?
to determine
(Bertolini et al.,
organization
Antikickback
the financial
2019).
will suffer
Statute.
arrangements
Not to obtain
reputational
that can lea...