information governance program paper

Information Governance and Legal Functions: the healthcare industry regulatory compliance requirements that the company has to meet and the corresponding security, privacy, digital forensics, and records management functions that would need to be enabled for a healthcare organization.

Many organizations face the severe impact of litigation if they are non-compliant with the governing laws and data and information regulations. It becomes one of the essential business operational problems to which the legal team and management need to collaborate closely. If IG security is neglected, the organization has to deal with the risk of fines and even scandal if electronic evidence necessary for the lawsuit is lost or poorly maintained. Data security techniques, policy, and culture are required by establishing rules and best practices dependent on the organization’s business and information maintenance. Ignoring these guidelines can bring about extreme fines, or more terrible, information penetration. Organizations must evaluate which security guidelines apply to them. Healthcare is perhaps the most pervasive business in the US because it serves virtually every person. Medical care is vital and ever-developing, as is the IT that supports it. Medical care compliance experts are expected to help clinical offices and associations address the always changing and often overlapping government guidelines that set security, use data principles, and guarantee quality patient consideration and privacy requirements. Below is an outline of a few of the significant laws and guidelines that apply to this industry:
Protecting Privacy and Ensuring Quality Care

The US Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG) is the executive wing answerable for securing understanding protection, guaranteeing quality consideration, and fighting extortion by assuring medical care associations policies and practices are consistent with Federal Government medical care laws and HHS programs. The Healthcare Information Portability and Accountability Act (HIPAA) provided medical care consistency across the business. HIPAA orders industry-wide norms and cycles for the security and private treatment of patient wellbeing data. The Health Information Technology for Economic and Clinical Health Act (HITECH) advances normalized electronic health records (EHR) (Maryville University, 2019). HITECH addresses the protection and security concern of patient information, EHR records, and how they are shared. HITECH also reinforces the authorization of HIPAA’s ensured persistent data rules, requiring the Department of Health and Human Services Office for Civil Rights to direct intermittent supplier reviews and punishments for penetration of data, which means a supplier or office discovered to be in default can confront a fine of up to $1.5 million (Kwon & Johnson, 2013).
The Emergency Medical Treatment and Labor Act (EMTALA) guarantees free access to crisis treatment if patients cannot pay. Turning patients away can result in severe lawsuits and penalties; thus, medical facilities need to maintain all such patients’ accurate records.
The Affordable Care Act (ACA) requires medical services suppliers to execute a compliant and morals program as a condition for repayment for patients who took a crack at governmentally supported medical care programs. The Affordable Care Act likewise builds up various quality and execution improvement programs, including the Medicare Shared Savings Program for setting up Accountable Care Organizations (ACOs). The objective of the ACOs is to minimize expenses and improve quiet results, boosting medical care suppliers with a “pay-for-esteem” model as opposed to the customary “pay-for-administration.” (National Research Council, 1997).
The Centers for Medicare and Medicaid Services (CMS) inside the HHS are responsible for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Nonetheless, directing these projects incorporates the authorization of a trap of consistent rules and repayment steps that medical care associations should follow. CMS oversight likewise incorporates the Electronic Health Record (EHR) Incentive Programs, which sets impetuses and measures for satisfying guidelines set by HITECH for the usage of electronic wellbeing records; the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), which incorporates the Quality Payment Program and its Merit-Based Incentive Payments System (MIPS), repaying doctors and medical care associations dependent on nature of care (Kwon & Johnson, 2013).
Battling Fraud and Abuse
According to the Centers for Medicare and Medicaid Services (CMS), US medical care spending is very high. According to appraisals by the National Health Care Anti-Fraud Association and Federal Bureau of Investigation, some of the cost is lost to fraud. Various laws, resolutions, and even whole units exist to battle misrepresentation and waste. For doctors and consistent experts, understanding these laws is vital, as infringement can bring about criminal accusations, fines, and, for doctors, perhaps removing their licenses to practice.
Medicaid Fraud Control Units (MFCU) explore and arraign Medicaid supplier fraud (which falls under the False Claims Act), just as patient maltreatment or disregard in medical care offices (Kwon & Johnson, 2013). Each state has its MFCU, typically a piece of the State Attorney General’s office, with the OIG liable for practicing oversight. A significant part of medical services consistency is working with the MFCU, or relying upon the office’s size, setting up an interior Medicaid misrepresentation control group to guarantee consistency through evaluating and checking for false action.
Government Anti-Kickback Statute: this rule precludes medical care experts from tolerating any “payoff” (for example, cash, contracts, items) as remunerations for references or suppliers’ proposals to patients on governmentally covered clinical projects, for example, Medicare and Medicaid. The resolution covers the payers of payoffs just as the beneficiaries of payoffs, with doctors who take care of or acknowledge payoffs confronting punishments of up to $50,000 per payoff (National Research Council, 1997).
The Physician Self-Referral forbids doctors from referring patients covered by Medicare or Medicaid to treatment (for example, care offices, drug drugs, and so on) that the doctor has a financial relationship with or stands to benefit from. While the Physician Self-Referral may appear to be a clear guideline for revenue-driven referrals, it has demonstrated an illustration of what can happen when government guidelines conflict with themselves. Compliance experts are compelled to follow new strategies without abusing existing ones.
The law indicates that medical care administrations be at reasonable market costs among its different arrangements and exemptions. The Affordable Care Act’s production of ACOs with motivators that pay-for-worth (and quality) over pay-for-administration put these two laws soundly in conflict. At last, the CMS and OIG gave waivers for bits of the Physician Self-Referral just as the Federal Anti-Kickback Statutes for ACO members. (Kwon & Johnson, 2013) However, the HHS saw that current extortion and misuse laws might fill in as an obstacle to creative projects that adjust suppliers by utilizing monetary impetuses to accomplish quality principles, produce cost reserve funds and diminish waste.

References:
 
Kwon, J., & Johnson, M. E. (2013). Security practices and regulatory compliance in the healthcare
industry. Journal of the American Medical Informatics Association: JAMIA, 20(1), 44–51.
https://doi.org/10.1136/amiajnl-2012-000906

Maryville University. (2019). 5 Important Regulations in United States Healthcare.
https://online.maryville.edu/blog/5-important-regulations-in-united-states-healthcare/ 
National Research Council (U.S). (1997). In For the record: protecting electronic health

information (pp.127–159). [eBook edition], National Academy Press.

https://web.b.ebscohost.com/ehost/ebookviewer/ebook/ZTAwMHhuYV9fNzg0X19BTg2?sid=b7

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