14. Regulatory Environment of US Health Care Businesses and Employment Law

Question 1

Noncompliance with Medicare/Medicaid coverage and reimbursement guidelines represents a substantial risk to the healthcare provider. Sanctions include:

Answer 1

• Recouping improper payments
• Imprisonment for owners and managers
• Exclusion from future participation in these programs

Question 2

⭐️ Organizations establish a ___________ to lessen risks of intentional or unintentional regulatory noncompliance.

Answer 2

Corporate Compliance Program

• Measures to prevent violations
• Measures to respond to violations

Question 3

Laws governing employment practices come from all levels of government – federal, state, or local

Answer 3

Employment Law

They stipulate the employer-employee (past, current, potential) obligations and rights. Areas include: wages, discrimination/harassment, privacy…

Question 4

⭐️ set standards for minimum wage and overtime pay rate that affect most private and public employers

Answer 4

Fair Labor Standards Act

Question 5

Employers required to pay employees who are _________ overtime

Answer 5

not exempt

Wage-based employees: nonexempt

Question 6

Title VII of the Civil Rights Act as Amended in 1991 Prohibits employment discrimination based on:

Answer 6

• National origin
• Race
• Color
• Religion
• Sex (including pregnancy discrimination)

Question 7

Salary-based employees are ______ from receiving overtime

Answer 7

exempt

Question 8

Title VII of the Civil Rights Act as Amended in 1991 applies to:

Answer 8

• Employers with 15 or more employees
• Employment agencies
• All levels of government
• Labor organizations

Question 9

Title VII of the Civil Rights Act as Amended in 1991. This legislation included the __________________, which established a commission to study the existence of artificial barriers to the advancement of women and minorities in the workplace.

Answer 9

Glass Ceiling Act

Question 10

Prohibits sex-based wage discrimination

Answer 10

Equal Pay Act of 1963

Question 11

This act prohibits employment discrimination against persons 40 years of age or older.

Answer 11

Age Discrimination in Employment Act of 1967 (ADEA)

It applies to:

• Employers with 20 or more employees
• Employees
• Job applicants
• Employment agencies
• All levels of government
• Labor organizations

Question 12

Employment discrimination against qualified individuals with disabilities

Answer 12

Titles I and V of the Americans with Disabilities Act of 1990

Applies to employers with 15 or more employees and others previously noted

Question 13

Americans with Disabilities Act (ADA) has four parts:

Answer 13

1. communications provisions
2. employment provisions
3. public accommodations
4. transportation (also four parts: communications, employment, public accommodations, transportation)

Question 14

regulates such things as definitions, standards, packaging, and labeling for food, food supplements, drugs, medical devices, and cosmetics

Answer 14

Federal Food, Drug, and Cosmetic Act

Question 15

regulation examples include efficiency of health care and regulation of biological materials, laboratories, blood banks, and mammogram facilities

Answer 15

Public Health Services Act of 1944

Question 16

Protects health insurance coverage for workers and their families when they change or lose their job

Answer 16

Title I, Health Care Portability, and Renewability

Health Insurance Portability and Accountability Act (HIPAA) has five parts. Most relevant to PT are Titles I and II.

Question 17

HIPPA Title II

Answer 17

Preventing Health Care Fraud and Abuse, Administrative Simplification, and Medical Liability Reform

Question 18

HIPPA Title I

Answer 18

Health Care Portability, and Renewability

Protects health insurance coverage for workers and their families when they change or lose their job

Question 19

Prohibits physicians from referring Medicare patients for certain designated health services to an entity the physician or an immediate family member has a financial relationship with unless an exception applies (in-office ancillary services)

Answer 19

Omnibus Budget Reconciliation Act of 1989 (OBRA) = regulates physician self-referral

Question 20

= expanded physician self-referral areas to include: home health services, inpatient and outpatient hospital services; occupational therapy; physical therapy

Answer 20

Omnibus Budget Reconciliation Act of 1993 (Stark II)

Question 21

= combats health care fraud and abuse by providing for triple damages and mandatory fines of $5,000 to $10,000 per claim that can total millions of dollars

Answer 21

Federal False Claims Act

Question 22

was established to aid employers, licensing authorities, and professional associations to track unprofessional and incompetent health care professionals who have had adverse actions taken against them

Answer 22

The National Practitioner Data Bank