15. External Oversight of Health Service Providers Flashcards
- Prevent waste and fraud (intentional misrepresentation)
- Protect civil liberties and individual rights
- Accumulate information to ensure compliance with laws and evaluate performance
External Oversight Organizations
occurs at the federal, state, and local level as mandated by laws.
Government oversight
= principal federal agency for the enforcement of laws related to protecting the health and providing essential human services
Department of Health and Human Services
There are 11 divisions of HHS
- Assures that programs are properly run by its contractors and state agencie
- Establishes payment policies for providers
- Conducts research on various methods of healthcare management, treatment, and financing
- Assesses the quality of health care facilities and services
- Enforces its regulations
Centers for Medicare and Medicaid Services (CMS)
With state and local government and other partners, ______________ provides health surveillance systems that monitor and prevent disease outbreaks
Centers for Disease Control and Prevention (CDC)
Oversees the assurance of the safety of foods and cosmetics, pharmaceuticals and biological products, along with their efficacy and medical devices
Food and Drug Administration (FDA)
oversees the national organ transplantation system. Also responsible for providing health care services for poor and uninsured people living where health care is scarce
Health Resources and Services Administration (HRSA)
Funds and oversees research projects, advancing the nation’s capacity to protect and improve health. Promoting the highest level of scientific integrity, public accountability, and social responsibility in the conduct of science
National Institutes of Health (NIH)
Enforces laws and defends the interests of the U.S. according to the law
Department of Justice (DOJ)
DOL administers federal labor laws related to:
- Workers’ rights to safe and healthful working conditions
- A minimum hourly wage
- Overtime pay
- Employment discrimination
- Unemployment insurance and other income support
Department of Labor (DOL)
Evaluate waste management rules and policies that impact health service facilities, Reduce waste, including mercury use
Environmental Protection Agency (EPA)
It is responsible for preventing fraud, deception, and unfair business practices in the marketplace, and is responsible for the enforcement of federal antitrust and consumer protection laws.
Federal Trade Commission (FTC)
It reports allegations of fraud, waste, abuse, or mismanagement of federal funds including Medicare and Medicaid funding. Is the audit, evaluation, and investigative arm of Congress:
General Accounting Office (GAO)
is an independent federal body that advises the U.S. Congress on issues affecting the Medicare program. includes MedPac input regarding durable medical equipment payment system and outpatient therapy services payment system
Medicare Payment Advisory Commission (MedPac)
the primary law governing relations between unions and employers in the private sector
National Labor Relations Board
This agency is responsible for assuring the safety and health of America’s workers by:
- Setting and enforcing standards
- Providing training, outreach, and education
- Establishing partnerships
- Encouraging continual improvement in workplace safety and health
Occupational Safety and Health Administration (OSHA)
Conducts audits, investigations, inspections, and related functions
Offices of the Inspectors General (OIG)
part of the Department of Education committed to improving results and outcomes for all people with disabilities
Office of Special Education and Rehabilitative Services (OSERS)
true or false: federal, state, and local governments may regulate the same health services activities
true
true or false: HIPAA rules are regulated by the federal government
false, HIPAA rules are regulated by the state
examples of nongovernmental oversight agencies
Joint Commission
true or false: the Joint Commission is a federal and state government oversight that set performance standards and/or provides external oversight to health services organizations and individual providers
false, the joint commision is a Nongovernmental oversight
true or false: the APTA, a federal government oversight agency, is often focused on setting policy and performance standards, while their local level branches (state affiliates) may provide direct oversight functions
false, the APTA is a nongovernmental oversight
a rigorous and comprehensive evaluation process to assess how well a healthcare organization manages all parts of its care delivery system
Accreditation
