Unit 2: Regulatory Flashcards
six areas of fraud
-false statements and or misrepresentations in order to obtain healthcare payments
-Paying for referrals with items or services
-making prohibited referrals for health services
-billing for services never provided
-Falsifying records in order to receive supplies
-Falsely billing for services at a higher level than what was provided
Why was the office of inspector general instructed to create guidelines regarding federal programs
The OIG guidelines were developed in order to ensure fair and legitimate charges
Why was the occupational safety and health administration created
OSHA (OHSA in Canada) was created to ensure safe and healthy working conditions
What does HIPAA stand for
Health insurance portability and accountability act.
-Establishes a framework for security and protection standards regarding healthcare data
Define informed consent
Patient is informed of
-A condition they may have
-The treatment and risks of treatment
-Possible risks if treatment is not performed
What are the stipulations of the red flags rule
Businesses should develop policies and procedures to thoroughly identify patients to prevent identity theft
What is ANSI
American national standards institute
-A nonprofit organization over seeing the development of standards for products, services, process systems, and personnel
What is a compliance program
A set of policies and procedures designed for any given practice detailing measures protecting every facet of patient and worker actions and information.
Four key regulatory bodies
-COA: College of Opticians of Alberta
-NACOR: National alliance of Canadian optician regulators
-IJCAHPO: International joint commission on Allied health personnel in ophthalmology
-ACO: Alberta college of optometrists
What does OHSA stand for
Occupational health and safety act
What does WHMIS stand for
Workplace hazardous materials information system
What does HIA stand for
Health information act
What does FOIP stand for
Freedom of information and protection of privacy
What does HPA stand for
Health professions act
What does PPCA stand for
Persons in protective care act
Criminal law
We are required to undergo a criminal record check before employment
Tort law
Deals with providing compensation to people who have suffered injury or harm because of another person’s actions. This can be intentional harm or negligence.
Regulatory bodies: characteristics of a “college”
-Protects patient interests
-Mandatory registration
-Sets requirements for consideration
-Does not provide benefits
-Is accountable to Alberta health
-Regulates Opticians
Regulatory bodies: characteristics of an “association”
-Protects Optician interests
-Voluntary registration
-Educational opportunities
-Advocates for members and provides benefits
-Accountable to membership
-Led by Opticians for Opticians
Alberta’s three Main laws related to access and privacy
-FOIP (Applies to public bodies)
-HIA (Applies to individual health service providers and organizations
-PIPA (Applies to private sector organizations)
What does PIPA stand for
Personal information protection act
Custodians versus affiliates
Custodians
-Gatekeepers of patient files (Optometrists, ophthalmologists, Opticians)
Affiliates
-Employees of custodians
Things that are part of a patient’s medical record
-Exam notes
-Referral letters
-Records of phone calls
-Eyeglass and contact lens orders
-Medications
Examples of when to release health information without consent
-To another healthcare provider for continuity of care
-To minimize risk of harm to the health or safety of a minor, or an imminent danger to any person
-If required by another act, like the public health act
-To law enforcement if you believe you have information related to a crime
