MedicalPracticeCME.com

cme tests / vocabulary / congress / federal laws / state laws / fraud & abuse / self-referral / compliance plans / HIPAA / antitrust / erisa / other countries / considerations / resources / current events

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fraud and abuse:  laws / qui tam actions / other cases / trial

compliance plans:  potential pitfalls / for physicians

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Class Description:

Laws and Public Policies and Health Care Delivery Systems in Other Countries

This class examines how the United States government impacts health care which in turn effects physicians. This class will examine how the United States Congress may be moving more toward managed care.  This class will explore the impact on physicians and managed care organizations by various laws such as privacy and security laws, fraud and abuse laws including anti-kickback and self-referral, and sunshine laws. Also, this class encourages physicians to analyze how antitrust type laws effect physicians as well as managed care organizations.  In addition, this class encourages physicians to explore what the United States Healthcare system could learn from other countries.

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Topics:   

VARIOUS UNITED STATES LAWS AND PUBLIC POLICES/HEALTH CARE DELIVERY SYSTEMS IN OTHER COUNTRIES

• I.    UNITED STATES CONGRESS
  • A.    HEALTH INSURANCE REFORMS
  • B.    HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA)
  • C.    ANTITRUST
•      D.    EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA)
• II.    STATES
  • A.    PATIENT PROTECTION AND PATIENT RIGHTS LAWS
  • B.    ANY WILLING PROVIDER LAWS
• III. FRAUD AND ABUSE LAWS
  • A.    LAWS
  • B.    QUI TAM ACTIONS
  • C.    OTHER CASES
  • D.    TRIAL
• IV.    SELF-REFERRAL LAWS
• V.    COMPLIANCE PLANS
  • A.    POTENTIAL PITFALLS
  • B.    FOR PHYSICIANS
• VI. HEALTHCARE SYSTEMS IN OTHER COUNTRIES
  • A.    GERMANY
  • B.    CANADA
  • C.    UNITED KINGDOM
  • D.    POLICY SOLUTIONS

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Key Objectives:

1. Examine the effect market based competition compared to legislative regulations in systems-based practice may have on physicians.
2. Synthesize laws that may effect physicians such as fraud and abuse and antitrust laws.
3. Examine what the United States can learn from other countries involving systems-based practice in the health care delivery system.

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Review:

1. Analyze the effect market based competition compared to legislative regulations in systems-based practice may have on physicians.
2. Describe the effect of fraud and abuse and antitrust type laws may have on physicians and systems-based practice.
3. Synthesize what the United States can learn from other countries involving systems-based practice in the health care delivery system.