Unit VII Assessment Completed

Unit VII Assessment
Question 1
Discuss the appeal process involved in responding to internal and external audits in
healthcare facilities.
An audit is known to be an assessment which has been finished and whose information is based
on facts trying to understand agreements with standards set. When it comes to healthcare, audits
are normally done by either the government or insurance companies to departments in the
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facility. Three major classes of problems normally come up as a result of the audit;
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First and foremost, is the overt problems- these are problems which come about as a result of
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nonconformity to the set rules that are obvious for the organization. For instance, nonobservance
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of HIPPA by some staff members of the facility which then prompts the administrator to take
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action. Such action towards HIPPA violators helps the facility a great deal, by avoiding
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unnecessary fines and penalties that could come up as a result of a complaint filed at the Office
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of Civil Rights.
Secondly, there are the Covert problems. These are hidden problems related to nonconformity
of the regulations. The performance of trend analysis that helps to know the problem patterns is
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crucial in bringing to picture these problems. For instance, a six-month analysis of a particular
data is crucial for the management to understand that there was a problem as compared to basing
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their analysis to just one month which could seem just ok to the management.
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Thirdly, there are the occult problems. These are the problems related to nonconformity to
regulations which are much hidden and can only be unveiled through a complete comprehensive
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investigation. For instance, a situation that could cause serious harm to the facility. It could also
mean someone who has been discovered to be of potential danger to the facility. For instance, a
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danger that has been unveiled of a staff who has come to work in a facility for the patients under
the influence of alcohol.
Question 2
Explain the impact of failure to comply with state and federal laws, regulations, and
statutes in health care. Be sure to include the doctrine of corporate negligence in your
answer. Also, discuss the steps that are employed for ethical decision making in health care,
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including the four key ethical principles.
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Serious problems can come up through failure by any healthcare staff to abide by the rules and
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regulations as expected of them. Some of these issues are in relation to fraud; this is one lies
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about some information that is crucial in the facility or when one steals funds from the facility.
Another one is battery; this is a situation when a staff attends to a patient without their
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permission. It is very important to get permission to carry out any medical procedure to a patient
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in the facility. Next, is non-reporting of a problem. Here, there are situations when a healthcare
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specialist realizes that a patient, for instance, was abused through raping or domestic abuse and
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doesn’t take an initiative of reporting to the relevant authority in charge so that an action is taken
accordingly as expected by the law. Also, it is a serious problem to falsify the records. It is not
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right to give out false records for purposes of covering up a problem. A criminal charge can
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easily be executed to a healthcare worker in case of such a situation. The last one is malpractice.
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This is commonly known as negligence by the professional.
Three key laws and regulations need to be taken into consideration by the healthcare specialist
when attending to the patients in the facility. The first one is The Emergency Medical Treatment
and Active Labor Act (EMTALA). It is among the 1986 laws which were passed to ensure that
CMC providers attend to emergency situations of patients irrespective of their financial ability to
make the payment for the service. Through this law, the patient is expected to receive medical
screening as well as care from the facility to make them stable so as to be discharged or referred
to another healthcare facility for further treatment. For the women who are in active labor, they
are also expected to be attended to as put forth in this law.

The second law that was put in place to help the patients and be followed by all healthcare
specialist is The Patient Self-Referral Actor Stark law. This is a law that prevents medical
specialists from doing patient-referrals in a situation that they either benefit accordingly or have
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an interest in terms of finances. This law is also allied to Anti-Kickback law which has played a
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big role in preventing situations where facilities pay physicians for making referrals of patients.
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The third important law in a healthcare setting is the Hill-Burton Act. This is an act that
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enables the giving out of grants as well as loans to the nearby patients to the facility in exchange
for their services in the construction and improvement of the facility since they are unable to pay
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for the services that they received.

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On the side of healthcare facility operations, there are also some laws that enable them to achieve
their objectives. Like; False Claims Act. This law prevents situations where illegal claims having
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false information can be submitted to the third party for purposes of payments.
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Another one is the Affordable Care Act. Here, a protection plan is offered to individuals whose
intention is to get good health insurance.

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For the sake of maintaining a good relationship between the employees and the employer in a
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healthcare facility, there are also laws that govern the same. First, there is the Doctrine of
Corporate Negligence. This is a law that tends to ensure that the incompetent staff of a healthcare
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facility can be liable for their actions. This is the law that has helped the staff who cause
malpractices to the patients out of negligence.
The second law that helps to bring sanity between the employer and the employee in a healthcare
facility is the Equal Employment Opportunity Act (EEO). Many facilities tend to hire and fire
their staff based on age, gender as well as race. The responsibility of this law is to prevent
situations where an employer can take an action against the staff based on either race, gender or
age of the staff. Another one is the Occupational Safety and Healthcare Act (OSHA), which tends
to ensure that all the employers put safety measures that will enable a safe working environment
for the staff. Also, there is America with Disability Act (ADA). This law prevents discrimination
of the disabled in employment. And also, the Wage and Hour Laws which ensure that the staff is
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paid better wages depending on the hours they have worked.
Ethical decision making is normally accompanied by four main principles. Autonomy is the
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first principle. Here, one has a right to make the decision for him or herself and which has to be
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respected. Staff members have a duty of knowing the right thing to do while the patients should
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decide whether to refuse or go ahead with the treatment.
Non-maleficence is the second principle in decision making. This principle ensures that people
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don’t cause harm to others. In relation to the Hippocratic Oath, physicians should not harm their
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patients in any way.

Beneficence happens to be the third principle in decision making. This principle ensures that
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good acts are not only done to the people but are also produced. Lastly, there is the principle of
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justice. Through this principle, all people are supposed to be treated not just as equally as others,
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but also fairly as dictated by humanity.

Before starting the process of ethical decision making, there is a need to state the issue at hand.
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Secondly, there is a need to define the facts about the issue. Identification of involved individuals
plus their relationship with the affected is done in the third step. The gathering of relevant
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resources about the issue is done in the fourth step. Input from the individuals in step three is
gathered in the fifth step. In the sixth step, at least three circumstances of decisions are evaluated
and lastly, the process of formulation and carrying out of the plan of action is done.
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Unit VII Assessment

the influence of alcohol.

This is commonly known as negligence by the professional.

are also expected to be attended to as put forth in this law.

for the services that they received.

intention is to get good health insurance.

malpractices to the patients out of negligence.

patients in any way.

but also fairly as dictated by humanity.

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