Regulatory Systems Flashcards
Potential penalties
loss of the opportunity to treat covered clients, monetary fines, imprisonment, or the loss of a professional license or credentials to practice
Oversight is what
the coordination of agencies, departments and offices that carefully watch the practices of health care organizations to protect the public, and ensure quality care and compliance with laws and regulations.
Watchful care
Delegation of enforcement of the regulations
What is the principal federal government agency for protecting the health of all Americans?
US department of health and human services (HHS)
HHS
US department of health and human services
largest departments in the federal government – encompasses Medicare, Medicaid, public health, medical research, child and family services…
Over 300 programs!
ACF
Administration on children and families
economic and social well-being of families, children, individuals, communities. Focus on creating strong communities (domestic violence, head start…)
AoA
Administration on Aging
coordinates and monitors home and community-based services for the older adult. (meals on wheals, adult day care)
AoA includes what
National Center on Elder Abuse – prevent elder abuse
Senior Medicare Patrol (SMP) – trained to recognize and report health care fraud
AHRQ
Agency for healthcare research and quality
improve the quality, safety, efficiency, and effectiveness of health care – One of 12 from HHS that supports research – focus on providing EBP info and clinical practice guidelines
CDC
Centers for disease control and prevention
protect health through health promotion, air and food quality, prevention of disease, injury and disability, and preparedness for new health threats. Maintains data and stats on stuff like cancer, diabetes, obesity
What is part of the CDC
NIOSH - national institute for occupational safety and health
- they provide recommendations
FDA
Food and drug administration
responsible for protecting the public health
What is part of FDA
MedWatch program – Providers report events with medical products to them
HRSA
Health resources and services administration
primary agency to improving access to basic health care for those who are medically underserved.
What is part of HRSA
Affordable care act falls under this administration
National Health Service Corps – loan or scholarship given to people who then practice in underserved areas
HIS
Indian Health service
provides the primary health care services American Indians and Alaskan natives.
Provides hospitals, health care clinics & agencies. – services only for members of tribe
NIH
National institute of health
nation’s medical research agency and makes important discoveries that improve health and research (majority of their budget goes to research too)
CMS
Centers for medicare and medicaid
Administers medicare, medicaid, state childrens health insurance program (CHIP), health insurance marketplace
MACs
Medicate administrative contractors
administer Medicare part A and B programs – review and process claims, decide what is covered under med program
RAC
Recovery audit contractors
developed to identify and recover improper Medicare payments for both part A and B services. – review claims, look for billing abnormalities and identify over and under payments
Which regulatory agency may file lawsuits in federal court to enforce ADA?
DOJ
DIA
OIG
OCR
DOJ
Department of justice - health care fraud and abuse program
enforces laws and defends interests of the US
Parts of the DOJ
Health Care Fraud and Abuse Program - a joint program under the direction of the Attorney General and Secretary of HHS. Disabilities Act (ADA). - civil rights law the prohibits discrimination among those with disabilities
DIA
Department of inspections and appeals
protects the health and safety of Iowans. May be different agencies in other states. In Iowa they inspect, and license places like restaurants and health care facilities – they can randomly perform an inspection
OIG
Office of Inspector General
oversees the integrity of Department of Health & Human Services (HHS) programs. Oversight of CMS, CDC, FDA, NAH… They have ability to exclude providers and organizations for participating in federally funded healthcare programs (like Medicare)
