What governance requirement-policy may have been violated

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Reference no: EM133435282

Assignment:

Read the hypothetical case study below carefully.

Congratulations. You have been hired as the first chief compliance officer (CCO) for Mystic Health Systems, a tax-exempt charitable organization located in the Midwest, which operates a 250-bed hospital with $400 million in annual revenue (Mystic Hospital), a 200-member multispecialty physician group (Mystic Medical Group), and a 100-bed skilled nursing facility (Mystic Nursing Home), each of which is separately incorporated. Mystic Hospital is located in an urban (city) setting approximately 5 minutes from the state's capital; Mystic Nursing Home is located in a developing, previously rural area approximately 45 minutes from the state's capital; and Mystic Medical Group has multiple offices throughout the five counties that surround and include the state's capital (mostly in suburban areas).

You review some of the business contracts in the files of Mystic Health Systems.

Cardiology Service: In order to increase patient revenue to support its new cardiology wing, Mystic Health Systems has signed a 5-year relocation agreement with a prominent cardiologist whose practice currently is located on the other side of town. Under the terms of the agreement, the cardiologist agreed to relocate his practice to the Medical Group and Mystic agreed to pay the cardiologist 25% of revenue generated by the cardiac catheterizations. Mystic Medical Group has also agreed to pay the relocated physician a starting bonus of $25,000.

After reading this case study answer the following questions below:

1. What are the legal and/or compliance issues raised by the hypothetical?

2. What law, regulation, or governance requirement/policy MAY have been violated? Consider among the following and explain why a potential violation may have occurred.

Federal False Claims Act
Physician Self-Referral "Stark" Law
Federal Anti-Kickback Statute
Federal Tax-Exempt Law
Emergency Medical Treatment and Labor Act (EMTALA)
Health Insurance Portability and Accountability Act (HIPAA)
Antitrust Law
Organizational bylaws
Scope of practice laws, licensure, certification
Employment law, corporate liability

3. Which issues merit highest priority? Why?

4. Which issues would you recommend for further investigation? Why?

5. What, if any, further steps would you suggest (e.g., referral to inside/outside counsel, involvement of additional departments or individuals, revision of policies/procedures, termination of employment or contractual relationships, self-reporting to the government, internal audit, etc.)?

6. To the extent you believe there to be a legal or compliance-related issue, please recommend alternatives to the problematic program, policy, programmatic element/component, departmental or corporate structure, and/or relationship that you believe would not violate any laws. These alternative proposals do not require detail; however, and particularly where the offending program/policy is designed to increase access, improve quality, or reduce costs, the CEO and board will want to know that these ultimate goals can still be achieved if you are recommending elimination or modification of existing activities.

Reference no: EM133435282

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