HA4070D – Regulatory Environment in Health Care

Discussion 09: Certification for Medicare & Medicaid

 Task: Reply to this topic

For this discussion, read the Research Exercise with the above title on page 372 of the text.

Your client is a hospital that has recently undergone a series of layoffs. A disgruntled former employee, a nurse, has complained to the state health department that the quality of patient care has suffered significantly. The hospital has had reason to be concerned about high rates of nosocomial infections (infections acquired in a hospital). There is also concern about bedsores and soiled linen. One patient’s open wound was infected by maggots. The nurse’s call to the state health department triggered a surprise inspection by the unit charged with overseeing certification for participation in the Medicare and Medicaid programs. It appears likely that the state Department of Health will seek summarily to terminate the hospital’s status under these programs as a “participating provider” (also known as the “provider agreement”). Consult the Code of Federal Regulations or one or more of the relevant practitioner treatises (e.g., the CCH Medicare and Medicaid Guide or the Aspen Hospital Law Manual) to determine what this means and what can be done about it.

.What financial, operational, and other repercussions is your hospital now subject to?

.What can you do to protect the interests of the hospital?

.What legal and regulatory factors are involved here?

.Discuss these and all variables that apply with your fellow students.

Base your discussion on material from the text and your own experience. Cite sources when necessary. Remember to write 150 words in complete sentences.

The Law of Health Care  Finance & Regulation–Vitalsource [email protected]#magicMAN61