Accountability and Liability in Healthcare

Introduction

In every organisation structure, each individual is assigned different duties and responsibilities. While at work, they should observe professionalism, integrity, and due care of the organisations interests in getting their work done, applying the best of their skills and knowledge for the best output, to utilise resources with care and to observe humanitarian rules and regulations for all the living creatures. Individuals are held accountable for all their actions and are liable for any faults made unless there were prior clauses in a contract that waive their liability (Cornock, 2011). We shall utilise the long-term care manager to represent the perspective of this paper.

In the healthcare industry, accountability has become a major concern. The long term healthcare manager ensures all parties take full responsibility for all their actions. At least eleven different parties can hold each other accountable in terms of application of professionalism, ethical conduct, legal conduct, financial honesty, access to the required facilities or care, application of public health and community healthcare. The procedures of accountability can be either formal or informal. The models of accountability are the professional model, the economical model, and the political model (Parker, 2010). There are various organisations that govern the healthcare industry so that all parties involved are protected by the law.

Implications of Accountability and Liability for Individuals and Organisations in the Healthcare Industry

Medical malpractice leads to the rising concern on the safety of patients. The long-term healthcare manager ensures patients are well informed on activities, processes and procedures rendered. Organisations are accountable for access to medical facilities and care to all patients who seek them. They should uphold professionalism, quality care and provision of information to patients, (Cox, 2010) failure to which they are held liable. The long-term care manager should carry out healthcare risk assessments ensuring awareness of all practitioners in relation to ethical   misconduct. They ensure systems and equipments are at par with the minimum standard requirements.

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The Standards of Care and Potential Liability for Healthcare Professionals and Organisations

Standard care within the health industry revolves around patients. High quality standards must be maintained by management, employees, doctors and physicians, and the general public.  The standard of quality care, professionalism, honesty and integrity is what determines the standard of treatment received. Commitment, confidentiality, personal accountability and moral obligations also maintain high standards of healthcare services. Customer’s rights to information, informed consent, treatment, advanced medical directives, to die, privacy and confidentiality must be maintained. Failure to comply would lead to penalties for damages caused by negligence.

The State and Federal Statutory and Regulatory Enactments Relative to Patient Rights and Responsibilities

The long term care manager and HR ensure federal statutes are followed. The rules and regulations relate to the patient rights to receive information pertaining to their health, consent during treatment, quality care and professionalism. The Health Insurance Portability and Accountability Act (HIPAA) include requirements for ethical, legal and confidentiality within the health industry. Patients must complete their medical history, follow prescribed treatments and abide by the rules and regulations. They have a right to treatment, advance medical directives, privacy and confidentiality. Principles to patient consent should respect autonomy, integrity and disclosure. Medical record storage in secure state locations governed by HITECH ensures privacy and confidentiality and the recovery act allows patients access to past medical records. Physicians should administer healthcare with professionalism, legal and ethical practices while maintaining integrity, confidentiality. The affordable care act (ACA) helps protect patients from financial fraud.

Forms of Healthcare Fraud

Fraudulent activities include practitioners withholding important information thus causing the patient to make misinformed decisions which could lead to further detriment in their health or ultimately death. Practitioners may prescribe substandard, expired or counterfeit medication and make mistakes during procedures like surgery and fail to inform patients and omit information from patient medical records. They may give false information on customer records such as incorrect dates, wrong billing, modifying records to cover their actions, incorrect diagnoses reports, incorrect identification of members or providers and billing for services not covered by insurance or the state under something covered. They also duplicate records to get double payments for the same job. Organisations hire staff with minimal requirements or unlicensed. Individuals or organizations accept kick backs or bribes to gain more clientele from referrals. Practitioners also inflate bills for personal gain via exploitation of insurance covers. Patients commit fraud via seeking medication in pretence of sickness using insurance cards then sell or distribute them. They take relatives or friends for treatment using the wrong identification misusing the medical cover or loan the cover to extend benefits like ambulance or transport to third parties. The Long term care manager works to provide information to patients and employees regarding fraud in order to reduce it.

Civil and Criminal Penalties Associated with Fraudulent Activities

The Fraud claim act protects patients and governments from receiving illicit drugs, services or overrated bills. Penalty would be a fine of three times the program loss plus an additional amount for each claim filed. The anti kickback statute (AKS) protects fraud in referrals of clients for personal gain. Penalty includes jail terms, fines and no participation in healthcare programs. The physician self referral law prohibits medical practitioners from referring patients for further treatment to other family members or friends. Penalty for breaking this stark law would be fines and non participation in federal healthcare programs. The exclusion statute denies participation in federal healthcare if practitioners were involved in Medicare or Medicaid fraud, patient abuse or neglect, financial felony convictions on medical grounds or theft, felony convictions on unlawful manufacture, distribution, and prescription or dispense of unorthodox drugs. Fraudulent patients would also be susceptible to fines and jail terms in relation to the extent of their fraudulent activities. The long term care manager mitigates risks that would lead to fraud and conviction or penalisation.

Provider Rights and Responsibilities

The long term care manager ensures provider rights and responsibilities are adhered to by all parties. Providers have rights to be respected, provided with information they require in regards to staff, patients, and disease guidance programs. They should be included in changes and decisions that affect them and interact directly with clients and employees as well as investigate or appeal payment claims. They have a right to a notice of termination. They are responsible for providing primary healthcare that doesn’t require speciality, checkups on pre qualifications of clients, train the clients on services rendered, and they should provide information on client medical conditions and the treatment plans available.

Legal and Ethical Implications of Using Technology in the Healthcare Industry

Technology is dynamic hence it is difficult to keep up with the very expensive equipment in healthcare. Storage of information has posed a big challenge to the healthcare industry via fraudulent activities in the cloud. The healthcare industry relies on a vast network where they are not guaranteed of sufficient upgrades, maintenance and security of the equipment in all the healthcare facilities nor are they confident on the competence the medical practitioners or operators of the machines globally. It is a multi cultural and multi lingual global environment with different ethical and moral codes as well as different laws and regulations hence different standards of healthcare facilities. A global law governing international healthcare is vital where policies ensure basic patient rights are adhered to (Ferraretti, et al., 2010). The internet provides information on various health afflictions, treatments and health facilities around the globe hence they are well informed. Technology helps clients’ access diagnosis and treatment faster.

Conclusion

Healthcare is inevitable to everybody and the patients are highly dependent on the medical practitioners to provide access to treatment, work with integrity and professionalism, exercise maximum quality care and keep their information private and confidential. The healthcare facilities and organisations are also dependent on the patients to earn a living. The future trend is in technology has everybody accessing information on everything. The social media spread good healthcare practices and fraudulent ones like a wild fire (Humber, 2013). It is therefore eminent that technology is embraced, upgraded, serviced and maintained. Every individual or organisation is accountable and liable for any activity they carry out or communication they have within the healthcare industry. This policy protects all the institutions namely the government, the health industries, insurance organisations, communities, families and individuals.

 

References

Cornock, M. (2011). Legal definitions of responsibility, accountability and liability. Nursing Children and Young People23(3), 25

Cox, C. (2010). Legal responsibility and accountability: Chris Cox looks at risk management and accountability issues for nurses, especially those undertaking extended roles. Nursing Management17(3), 18-20.

Ferraretti, A. P., Pennings, G., Gianaroli, L., Natali, F., & Magli, M. C. (2010). Cross-border reproductive care: a phenomenon expressing the controversial aspects of reproductive technologies. Reproductive Biomedicine Online20(2), 261-266.

Humber, J. M. (Ed.). (2013). Biomedical ethics and the law. Springer Science & Business Media.

Parker, M. (Ed.). (2013). Ethics and community in the health care professions. Routledge.