One of the primary objectives of individuals and organizations in the health care industry is to ensure that efficiency and quality of service is enhanced using quality improvement initiatives and performance management techniques. Like several organizations, health care organizations deal with data-based practices, with most of these practices being inclined to financial management or resource distribution and allocation. In such situations, it is important for health care organizations to conceive and ensure that employees embrace the idea of accountability. Long-term care managers are tasked with holding people accountable and liable for their day-to-day actions, and this is crucial to improvement and stability of performance. The concepts liability and accountability are used interchangeably as they both bring the meaning of being responsible for actions taken. This paper focuses on evaluating accountability and liability implications for individuals and organizations in the health care industry, standards of care and potential liability for healthcare professionals and organizations, the status of provider rights and responsibilities in the delivery of health care, the state and federal statutory and regulatory enactments relative to patient rights and responsibilities, various forms of health care fraud, civil and criminal penalties associated with fraudulent activities, and the legal and ethical implications of using technology in the health care industry.
Accountability and liability implications
Long-term care managers are facing the challenge of dealing with real changes in the health care industry. The changes seen in the health care sector are aimed at reducing the costs of long term care (LTC), which can be realized through additional reimbursement. The latter often comes with an increased need for accountability and liability among employees and other stakeholders of a health care organization. A perfect strategy for promoting accountability and liability among individuals and organizations is embracing a method where programs such as Medicare provide separate payments to providers and individuals for the services offered. Violation of such interventions or guidelines by individuals or organizations in entirety could lead to civil or criminal charges (Feldman, 2014).
Standards of care and potential liability
Standards of care are equally important to long-term care managers as they are to other healthcare professionals. In fact, they are considered important as they recognize the key or trusted roles played by long-term care managers in health care organizations(Moffett & Moore, 2011). They are often developed based on the assessment of state and federal rules, laws, and regulations that govern long-term care.From the long-term care perspective, standards of care are important as they outline professional expectation, provide consistency so that patients receive quality care, and give LCT managers the information and knowledge on the quality of care that must be provided to patients. LCT managers who do not meet accepted standards of care be found negligent in scenarios where harm is caused to a patient. There are multiple potential liabilities to which LCT managers have grown accustomed in care provision. Some of these potential liabilities include changing care models, new duties and heightened standards of care as already mentioned, heightened informed consent, and the need to use new technologies in the provision of patient care. Despite the challenges that are faced by LCT managers in dealing with the potential liabilities, they have a duty to respond to them effectively to prevent further complications such as arrest, fine, or imprisonment on legal grounds.
The status of provider rights and responsibilities
Long-term care managers form part of providers of health care in health care organizations, and like other health care professionals, they have various rights and responsibilities. The rights of LCT managers include the right to be treated courteously and respectfully by their organizations, the right to request information about disease guidance programs, and the right to make decisions with other members regarding healthcare. Their responsibilities include adhering to administrative policies and procedures, maintaining open communications with other members, and complying with utilization management decisions(Lezovic et al., 2007).
State and federal statutory and regulatory enactments
Most state and federal statutory and regulatory enactments relative to patient rights and responsibilities revolve around protection and privacy of medical records. LCT managers have the responsibility to implement or abide by these enactments. Through their constitutions, basic law, and statutory procurements, states have played a key role by being controllers of health information. States have come up with itemized health security statutes that ensure that providers such as LCT managers apply reasonable data practice standards to patients’ health data.The Federal Rule, on the other hand, restricts pertinence and regions of sloppy protection of patient data by providers such as LCT managers(Pritts, 2013).
Various forms of health care fraud
There are various forms of health care fraud in existence in the health care sector, and LCT managers are also involved in these. These frauds can be classified as kickbacks, billing for extra or unnecessary items or services, medical identity theft, unbundling, and upcoding(Rudman et al., 2009). Involvement of a provider such as LCT managers in these forms of frauds is punishable under health care laws.
Civil and criminal penalties associated with fraudulent activities
Involvement of health care professionals, LCT managers include, in fraudulent activities is highly prohibited(Rudman et al., 2009). Some of the laws or enactments associated with fraudulent activities include the Anti-Kickback and US Criminal Code, the stark law, Untrue Claim, social security act, and others. The civil and criminal penalties that accompany involvement in fraudulent activities include fines of between $5,599 and $12,000 for every untrue claim. In other situations, a provider, say LCT manager, involved in fraudulent activities may be forced to pay up to three times the quantity of damage, which as a result of an untrue claim, is sustained by the government.
Legal and ethical implications of using technology in the health care industry
The multiple advantages of using technology such as electronic health records notwithstanding, numerous challenges or shortfalls have been witnessed in the use of the same in the health care industry. Some of the challenges include increased health care costs for patients and the fact that health care providers such as LCT managers can trigger unintentional outcomes from the use if the technologies. Numerous blunders or health risks are attributed to the use of technologies such as EMRs, and the fact that these can endanger the lives of patients or jeopardize the quality of care provided can attract legal and ethical implications. For instance, when a long-term care manager uses the mentioned technologies in a way that jeopardizes the health of a patient or quality of care provided, he or she may be arrested, fined, and imprisoned for the same(Rudman et al., 2009). Moreover, ineffective use of the mentioned technologies by a long-term care manager can have ethical implications in that patients may lose confidence or trust in him or her.
Feldman, J. R. (2014). Medical Malpractice Liability and Accountability: Potential Legal Ramifications and Solutions for Florida Accountable Care Organizations. U. Miami L. Rev., 69, 1073.
Lezovic, M., Dzundova, Z., Kovac, R., & Raucinova, M. (2007). Long-term care as an urgent challenge. Bratislavske lekarske listy, 108(3), 161.
Moffett, P., & Moore, G. (2011). The standard of care: legal history and definitions: the bad and good news. Western Journal of Emergency Medicine, 12(1), 109.
Pritts, J. L. (2013). Altered States: State Health Privacy Laws and the Impact of the Federal Health Privacy Rule. Yale Journal of Health Policy, Law, and Ethics, 2(2), 6.
Rudman, W. J., Eberhardt, J. S., Pierce, W., & Hart-Hester, S. (2009). Healthcare fraud and abuse. Perspectives in Health Information Management, 6(5).