Module 1: Federal Sentencing Guidelines and Office of Inspector General (OIG) Compliance Program Guidance
Be able to understand the role of the Federal Sentencing Guidelines in healthcare enforcement
Be able to identify the components of an effective compliance plan
Be able to identify key compliance risk areas for hospitals, according to the OIG
Be able to understand options for voluntary self-reporting of violations, including the OIG's Self-disclosure Protocol
Module 2: False Claims Act
Be able to identify the elements of the civil False Claims Act
Be able to understand the rights of potential whistleblowers in False Claims Act qui tam suits
Be able to identify major criminal laws applicable to false claims
Be able to identify the requirements of the False Claims Act compliance program mandated by the Deficit Reduction Act of 2005
Module 3: Anti-kickback Statute
Be able to identify the elements of the Anti-kickback Statute
Be able to identify Anti-kickback Statute "safe harbors"
Be able to identify arrangements that raise special concerns under the Anti-kickback Statute
Be able to analyze common arrangements under the Anti-kickback Statute
Module 4: Stark Law
Be able to identify the elements of the Stark Law
Be able to understand the framework for analyzing arrangements under the Stark Law
Be able to identify financial relationships that may implicate the Stark Law
Be able to identify exceptions to the Stark Law
Be able to identify sanctions and reporting requirements for the Stark Law
Module 5: Civil Monetary Penalties laws and Exclusion Authority
Be able to identify key components of the Civil Monetary Penalties laws
Be able to understand the problems of "gainsharing" and "gifts to beneficiaries" under the civil monetary penalties laws
Be able to identify the potential penalties and mitigation for civil monetary penalties laws
Be able to identify the key components of the Office of Inspector General's Exclusion Authority
Module 6 : Non-profit Hospital Issues
Be able to identify the key elements of the tests for establishing and maintaining tax exempt status
Be able to identify relevant factors under the community benefit standard for maintaining the charitable mission of a tax exempt hospital
Be able to avoid problems of private insurement and private benefit
Be able to avoid inappropriate political activity that could jeopardize tax exemption
Be able to identify and avoid "excess benefit" situations that could result in potential intermediate sanctions
Be able to understand the applicability of the Sarbanes-Oxley Act to non-profits
Be able to identify the core fiduciary duties of nonprofit directors
Module 7: Antitrust Laws
Be able to identify the core Antitrust laws and their key elements
Be able to identify the Antitrust enforcement agencies and the rights of private parties under the Antitrust laws
Be able to identify common conduct by hospitals that potentially implicates the Antitrust laws
Be able to identify federal enforcement agency guidance for healthcare organizations under the antitrust laws
Module 8: Medicare Conditions of Participation
Be able to identify the requirements for certification under the Medicare Conditions of Participation for hospitals
Be able to differentiate Medicare certification from Joint Commission accreditation
Be able to identify the process of certification under the Conditions of Participation
Be able to use the State Operations Manual on Medicare Conditions of Participation for hospitals
Be able to differentiate between conditions and standards of participation
Be able to identify the new Conditions of Participation for restraints and seclusion
Be able to understand the processes that could lead to loss of certification under the Medicare Conditions of Participation
Module 9: Emergency Medical Treatment and Labor Act (EMTALA)
Be able to identify the elements of EMTALA for hospitals with emergency departments
Be able to determine applicability of EMTALA in common situations
Be able to use the State Operations Manual for evaluating hospital compliance with EMTALA, including the standards for screening, stabilizing, and transferring patients
Be able to understand the relationship of EMTALA to the Conditions of Participation
Module 10: Health Insurance Portability and Accountability Act (HIPAA)
Be able to identify the key elements of the Privacy Rule
Be able to identify the key elements of the Security Rule
Be able to differentiate between "standard" and "implementation specifications"
Be able to use HIPAA regulations to answer common questions
Be able to determine the obligations of a covered entity under the Privacy Rule and the Security Rule
Be able to maintain compliant business associate agreements
