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BHA FPX 4020 Assessment 1 Health Care Problem Analysis Proposal

BHA FPX 4020 Assessment 1 Health Care Problem Analysis Proposal

Health Care Problem Analysis Proposal Patient information security is one of the many reoccurring issues in the healthcare organization. This is a major problem because poor patient data management can result in serious consequences such as identity theft, financial loss, and a violation of patient confidentiality (Shah & Khan, 2020). This issue occurs more frequently than it should, prompting more attention and the creation of effective methods to prevent similar occurrences inside healthcare facilities. Other Assessment:NURS FPX 4020 Assessment 1 Enhancing Quality and Safety Patient information security is a major problem for all countries, with increased cyber threats and data breaches impacting every group of people. Individuals, families, and healthcare communities are all affected by incorrect patient data management, and many healthcare systems lack the resources to address these security concerns (Pool et al., 2024). The purpose of this assessment is to emphasize the essential components of patient information security within the healthcare framework by identifying the variables that contribute to data breaches and establishing prevention techniques, therefore improving patient information security and privacy. The healthcare sector suffers significant expenditures because of data breaches and security deficiencies, taking into account numerous aspects such as technology improvements, organizational rules, and personnel training (Javaid et al., 2023). According to a report (Watson, 2022), a large proportion of people will be affected by a data breach that affects their personal information at least once in their lives. Unfortunately, the problem of patient information security is frequently disregarded on healthcare agendas, causing the difficulty of managing it successfully. Assessment and Measurement of Patient Information Security Patient information security is assessed and measured using a variety of quality improvement techniques and metrics. These assessments typically involve analyzing compliance with industry standards, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States, which establishes the legal and ethical basis for patient data protection (U.S. Department of Health and Human Services, 2022). The amount of data breaches, the level of illegal access, encryption technique efficacy, and security protocol implementation are all important considerations. Units of measurement can include the number of reported breaches per year, the proportion of workers educated in data security, and the average time required to discover and respond to a breach. 1: Office for Civil Rights (OCR), U.S. Department of Health and Human Services (HHS) 2: National Institute of Standards and Technology (NIST) 3: HealthIT.gov, Office of the National Coordinator for Health Information Technology (ONC) 4: International Organization for Standardization (ISO) 5: Healthcare Information and Management Systems Society (HIMSS) 6: Ponemon Institute Benchmarks for Patient Information Security When researching patient information security, it becomes evident that the problem exists inside healthcare institutions. According to 2020 data, 45% of healthcare businesses had five security breaches in the previous two years, with just 53% adhering to policies and procedures for proper patient data security (Seh et al., 2020). This data acts as a standard, allowing us to track quality improvement when new policies and processes are adopted. Stronger security measures are associated with fewer security breaches, resulting in improved protection of patient information. We can evaluate the success of these actions by comparing benchmarks before and after the adoption of improved security measures. Industry Assessment Tool or Framework Patient information security will be assessed using the NIST Cybersecurity Framework. This framework offers complete instructions for strengthening critical infrastructure cybersecurity, as well as best practices for managing and mitigating cybersecurity risks (NIST, 2019b). It has five fundamental functions: identify, protect, detect, respond, and recover, which correspond to the criteria mentioned above. Preliminary Action Plan for Capstone Health Care Problem Analysis Project Conduct Library Search Formulate Problem Statement Identify Factors and Units of Measure Develop Assessment Criteria Technical Safeguards Policies and Procedures Physical Safeguards Administrative Safeguards Organizational Standards Implement and Monitor Solutions Evaluate and Adjust Report Findings ACHE Leadership Competencies The American College of Healthcare Executives (ACHE) defines good healthcare leadership as having five fundamental traits. The study, which aimed to reduce readmission rates among opioid-using patients, exemplifies these competencies in practice. The next part will describe how each leadership quality is utilized in the context of this project, demonstrating its relevance and efficacy. Table: ACHE related to reducing readmission rate related to proposal ACHE Domain ACHE Competency Selected How this Competency Relates to the Capstone Health Care Problem Analysis Proposal Communication and Relationship Management Building Effective Stakeholder Relationships Facilitates collaboration with patients, families, healthcare professionals, and community organizations involved in managing patient information security. Leadership Leading Change Initiatives Demonstrates ethical conduct, transparency, and responsibility in leading efforts to improve care for patients with patient information security. Professionalism Upholding Ethical Standards Ensures integrity, accountability, and ethical behavior in the care and management of patients with patient information security. Knowledge of the Healthcare Environment Understanding Healthcare Systems and Policies Comprehends the complexities of mental health funding, policies, healthcare systems, and advancements in patient information security treatment. Critical Thinking Evaluating Complex Issues and Making Informed Decisions Assesses complex challenges related to patient information security, such as treatment efficacy and readmission statistics, to drive evidence-based improvements. Conclusion BHA FPX 4020 Assessment 1 Health Care Problem Analysis Proposal In terms of patient information security, it is clear that strong methods are required to protect sensitive data and retain patient confidence. Healthcare businesses may considerably limit the risk of data breaches by establishing comprehensive measures such as technological, administrative, and physical security. Using industry benchmarks and frameworks, such as the NIST Cybersecurity Framework, aids in the development of effective security measures and their impact assessment. Adherence to ACHE competencies improves the execution of these techniques, encouraging ethical behavior and informed decision-making. Continuous review and modification are critical for improving patient information security and successfully responding to emerging threats. References BHA FPX 4020 Assessment 1 Health Care Problem Analysis Proposal: Health Information Privacy. (2019, August 26). Health Information Privacy. HHS.gov. https://www.hhs.gov/hipaa/ BHA FPX 4020 Assessment 1 Health Care Problem Analysis Proposal: HealthIT. (2019). Security Risk Assessment Tool | HealthIT.gov. Healthit.gov. https://www.healthit.gov/topic/privacy-security-and-hipaa/security-risk-assessment-tool BHA FPX 4020 Assessment 1 Health Care

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BUS FPX 4121 Assessment 2 External Forces and Ethical Challenges

BUS FPX 4121 Assessment 2 External Forces and Ethical Challenges

External Forces and Ethical Challenges Economic conditions (BUS FPX 4121 Assessment 2) and outside factors have a variety of effects on health care. The quantity of healthcare services required, the accessibility of healthcare facilities, and the expense of medical professionals are some of the difficulties encountered. These constantly evolving occurrences have the potential to impact managed care as well as the healthcare industry. Related Assessment:PSY 7708 Assessment 1 Mentalism and Radical Behaviorism Changes in the economy can have a big impact on how resources are distributed in healthcare systems. Reduced government funding on healthcare services and infrastructure may occur during economic downturns, placing a pressure on hospital capacity and limiting patient accessibility. Furthermore, the price of medical equipment and supplies frequently changes in response to changes in the economy, which has an impact on patients and healthcare providers by potentially raising out-of-pocket costs or insurance premiums. Furthermore, external circumstances (BUS FPX 4121 Assessment 2) like natural disasters, geopolitical events, or global health crises can disrupt healthcare delivery networks and force healthcare companies to respond and adapt quickly. These outside shocks highlight the value of strong healthcare management plans that can reduce risks and preserve patient care under trying conditions. Coordinated Care The most common type of health insurance is managed care. These programs were established in the 1980s with the goals of promoting equity and improving patient care while lowering healthcare costs and boosting business. Because they make healthcare more affordable and only require the provision of treatment and services, managed-care plans have had a significant positive impact on the healthcare system (Ayu et al., 2023). Despite the fact that these programs have brought about improvements. These policies have had certain unfavorable effects on the healthcare sector. One issue is the restrictions on provider access, which limit patients’ options for where to receive medical attention (Berwick, 2020). Managed-care organizations have a designated supplier network and mandate that its members only obtain services from providers in that network. Although seeing out-of-network doctors is permitted for patients enrolled in managed care, doing so will require them to pay out-of-pocket for these treatments. Another problem that patients in managed care plans deal with is referrals. When sending a patient to a specialist under a managed care plan, doctors must take into account the patient’s health plan in order to prevent the patient from having to pay out of pocket. Many people can now afford health insurance thanks to managed-care plans, but the healthcare sector is impacted since fewer within the network services, suppliers, and facilities are available. According to research, managed care coverage has expanded from 50% to 70% by 2019 over the last 30 years (Bin Abdul Baten & Wehby, 2023). When developing treatment programs for patients, healthcare professionals encounter ethical dilemmas due to the growing number of participants and constraints on providers. Accessibility is a moral dilemma in the managed healthcare sector (Lior Naamati-Schneider et al., 2024). Limitations on medical providers raise problems for healthcare professionals while determining the best course of therapy for a patient. Healthcare workers have an ethical duty to uphold the values of justice, beneficence, autonomy, and non-maleficence (O’Donoghue, 2022). The unwillingness to send patients to specific providers or institutions for suitable therapy presents a question of ethics, which raises concerns when developing a plan of care or treatment for patients. Healthcare workers are forced to choose between providing a patient with the medical attention they require while keeping low healthcare costs in order to generate the greatest revenue. Recommendations  It will take time to address the difficulties associated with managed care. Nonetheless, there are certain adjustments that can be made to lessen these moral dilemmas. Depending on the patient’s care needs, authorizations for out-of-network doctors can be granted as a short-term measure to allay ethical worries about patient treatment plans. Reducing ethical conundrums in the healthcare sector can be achieved by allowing patients to get treatments for medical issues as needed, independent of the physician giving the care. One long-term approach that could be used to help address these issues is to gradually grow the managed care network. Patients can obtain care with less restrictions and disruptions by increasing the number of in-network physicians and facilities, which can also help to minimize problems with treatment plans. As more providers become available, healthcare practitioners will have fewer ethical dilemmas when determining a patient’s course of treatment.  By giving consumers the option to receive appropriate treatment based on their medical issues rather than on cost or a network of providers, the suggested strategy adjustments to the managed care plans will increase access to healthcare. Within managed care plans, the cost of treatments can still be controlled and managed, which helps to lessen moral quandaries when it comes to patient care.  Conclusion BUS FPX 4121 Assessment 2 External Forces and Ethical Challenges Managed-care plans have greatly improved healthcare services for many, however, the limitations these plans have on available providers cause ethical concerns for medical professionals. By increasing the availability of in-network providers healthcare professionals can create a plan of care or treatment plans for their patients based on necessity and not on the availability of providers. Expanding their network of managed care plans can continue to manage the cost of services while reducing the need for medical professionals to restrict patient’s care based on their health plans and the providers that are available under it. References BUS FPX 4121 Assessment 2: Ayu, G., Fermansyah, H., & Mahadewi, E. P. (2023). A Study of Managed Care Health System During Pandemic. International Journal of Science, Technology & Management, 4(4), 802–808. https://doi.org/10.46729/ijstm.v4i4.846 BUS FPX 4121 Assessment 2: Berwick, D. M. (2020). The Moral Determinants of Health. JAMA, 324(3), 225–226. https://doi.org/10.1001/jama.2020.11129 BUS FPX 4121 Assessment 2: Bin Abdul Baten, R., & Wehby, G. L. (2023). Effects of the Affordable Care Act Insurance Expansions on Health Care Coverage, Access, and Health Status of 50–64-Year-Old Adults: Evidence From the First Six Years. Journal of Applied Gerontology, 42(8), 073346482311701. https://doi.org/10.1177/07334648231170166 BUS FPX 4121 Assessment

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PSY 7708 Assessment 1 Mentalism and Radical Behaviorism

PSY 7708 Assessment 1 Mentalism and Radical Behaviorism

Mentalism and Radical Behaviorism PSY 7708 Assessment 1: Phrases  Behavioral or mentalistic Instructions (your texts are acceptable; use the source here) If mentalistic, offer a different example of your actions. Kayla was quite depressed today at school. She wept, according to her instructor, when playing with other kids at school. Mentalistic It is mentalistic because it explains her emotions rather than the actions that led to her sadness. She was upset at school because one of her classmates had taken her cherished teddy animal. Every time Michael’s teacher set a worksheet down on his desk, he collapsed to the ground. Behavioral It characterizes an observable activity that gave rise to Michael’s behavior, which makes it behavioristic. Martin knows he needs a root canal, so he phones the dentist’s office to schedule an appointment. Mentalistic This is mentalistic since it fails to explain Martin’s phone call to the dentist in terms of visible and quantifiable behaviors.  Martin made an appointment with the dentist after seeing that his face was bloated. After a difficult day, Shawnia indulged in cake to soothe her feelings following her boyfriend’s breakup. Behavioristic Because it explains both an observable behavior and its observable cause, this is behavioristic. Johnny goes to the sink, turns on the water, and washes his dish whenever the instructor asks him to. Behavioristic Because it explains observable and quantifiable behaviors, this is behavioristic. Meredith follows her mother’s instructions since she is aware that doing so will result in a reward for her good behavior. Mentalistic  Since it doesn’t explain observable and quantifiable behaviors, this is mentalistic. Knowing that her mother gives her $20 for every task, Meredith washes her clothes and cleans her bathroom. Marcus was so angry at the questions on his math homework that he threw his math book. Mentalistic  This is mentalistic since it explains Marcus’ actions without describing the appearance of his behavior. Marcus did not learn the problems on his math homework, therefore he destroyed property by throwing his math book. The rat moves toward the lever and presses it every time the buzzer rings. A food pellet is formed as a result. Behavioristic It is observable and measurable, which makes it behavioristic. The rat is seen to press the lever to receive a food pellet each time the light is on. Behavioristic Because it is measurable and observable, it is behavioristic. Janice scored a perfect 100 on her exam, demonstrating her high level of intelligence. Mentalistic  Janice scored a perfect 100 on her exam, demonstrating her high level of intelligence. For her biology exam, Janice studied all night, and she received a perfect score of 100. Summarize the ways in which the behavioristic approach (PSY 7708 Assessment 1) differs from most other areas of psychology in well-written, well-supported paragraphs. What distinguishes the behavioristic approach from the majority of other psychological specialties? The investigation of mental processes, pictures, and states of consciousness dominated psychology in the early 1900s,(Gonzalez-Castillo et al., 2021). One of the main methods of inquiry was introspection, which is the act of closely observing one’s own conscious thoughts and feelings. While some writers from the first decade of the 1900s described psychology as the study of behavior. According to behaviorists (PSY 7708 Assessment 1), psychology is a field of natural science that is solely focused on objective experimentation. The prediction and management of behavior is its theoretical objective. Its procedures do not require introspection, nor does the scientific value of its findings depend on how easily they can be interpreted in terms of awareness (Gonzalez-Castillo et al., 2021). How might one’s practice be informed by a mentalistic approach? A mentalistic approach would use one’s experience as a starting point for hypotheses. According to the mentalist (PSY 7708 Assessment 1), there is a distinct mental dimension that differs from the behavioristic dimension. According to thementalists, the majority of behaviors are directly caused by one’s mental dimension (Ezenwa-Ohaeto & Ugochukwu, 2021). When employing a mentalistic approach, one could overlook the significance of managing environmental factors and how they could influence or shape their behavioral reaction to both internal and external stimuli. What practical applications might a behavior analytic methodology have? A behavior analytical approach (PSY 7708 Assessment 1) would help one’s practice by helping them to comprehend and regard human behavior as a physical phenomena that depends on external factors to continue functioning. The same kinds of variables sustain the function of behavior, or an individual’s response to particular stimuli, whether they are private or public. One attempts to examine and quantify observable behavior by using a behavior analytical technique (Ezenwa-Ohaeto & Ugochukwu, 2021). Other Assessment:BHA FPX 4004 Assessment 4 PSY 7708 Assessment 1 Mentalism and Radical Behaviorism References PSY 7708 Assessment 1: Ezenwa-Ohaeto, N., & Ugochukwu, E. N. (2021). LANGUAGE LEARNING THEORIES: BEHAVIOURISM, MENTALISM AND AFFECTIVISM. AWKA JOURNAL of ENGLISH LANGUAGE and LITERARY STUDIES, 8(1). https://www.nigerianjournalsonline.com/index.php/AJELLS/article/view/1993 PSY 7708 Assessment 1: Gonzalez-Castillo, J., Kam, J. W. Y., Hoy, C. W., & Bandettini, P. A. (2021). How to Interpret Resting-State fMRI: Ask Your Participants. Journal of Neuroscience, 41(6), 1130–1141. https://doi.org/10.1523/JNEUROSCI.1786-20.2020

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BHA FPX 4004 Assessment 4 Analyze and Apply Dashboard Data

BHA FPX 4004 Assessment 4 Analyze and Apply Dashboard Data

Introduction The Healthcare Performance Visualization Platform (BHA FPX 4004 Assessment 4 Analyze and Apply Dashboard Data) is an essential resource in the healthcare industry, offering a visual representation of hospital performance. Its implementation has produced positive results, improving overall hospital performance while reducing errors. This assessment investigates the platform’s various elements and their implications for increasing patient safety and treatment quality. Related Assessment:BHA FPX 4004 Assessment 3 Goals and Outcomes The Healthcare Performance Visualization Platform has the goal to deliver the best health outcomes for patients by concentrating on certain areas. It uses specific measures to track progress, ensuring that attempts to improve are acknowledged and encouraged (Bhati, 2023). Furthermore, the platform identifies areas that need further attention, allowing for focused interventions to improve overall performance. The platform’s goal is to develop an excellent culture in healthcare delivery through constant monitoring and assessment, resulting in better patient care and outcomes. The platform’s powerful analytics capabilities enable healthcare providers to constantly monitor and assess their practices, creating a culture of continuous development and excellence in healthcare delivery (Haleem et al., 2021). It helps in the identification of patterns and trends, allowing for early actions to address possible concerns before they become more serious. The platform promotes openness and accountability, allowing healthcare organizations to provide the greatest quality of medication, which ultimately enhances patient happiness and health outcomes. Furthermore, it is an effective training and development tool, helping workers interact with best practices and creative approaches to patient care (Bhati, 2023; Haleem et al., 2021). Analytical Framework The platform works as a complete portal for recognizing and categorizing healthcare concerns, allowing root cause investigation and error detection. It uses approaches such as Six Sigma to eliminate faults and improve process efficiency (Rathi et al., 2021). Additionally, Failure Mode and Effects Analysis (FMEA) is used to proactively avoid bad occurrences, resulting in a safer healthcare environment. The adoption of Healthcare Failure Mode and Effects Analysis (HFMEA) gives more precise insights into possible problems, allowing for proactive risk mitigation actions (El-Awady, 2023). This methodical strategy guarantees that healthcare organizations efficiently address underlying issues, fostering a culture of safety and continual improvement in patient care. Roles and Responsibilities The Quality Director is critical to using platform insights. This includes identifying areas for evaluation, acquiring relevant data, and devising improvement initiatives. The director follows the Plan-Do-Check-Act (PDCA) quality model, focusing on continuous improvement via the implementation and evaluation of new procedures (Neutze & Wiggs, 2023). The Patient Safety Officer is in charge of closely monitoring crucial indicators like as patient falls and wait times for procedures like EKGs. The officer identifies problem areas and tackles them by formulating and implementing specific approaches based on time-sensitive data analysis (Vaismoradi, 2020). Recognizing departments that meet their goals reinforces positive behaviors and motivates workers. Similarly, the Risk Manager keeps a careful eye on departments that are suffering a drop in quality, realizing the resulting increase in related risks. The manager develops strategies to minimize possible risks by effectively identifying and analyzing them, with careful follow-up to ensure that risk reduction initiatives are sustained over time (Ferdosi et al., 2020). This aggressive approach contributes to the organization’s overall high safety and quality requirements. Leadership and Oversight Senior Leaders play an important role in giving necessary approval, authority, and strategic vision to support quality improvement efforts inside healthcare organizations. Their assistance is critical in building an environment that encourages continual development and excellent levels of patient care (Sfantou, 2019). Senior leaders promote cooperation and collaboration by cultivating strong connections and creating an enabling atmosphere, all of which are critical for attaining corporate goals. These senior leaders create the strategic direction for safety and quality by creating clear goals and expectations, ensuring that all team members understand their position in the organization’s overall mission (Schoemaker et al., 2019). Their commitment to quality improvement goes beyond strategic monitoring; they actively participate in assessing performance indicators, supporting improvement programs, and providing resources to support these projects. For example, senior leaders can create procedures based on research and promote the use of modern technology to improve patient safety. They can additionally create a transparent culture in which workers feel empowered to report errors or near-misses without fear of repercussions, encouraging a learning and improvement environment. The role of senior leadership in quality improvement has been extensively established in professional literature. Studies (Alsadaan et al., 2023; Fagerdal et al., 2022) show that engaged leadership improves patient outcomes and company success. Leaders who openly commit to safety and quality and demonstrate these objectives in their everyday activities can have a tremendous impact on the mindsets and actions of staff members resulting in an excellent culture. Conclusion BHA FPX 4004 Assessment 4 Analyze and Apply Dashboard Data Regulatory bodies such as the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) play important roles in improving healthcare quality and safety. CMS compels hospitals to submit performance data, which drives national quality improvement efforts and promotes transparency. JCAHO focuses on particular areas to provide safe and secure patient care, using data to evaluate performance and encourage focused changes. Both organizations help to provide a high level of care by enforcing laws and encouraging ongoing improvement of healthcare procedures. References BHA FPX 4004 Assessment 4 Analyze and Apply Dashboard Data: Alsadaan, N., Salameh, B., Reshia, F. A. A. E., Alruwaili, R. F., Alruwaili, M., Awad Ali, S. A., Alruwaili, A. N., Hefnawy, G. R., Alshammari, M. S. S., Alrumayh, A. G. R., Alruwaili, A. O., & Jones, L. K. (2023). Impact of nurse leaders behaviors on nursing staff performance: A systematic review of literature. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 60(60). https://pubmed.ncbi.nlm.nih.gov/37269099/ BHA FPX 4004 Assessment 4 Analyze and Apply Dashboard Data: Bhati, D. (2023). Improving Patient Outcomes Through Effective Hospital Administration: A Comprehensive Review. Cureus, 15(10). https://doi.org/10.7759/cureus.47731 BHA FPX 4004 Assessment 4 Analyze and Apply Dashboard Data: El-Awady, S. M. M. (2023). Overview of Failure Mode

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BHA FPX 4006 Assessment 3 Compliance Training: Essential for All

BHA FPX 4006 Assessment 3 Compliance Training: Essential for All

Regulatory Compliance Regulatory compliance (BHA FPX 4006 Assessment 3 Compliance Training) is a vital part of organizational management which means complying with industry-specific rules, regulations, and standards to ensure that activities are performed legally (Cole, 2022). This concept is critical for sustaining the legality and ethical standards of an organization’s operations. Related Assessment:BHA FPX 4006 Assessment 4 Voluntary Accreditation For example, in the healthcare sector, HIPAA (Health Insurance Portability and Accountability Act) compliance plays an important role in securing patient information and maintaining privacy requirements (Oakley, 2023). Similarly, financial organizations have to deal with standards like the Sarbanes-Oxley Act, which requires accurate financial reporting and internal controls to avoid fraud. Noncompliance can lead to serious consequences, such as fines and legal action, as well as harm to an organization’s image (Phillips et al., 2022). These standards are implemented by regulatory authorities such as the Securities and Exchange Commission (SEC) and the Food and Drug Administration (FDA) to protect the public interest and promote accountability and transparency in an organization’s operations. For example, the GDPR (General Data Protection Regulation) in the European Union promotes strong data protection and privacy requirements, requiring businesses to implement strong data security protections (Commissioner, 2022). Ethical Considerations Ethical compliance means following moral principles and taking morally correct activities even in the lack of clear rules or regulations. It includes actions that are consistent with ethical norms, and establishing trust and integrity inside the company (Resnik, 2020).  For example, an organization can go above and beyond legal standards (BHA FPX 4006 Assessment 3 Compliance Training) to ensure fair labor practices, such as providing employees an adequate salary even when it is not required by law. Organizations in the technology sector, such as Google and Microsoft, have set ethical rules for AI research to eliminate biases and assure fairness in their algorithms, addressing discrimination and privacy issues (Strine & Smith, 2020). Ethical compliance also involves corporate social responsibility (CSR) efforts, in which firms participate in actions that benefit society, such as lowering carbon footprints or assisting local communities. For example, Patagonia’s commitment to environmental sustainability highlights how ethical considerations can affect company activities beyond regulatory compliance. In healthcare, ethical compliance entails prioritizing patient well-being and informed consent while ensuring that medical procedures respect patient autonomy and dignity (Aneta ALEKSANDER & PATIENCE, 2023).  Organizations frequently develop codes of conduct and ethics training programs to reinforce these ideals and promote an ethical culture. According to recent research (Cabrera-Luján et al., 2023), organizations that prioritize ethical compliance do better financially in the long run because they develop deeper relationships with consumers and workers, boosting overall reputation and sustainability. Common Healthcare Regulations, Compliance Requirements, and Laws Healthcare regulations and compliance requirements are intended to assure the safety, quality, and efficiency of healthcare delivery while also safeguarding patient rights. Several significant laws and regulations control healthcare practices in the United States, each having unique demands and ramifications for healthcare practitioners and organizations (Bani Issa et al., 2020). One of the most significant laws is the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which requires the security of patient health information. HIPAA establishes privacy and security requirements for health data, requiring healthcare providers to install protections to assure the confidentiality, integrity, and availability of electronic protected health information (ePHI). For example, hospitals must employ secure electronic health records (EHR) systems and limit access to authorized workers (U.S. Department of Health and Human Services, 2022). The Affordable Care Act (ACA), passed in 2010, included substantial changes aimed at increasing healthcare coverage, enhancing quality, and lowering costs. The ACA contains features such as the creation of health insurance markets, the expansion of Medicaid, and the restriction on rejecting coverage because of pre-existing diseases. To join these exchanges and serve Medicaid customers, healthcare providers must meet ACA standards (Kominski et al., 2019). Medicare and Medicaid are extensively regulated to ensure that providers meet quality and safety standards. The Centers for Medicare and Medicaid Services (CMS) establishes Conditions of Participation (CoPs) that hospitals and other healthcare institutions must comply with in order to receive Medicare and Medicaid reimbursements. These CoPs address a wide variety of operational issues, including patient rights, infection control, and disaster readiness (CMS, 2023). The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals with emergency departments to provide a medical screening examination and any necessary stabilization therapy to anybody seeking emergency medical care, regardless of their insurance status or ability to pay. Noncompliance with EMTALA can lead to large fines and expulsion from Medicare and Medicaid programs (ACEP, 2021). The Occupational Safety and Health Administration (OSHA) monitors workplace safety in healthcare settings, with an emphasis on protecting healthcare workers from risks such as infectious disease exposure, toxic chemicals, and workplace violence. OSHA requirements require healthcare companies to follow safety practices, provide personal protective equipment (PPE), and ensure sufficient staff training (OSHA, 2023). Another important law is the Clinical Laboratory Improvement Amendments (CLIA), which creates quality requirements for laboratory testing to guarantee patient test results are accurate and reliable. The Clinical Laboratory Improvement Amendments CLIA, (2020) state that laboratories must get CLIA accreditation and perform regular inspections to ensure compliance. Accreditation Accreditation in healthcare serves as an endorsement, demonstrating that an institution achieves established quality and competency requirements. Unlike regulations, which are necessary legal requirements imposed by government agencies, accreditation is usually a voluntary procedure carried out by independent certifying bodies (Brooks et al., 2021). These groups, such as The Joint Commission or the National Committee for Quality Assurance (NCQA), assess healthcare institutions against predetermined criteria to guarantee that they offer high-quality treatment. Accreditation boosts trust in the organization’s ability to provide safe and effective treatment, and it can improve patient outcomes by encouraging ongoing quality improvement. For instance, a hospital that has received Joint Commission accreditation has undergone a thorough assessment of its administrative procedures, safety measures, and patient care standards. This accreditation demonstrates to patients and other stakeholders that the hospital follows best practices and is dedicated to sustaining high

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BHA FPX 4006 Assessment 4 Voluntary Accreditation

BHA FPX 4006 Assessment 4 Voluntary Accreditation

Accreditation in Health Care BHA FPX 4006 Assessment 4 Voluntary Accreditation: Healthcare is a complicated structure in which many aspects impact an individual’s decision about which facility to use. One important component is accreditation, which is a national credential given to high-performing facilities. Accreditation demonstrates a hospital’s continual commitment to quality patient care and continuous improvement, which resonates with the public, other organizations, and stakeholders. According to Alhawajreh et al. (2023), accreditation not only improves a hospital’s reputation but also gives a competitive advantage, encouraging the institution to adapt and grow in a changing healthcare sector. It’s important to keep in mind that accreditation is often voluntary. However, it will become essential for healthcare organizations seeking Medicare funding (World Health Organization, 2024). The Department of Health and Human Services has set specified conditions that an organization must achieve in order to be eligible for this funding, and accreditation is one of these essential needs (The Joint Commission, 2020). Failure to gain accreditation can result in a loss of funding, with serious financial consequences for the healthcare organization.  The Joint Commission (J.C.), established in 1951, is the oldest and biggest accreditor of healthcare organizations in the United States. It manages accreditation for approximately 23,000 organizations and programs, conducts over 10,000 accreditation-related surveys each year, and conducts an estimated 4,000 accreditation evaluations (The Joint Commission, 2023). The Joint Commission accredits over 88% of US hospitals, making it the industry’s leading accreditor. However, it is also the most expensive, costing healthcare institutions thousands of dollars every year (The Joint Commission, 2021). Related Assessment:BHA FPX 4006 Assessment 2 Accreditation Requirements The accreditation procedure with the Joint Commission is lengthy and time-consuming. Before moving forward with the application, the company must confirm that it fits the standard standards. According to The Joint Commission (2020), there are two basic qualifying criteria: the organization must be based in the United States or its territories, and if it is an outside organization, it must be administered by the United States or established by the United States Congress. These conditions are necessary to decide if an organization can move forward with the accreditation process. The Joint Commission requires organizations to satisfy particular “minimum number of patients/volume of services” ratios. The J.C. specifically demands that an organization have treated at least 10 inpatients, with at least one actively receiving care at the time of the survey (The Joint Commission, 2023a). In addition, the business must be able to offer an adequate quantity of inpatient charts for examination. For organizations new to the Joint Commission and seeking Medicare accreditation, at least one active inpatient must be present during the survey (The Joint Commission, 2023). These requirements guarantee that the organization has a sufficient patient volume to evaluate compliance with accrediting standards. Once an organization has been determined qualified for accreditation, it must go through an on-site examination. This examination is carried out by properly qualified individuals with substantial hospital experience and expertise (Hussein et al., 2021). The on-site survey evaluates the organization’s adherence to Joint Commission criteria, offering an in-depth assessment of the institution, including patient experiences and medical records. This careful assessment assures that the organization satisfies the high criteria necessary for accreditation. The surveyors begin their review by randomly selecting patients’ medical records (Shen, 2020). Second, they interview physicians, nurses, and patients to evaluate their interactions with the healthcare organization (Shen, 2020). Third, surveyors observe the care given by doctors and nurses. After completing the survey, the organization receives a report card that outlines areas for growth. The Joint Commission created the Survey Analysis for Evaluating Risk (SAFER) tool to assist companies in developing corrective action plans (The Joint Commission, 2024). Following the survey, the company is given a set timetable to undertake these corrective measures and submit evidence of full compliance. The Joint Commission (n.d.) specifies a ten-step accreditation process: Learn how to work with the accrediting organization: Develop a full grasp of the Joint Commission’s responsibilities and services. Review the requirements: Familiarize yourself with the exact requirements and criteria required for accreditation. Assess your readiness: Conduct mock surveys to identify compliance gaps and provide a schedule for achieving compliance (Our Standards, n.d. Apply for Accreditation: Submit your application to start the accreditation process. Prepare for the on-site survey: Ensure that the required paperwork and processes are in place. Address any identified shortcomings. Resolve any compliance problems raised during your readiness assessment. Participate in the first Joint Commission survey: Engage surveyors throughout their on-site examination. Conduct any post-survey follow-up activities: Implement the necessary adjustments and provide documentation of compliance. Celebrate and highlight your accomplishments: Recognize and celebrate your accreditation success with stakeholders and the public. Maintain survey readiness: Consistently follow guidelines to maintain continued compliance and preparation for future surveys. Accreditation and Regulatory Compliance Regulatory compliances include laws, norms, and rules that a company must follow. These standards protect personal information and guarantee that safety precautions are in place. Accreditation, on the other hand, is often optional unless an entity wants government money through Medicare or Medicaid (Szalados, 2021). Accreditation is a stamp of approval from an accrediting agency, which improves the organization’s image in the eyes of patients, communities, and stakeholders by demonstrating a commitment to high-quality treatment and ongoing development. Accreditation and regulation are different but related concepts in healthcare. While they serve distinct functions, accreditation can help healthcare businesses fulfill and maintain regulatory obligations (Frank et al., 2020). Accreditation frequently aids in ensuring compliance with numerous rules, therefore improving the organization’s capacity to meet legal and safety requirements. High-quality care and quality improvement are two important but different components of healthcare that are impacted by accreditation and regulations. High-quality care focuses on minimizing mistakes and harm, ensuring that patients receive safe and effective treatment. It focuses on achieving set criteria to avoid negative effects and promote patient safety. In contrast, quality improvement is focused on providing ‘really great treatment.’ This entails constantly assessing and improving procedures, methods, and results in order to achieve higher

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PSYC FPX 5410 Assessment 1 Psychological Specialization Project Paper

PSYC FPX 5410 Assessment 1 Psychological Specialization Project Paper

Introduction PSYC FPX 5410 Assessment 1: Psychology is a field that is always changing and growing in both academia and philosophy. The discipline of study addresses issues related to human behavior, the mind, and the brain and is data-driven. In psychology, there are various schools of thought, and each one either competes with the other or reflects a particular way of thinking. Theoretical perspective, foundation, beliefs, and theories differ throughout the schools. Psychoanalysis, behaviorism, Gestalt psychology, structuralism, humanism, and cognitive psychology all made significant contributions to the development of cognitive, behavioral, functional, structural, and humanistic educational institutions of thought. Through life-changing experiences that shaped his specialization, Aaron T. Beck made contributions to the field of psychology. He also had an impact on the school of cognitive psychology by influencing the development of Cognitive Behavioral Therapy (CBT). His studies influenced psychology research as well as the direction of the field in cognitive disorders and cognition. Other Assessment:PSYC FPX 5300 Assessment 1 Physical Activity and Matching Law Beck’s Formative Years Aaron Beck, who was born in 1921, had three sisters and one brother. His parents were Jewish immigrants from Russia, and he was a resident of Rhode Island. Beck was the valedictorian of his high school class and attended grammar school. Beck was the editor of the high school newspaper and had aspirations of becoming a journalist. He studied at Brown University, where he earned an honors degree. Beck applied to Yale University School of Medicine after rapidly developing a passion for medicine. Initially, he registered for a neurology residency, but as his interest in psychiatry grew, he pursued a psychiatric fellowship in Stockbridge, Massachusetts. After then, he started working at the University of Pennsylvania’s Department of Psychiatry (Beck, 2022). Beck’s Biography Psychoanalysis, a science that clarifies how to treat psychological and emotional diseases by letting patients speak openly about their issues, dreams, and early memories and experiences, piqued Beck’s interest. When Beck began investigating depression, he did so with the objective of proving the psychoanalytic theory—that people suffering from depressive disorders desired punishment while directing their rage at themselves rather than others. His investigation’s findings, meanwhile, contradicted that theory. The results showed that depressed individuals were probably trying to fit in and get approval, but they were unsuccessful. This led Beck to reevaluate the applicability of his theory to other conditions, and as a result, cognitive behavioral therapy (CBT) was developed to treat depression, anxiety, and other psychotic conditions. Beck sought to develop an evidence-based CBT recovery approach (Beck, 2022).     Beck’s Position In 1954, Beck began working as an intern at the University of Pennsylvania. He was employed as a professor in the psychiatry department. Additionally, he attended the Philadelphia Psychoanalytic Institute to begin his training in psychiatry. In 1971, Beck started teaching psychiatry full-time, and in 1992, he was granted emeritus status. Along with his daughter, he established the Aaron Beck Institute in 1994. However, he continued to work as an active member of the University of Pennsylvania’s Department of Psychiatry until 2021. At the Beck Institute for Cognitive Behavior Therapy, Beck carried on with his work. The Beck Institute for Cognitive Behavior Therapy is a global hub for cognitive behavior therapy research.  Furthermore, Beck collaborated with colleagues globally on evidence-based methods and psychotherapy for a wide range of disorders, including eating disorders, drug abuse, anxiety disorders, personality disorders, bipolar disorder, depression, and other psychological conditions like schizophrenia and borderline personality disorder (Silberner, 2021). Principal Affects Initially, psychology was distinguished as a science from philosophy and biology. On how to characterize and explain behavior and the mind, many scholars disagreed. Major theories in the subject were represented by many schools of psychology. The structuralism school of thought was the first.The goal was to break down mental processes into their most basic components. Structuralism employs methods to examine how the mind functions. Other ideas quickly followed, including cognitivism, psychoanalysis, behaviorism, humanism, and functionalism. Beck connected his theory to a number of cognitivism-focused schools. Psychologists used to identify as members of a single school of thought, but these days they have many perspectives and use ideas and theories from several schools. It is said that Aaron Beck revolutionized the mental health industry. CBT is a result of his influence in psychology. Numerous honors and recognitions flowed from his efforts in CBT and his institute. His initial goal was to support Freudian psychoanalytic concepts, but the effect eventually resulted in his novel theory of depression. From the patient’s point of view, Beck appreciates the cognitive and emotional substance of psychopathology. His knowledge of cognitive distortions helped him create a viable depression treatment that combined behavior interventions with cognitive restructuring. In the decades following World War II and up to the present day, his insight transformed therapy. Psychotherapy adopted a more scientific stance as a result of his practical study of theoretical models and tests in clinical trials. CBT is one of the main influences on the treatment of adolescent depression. Teenagers with depression can experience stigma and shame, which makes them reluctant to discuss sadness and mental health in public. Beck made significant contributions to the treatment of depression in teenagers, according to the study Analyzing User-Generated Web-BasedPosts of teenagers’ Emotional, Behavioral, and Symptom Responses to Beliefs About Depression: Qualitative Thematic Analysis. The study closed the information gap between depression and health-related cognitive responses. The study has an impact on psychology schools through the development of particular technologies like chatbots, which are computer programs created to facilitate human-user discussions and help decrease feelings of guilt and shame while encouraging teenagers to discuss sadness. The development of clinical therapeutic instruments to improve therapy was influenced by cognitive behavior therapy (Kim et al., 2023). A persistent and severe fear of particular social situations that results in unpleasant, humiliating, and embarrassed feelings is known as social anxiety disorder. Prior to Aaron Beck’s influence, the disease was covered by the DSM-III and was associated with a number of hypotheses and treatment modalities. Generalized anxiety disorders (GAD)

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PSYC FPX 5300 Assessment 1 Physical Activity and Matching Law

PSYC FPX 5300 Assessment 1 Physical Activity and Matching Law

Physical Activity and Matching Law This piece of writing (PSYC FPX 5300 Assessment 1) will concentrate on radical behaviorism, one of the many approaches utilized by Applied Behavior Analysis (ABA) to explain behavior and the factors that drive it. In their attempts to explain why a behavior occurred and what may be done to modify it if necessary, radical behaviorism and ABA are related. There are also a number of ABA concepts that center on behavior modification. The Matching Law is one such technique. In contrast to a less reinforcing behavior, this approach suggests that an individual will engage in conduct that they find more reinforcing (Cooper et al., 2020). The Matching Law can be applied in a number of ways, all of which center on altering the relative reinforcement of an action in order to increase or decrease its frequency. The Matching Law will be applied in this essay to try and determine whether there has been a rise in physical activity behavior, which would improve people’s self-care by making it more rewarding.  The Matching Law’s history (PSYC FPX 5300 Assessment 1) started in 1961 when Herrnstein employed pigeons. From then, it developed to support better shot selection in professional and collegiate basketball players (Holthaus, 2020). An electronic gadget would be used to gather data for the study by measuring the amount of physical activity that resulted in the subject burning calories. The more effort displayed, the greater the reinforcing consequence would be. Of course, there are moral standards to ensure that study participants’ safety and welfare come first. Other Assessment:BHA FPX 4006 Assessment 2 Health Care Fraud and Abuse Applied Behavior Analysis: What Is It? The discipline of applying variables discovered via experiments to develop strategies for enhancing socially significant behaviors is known as applied behavioral analysis (Cooper et al. 2020). Teodoro Ayllon and Jack Michaels established the area in 1959 when they published a paper titled “The psychiatric nurse as a behavioral engineer,” which inspired scholars to start the Journal of Applied Behavior Analysis. This gave rise to a field that looked for the reason behind actions in order to encourage constructive behavior modification. As the area developed, it became clear that a system for judging the caliber of these ABA papers was required. In their 1968 study, “Some current dimensions of applied behavior analysis,” Todd R. Risley, Montrose M. Wolf, and Donald M. Baer established these Seven Dimensions. The Applied, Behavioral, Analytical, Technological, Conceptually Systematic, Effective, and General dimensions are among these seven. The first is Applied, which focuses on the behavior’s social relevance and how altering it will have an immediate impact on the individual exhibiting the target behavior as well as others close to them, including parents and siblings.(Bak et al., 2021)Behavioral analysis is then demonstrated by means of measures made by analysts that precisely capture an individual’s behavior, track its changes, and pinpoint the specific person whose behaviors altered.  The third behavior study (PSYC FPX 5300 Assessment 1), Analytic, demonstrates that the behavior can be turned on or off and that the variables that improved the behavior are under your control. Technological understanding is rather simple, as it simply refers to the capacity to reproduce research findings based on the degree of descriptiveness that the investigators employed in their study components. (Bak et al., 2021) Conceptually Systematic approaches require that all information or techniques be connected to the study’s guiding principles, which makes them a little more complex. Effective simply indicates that there was a sufficient shift in the target behavior to warrant calling it a meaningful change.The final category is General, which explains how the behaviors can be applied throughout time in various contexts and circumstances and influence non-targeted behaviors as well. To assess the level of competency of ABA research and treatment plans utilized on clients in clinical settings, all seven of these dimensions are essential. Extreme Behaviorism According to John O. Cooper, Timothy Heron, and William Heward, radical behaviorism is the effort to use ontogeny and phylogeny to explain all human behaviors, including thoughts and feelings that are typically disregarded since they are private occurrences (2020). Behavioral analysis was founded on this theory, which was first created by John B. Watson in 1913 and then coined to B.F. Skinner’s work alone by 1945 (Cranmore, 2022). Both Applied Behavior Analysis and Experimental Behavior Analysis (PSYC FPX 5300 Assessment 1), which aimed to understand behavior better and apply what they learned, were founded on this idea. Using the aforementioned Seven Dimensions was one of them.  Actions of Interest Definition Operational Physical activity is any movement of the body that burns more than 7 calories per minute in any capacity and results in the expenditure of energy in kilocalories. This can be monitored by tracking when you burn more than 7 calories per minute with an electronic gadget like an Apple Watch or Fitbit. Important Works of Literature Herrnstein conducted the first study utilizing the Matching Law in 1961, measuring the pigeons’ response times to two distinct reinforcement schedules. Even though animal subjects were used in place of human participants, this set the stage for later research with humans. It took some time for the procedure to switch from mostly employing pigeons and monkeys to human subjects; William M. Baum’s subsequent investigation was conducted in 1975. He aimed to develop the idea (PSYC FPX 5300 Assessment 1) that every action is a decision that may be seen as dividing one’s time between several options (Avila & Nurrani Kusumawati, 2021). Presently Utilized There is currently a dearth of research on the application of the Matching Law theory to human behavior, particularly with regard to raising self-care levels through physical activity. There are numerous instances of the Matching Law being applied to young toddlers or people who are already quite physically fit. According to a study by Patel, Normand, and Kohn, preschool-aged children’s physical activity levels could be raised by using a token system to make it more encouraging . A study that discovered

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BHA FPX 4006 Assessment 2

BHA FPX 4006 Assessment 2 Health Care Fraud and Abuse

Major Categories of Health Care Fraud and Abuse Fraud and abuse are major issues (BHA FPX 4006 Assessment 2) in healthcare, affecting taxpayers, patients, organizations, and other covered entities—everyone. Due to popular assumption, fraud is not a victimless crime. The National Health Care Anti-Fraud Association (NHCAA, 2023) claimed that healthcare spending was $3.6 trillion in 2018, with billions of dollars related to healthcare insurance claims. Healthcare fraud and abuse cost the United States an estimated $68 billion each year (NHCAA, 2023). Related Assessment:BHA FPX 4006 Assessment 1 The FBI is the primary agency in charge of investigating healthcare fraud and abuse (FBI, 2024). The Office of Inspector General (OIG), a federal office dedicated to government monitoring, employs about 1,600 people. Their major aim is to eliminate fraud, waste, and abuse while improving healthcare systems’ efficiency (Office of Inspector General, 2023). It is critical to distinguish between fraud and abuse in healthcare. This distinction is based on unique facts, circumstances, intent, and information influencing how each scenario is handled (Centers for Medicare and Medicaid Services, 2021). Fraud is the purposeful and willful conduct of “wrongful or criminal deception” for financial or personal benefit. Fraud has become more complex as technology advances. Fraud can result in monetary fines, prohibition from charging future services to federal healthcare programs, and incarceration (Stowell et al., 2020). Abuse is described as the improper or excessive use of an object or activity to deceive or injure an individual or organization while breaching legal guidelines (Legal Information Institute, 2021). Abuse can occur in both financial and non-financial settings. According to the Centers for Medicare and Medicaid Services (2021), the journey from an error to fraud may be divided into four stages:  1. Mistakes cause errors.  2. Inefficiencies produce waste.  3. Disregarding the rules leads to abuse.  4. Intentional deceit leads to fraud. The major categories of healthcare fraud and abuse include phantom billing, nonexistent patients, anti-kickback violations, upcoding service claims, unbundling related services, and providing medically “unnecessary” services (Dehnavi et al., 2021). Phantom billing refers to invoicing for services or commodities that were never provided (Leap, Terry L., 2019). This occurs when physicians file payment claims with Medicare or Medicaid for operations or services that were not performed. For example, a doctor may submit a reimbursement request for a dental filling that was never completed. Similarly, a physician may seek reimbursement for medical equipment, such as a wheelchair, that the patient never achieved. Billing for nonexistent patients is another type of fraud. In this scam, the physician or guilty party invoices insurance companies using the identities of people who are not their patients. They charge for services that were not provided to individuals who were never seen in their office. For example, a doctor may bill Medicare for an x-ray allegedly conducted on “Mary Smith” when Mary is not a patient and did not get the x-ray or any other treatments. Anti-kickback breaches arise when someone knowingly and deliberately provides, pays, solicits, or gets anything of value in exchange for referrals (HHS Office of Inspector General, 2021). Healthcare organizations are not permitted to make payments or give anything of economic value in exchange for referring patients to their business. In 2019, three physicians and five marketers were charged with anti-kickback violations and other offenses. The physicians were charged with conspiring to conduct fraud and accepting illicit bribes and kickbacks (DOJ USAO Northern District of Oklahoma, 2019). Upcoding means invoicing for more expensive versions of services or procedures than were provided (Geruso & Layton, 2020). Most healthcare institutions and providers establish reimbursement levels using Evaluation and Management codes(AAPC – Advancing the Business of Healthcare, 2023). For example, sending a code for a new patient visit rather than an existing one is an example of upcoding. A new patient visit often takes longer than a visit with an existing patient, resulting in greater compensation for the physician (Alexander & Schnell, 2024). Medically “unnecessary” services are those that are done without being required for the patient’s well-being, intending to cost them more money. According to the OIG (2019), while this may appear victimless to the practitioner, it can be harmful to patients. For example, a patient may be subjected to needless radiation from X-rays and MRIs just because the physician wants better reimbursement. Unbundling-related services entail invoicing for each phase of a procedure that is normally invoiced as a single comprehensive service (Medical Billing Analysts, 2022). This technique also applies to office visits. For example, if a patient requires a pre-operative consultation, it might be completed in a single visit. However, a physician may divide it into three independent appointments to charge the insurance company for three office visits rather than one. Five Health Care Fraud and Abuse Laws Healthcare professionals who utilize federal healthcare systems such as Medicaid and Medicare for personal or financial benefit demand the adoption of regulations to combat and prevent fraud and abuse (American Academy of Pediatrics, 2021). The five most important healthcare fraud and abuse laws are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (STARK Law), the Civil Monetary Penalties Law (CMPL), and the Exclusion Statute. These statutes are enforced by the Departments of Justice (DOJ) and Health and Human Services (HHS). The False Claims Act (FCA) is the government’s most effective instrument for addressing healthcare abuse, waste, and fraud (Bagby & Packin, 2020). The FCA safeguards against fraudulent claims made to Medicare, Medicaid, and other federally sponsored healthcare programs (HHS Office of Inspector General, 2021). According to the OIG (2021), a physician found guilty under the FCA might face a penalty of up to three times the amount lost by the program, plus $11,000 per violation. If a breach is uncovered, the covered entity must reimburse any overpayments to the government program within sixty days to avoid the FCA penalty. The OIG presented an example of an FCA case in which a cardiologist was suspected of submitting claims that were not supported by the patient’s medical documents

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BHA FPX 4006 Assessment 1 Compliance Program Implementation and Ethical Decision Making

BHA FPX 4006 Assessment 1 Compliance Program Implementation and Ethical Decision Making

BHA FPX 4006 Assessment 1 Background This brief describes a recent HIPAA violation at our organization. While attempting to conduct a surgical procedure pre-authorization, an employee sent clinical documents including protected health information (PHI) to an insurance company by fax. The insurance company’s customer support representative contacted the employee’s supervisor, explaining that additional talks concerning the patient’s care could only occur with the patient’s written agreement. The (U.S. Department of Health and Human Services, 2022) allows a covered entity to release PHI for treatment, payment, or healthcare operations without patient consent. However, the hospital where this event happened is in Minnesota, which has tougher restrictions for patient health information, resulting in a HIPAA violation (The HIPAA Journal, 2019). Other Assessment:NURS 4020 Assessment 2 Problem Summary: Privacy Breach – HIPPA Violation When an organization experiences a HIPAA violation, it must adhere to numerous laws, regulations, and industry standards.  Vila Health, which runs hospitals in Minnesota, is subject to the state’s stricter patient health record rules and HIPAA. Minnesota hospitals must get written patient agreement before releasing any protected health information, including to other healthcare providers (Minnesota Legislature, 2021). Furthermore, the Joint Commission’s accreditation criteria include laws regarding HIPAA infractions. Depending on the gravity of the violation, the organization could risk losing its accreditation. The legislation known as the HITECH Act created the HIPAA breach notification standards. Depending on the significance of the breach, notifications must be given to the patient, the United States Department of Health and Human Services, and, if necessary, the media. In this situation, the HIPAA breach must be disclosed to both the patient and the US Department of Health and Human Services. The HITECH Act also includes an enforcement regulation that specifies the financial penalties for HIPAA infractions (U.S. Department of Health and Human Services, 2019). Because this breach is not regarded as severe, the financial consequences would be limited. Human resource standards play a crucial role when addressing a HIPAA violation.  Human resources are responsible for creating and maintaining organizational guidelines, as well as providing training and staff development. They would be engaged in deciding the repercussions for the employee who violated HIPAA and resolving any re-training needs. The Security Awareness and Training standard requires all workers to complete particular security and awareness training, including periodic reminders of rules and procedures (American Healthcare Compliance, 2023). The training or education program previously completed by the employee engaged in the breach would have to be re-evaluated for any weaknesses. Seven Essential Elements of an Effective Compliance Program The first essential element of a compliance program is the creation and dissemination of organizational standards, rules, and procedures to workers (HIPAA Journal, 2023; Pererva et al., 2021). The employee implicated in the HIPAA breach should have received HIPAA training upon employment. An inquiry must be done to determine what training the employee received and the efficacy of the training program. The third critical component is the roles of the compliance officer and compliance committee, who are in charge of developing and managing compliance programs (HIPAA Journal, 2023). The compliance officer and committee can interview the employee to determine the cause of the compliance program’s failure. Regular training is the third critical component of a successful compliance program (HIPAA Journal, 2023). This training should consist of extensive educational sessions. Documentation detailing the programs completed by the employee could be sought to ensure that they have a comprehensive working knowledge and comprehension of HIPAA regulations at the time of the breach. The fourth critical need is the presence of many open communication lines between workers and the compliance officer (HIPAA Journal, 2023). These open channels enable employees to express any areas of concern that might result in a HIPAA violation before it occurs. The fifth and most important component of a successful compliance program is regular audits. These audits must be carried out regularly and continually monitored to assess the program’s performance (HIPAA Journal, 2023). This approach helps the compliance officer and committee develop or improve compliance initiatives. Monitoring can determine if the occurrence was a one-time HIPAA breach or if there is a major underlying issue that could result in future violations. Disciplinary action is the sixth important ingredient. Disciplinary action must be taken against the employee and any other agents who break compliance requirements (HIPAA Journal, 2023). The disciplinary action for this employee should take into account their knowledge and awareness of HIPAA requirements before the infraction. The final component of a successful compliance program is an inquiry. When a breach or suspected violation of the compliance program occurs, an investigation and corrective action are required (HIPAA Journal, 2023). The investigation should seek to determine the fundamental cause of the HIPAA breach and execute an action plan to address and correct the problem. Privacy Breach Consequences The consequences of a privacy violation can differ greatly depending on its severity. The employee might incur civil fines ranging from $100 to $25,000 (Alder, 2022). Criminal charges and jail are also conceivable, depending on the severity and purpose of the offense (Lewis, 2022). Personal legal action can be filed against the employee, either by the hospital or on behalf of the patient. Termination of employment is another possible outcome. In addition, depending on the severity of the HIPAA violation, the employee can lose their state licensing. Other stakeholders in the organization could face restrictions as a result of the HIPAA breach. If the root cause investigation reveals a weakness or flaw in the compliance program that contributed to the violation, the compliance officer and/or compliance committee could face sanctions (Armour et al., 2020). Furthermore, if the compliance officer and members of the compliance committee are determined to be responsible for the breach, they could face the firing procedure. There are substantial consequences for the organization as well. The organization can face financial penalties based on the type and severity of the HIPAA breach (Alder, 2022). In addition, constant HIPAA breaches could result in the loss of Joint Commission certification. The organization’s reputation

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