Prepare a workplace brief (8-10 double-spaced pages) to address a privacy breach that occurred in a health care organization. Include the consequences of failure to act and evidence-based recommendations for addressing the breach.
Introduction
Health care is one of the most heavily regulated major industries in the United States. Leaders are challenged to stay current and to comply with federal, state, and local laws and their associated regulations. Health care organizations are also responsible to meet industry standards. In some cases, payers equate meeting industry standards with achieving and maintaining accreditation. In fact, many payers consider accreditation a minimum condition of participation. In addition, individual licensure and certification requirements establish basic expectations for health care leaders’ professional conduct.
In summary, health care leaders are responsible to:
- Meet ethical personal, professional conduct, certification, and licensure expectations.
- Comply with local, state, and federal health care and human resources laws.
- Provide evidence of compliance with existing regulations and scan the field for emerging regulations.
- Identify and meet appropriate accrediting body standards (for example, Joint Commission’s National Patient Safety Goals standards).
As an individual’s health care leadership career advances, so does the corresponding level of accountability. Not knowing the laws or regulations is not an excuse for not complying with them.
This assessment allows you to demonstrate your knowledge of and skills relating to compliance concepts, and governmental and regulatory agencies that oversee health care service delivery, billing, and general operations. You will also have the opportunity to apply the components necessary to initiate and maintain an effective compliance program. Finally, you will consider relevant human resources laws that may pertain to your compliance recommendations.
Instructions
In this assessment, you are assuming the role of an early careerist in risk management and quality improvement at one of Vila Health’s community-based hospitals. Vila Health is a medium-sized system of health operating facilities in Minnesota and Wisconsin. You are working on a team-based initiative under the supervision of the Vila Health Chief Compliance Officer. Your role is to assist in addressing a specific compliance risk regarding a breach of privacy and a potential HIPAA violation. A Vila Health employee has disclosed—without prior written authorization—a patient’s protected personal health information.
Here is the information the team has collected about the privacy breach and potential HIPAA violations to date. A Vila Health supervisor instructed an employee to obtain pre-authorization for an upcoming surgical procedure for a patient. The Vila Health employee submitted confidential, protected health care information about the patient to the insurance company. The Member Services Representative at the insurance company contacted the Vila Health supervisor. The insurance company representative indicated that further discussion of the matter without prior written consent from the patient is prohibited.
As part of the team exploring the privacy breach, you will prepare a workplace brief with authoritative, evidence-based references to support your work.
Preparation
You are already familiar with HIPAA but may want to conduct independent research to enhance your knowledge. Consult this resource for additional guidance on how to conduct research using credible sources: Health Care Administration Undergraduate Library Research Guide.
Instructions
This is a workplace brief rather than an academic paper. Download the Compliance Program Implementation and Ethical Decision-Making Template [DOCX]. Be sure to address all of the following in your brief:
Background
Include a short paragraph of no more than five or six sentences describing the known details about the privacy breach and HIPAA violation.
Privacy Breach—HIPAA Violation
Summarize the relevant health care compliance concepts that apply to this privacy breach and HIPAA violation. Be sure to consider the following:
- Federal, state, and local laws and associated regulations.
- Disclosure.
- Human resource concepts and laws.
- Industry and accrediting body standards.
Seven Essential Elements of an Effective Compliance Program
Apply to this HIPAA breach the seven essential components of an effective health care compliance program, as determined within the Federal Register.
Privacy Breach Consequences
Provide a synopsis of the consequences for an individual leader and for other internal health care organization stakeholders for not taking immediate actions to address a privacy breach. At a minimum, be sure to consider all of the following in your synopsis:
- Patient safety.
- Financial losses.
- Individual and organizational violations of the law.
Evidence-Based Recommendations
Construct evidence-based recommendations to resolve the HIPAA-related privacy breach. You may also want to include relevant information related to:
- Human resource laws.
- Professional codes of ethical conduct and standards.
- Previous case precedents.
- Current alleged health care legal violations.
For help in identifying appropriate evidence-based recommendations, you may want to visit some of the authoritative sources, such as the DOJ/OIG, CMS/HHS, et cetera, listed under the suggested resources for this assessment.
Ethical Decision-Making Framework for Health Care Leaders
Describe an ethical decision-making framework as one of your concluding recommendations. Tip: You may want to use the ACHE’s ethical decision-making framework.
Conclusion
Write a paragraph that summarizes the following:
- Key concepts.
- Importance of compliance.
- Best practices to monitor for future quality improvements.
- Short list of resources.
- Be sure to include all appropriate citations.
Additional Requirements
- Written communication: Use the Compliance Program Implementation and Ethical Decision-Making Template linked above. Your workplace brief needs to be clear, concise, well-organized, and generally free of errors in grammar, punctuation, and spelling. The title page, citations, and references need to be in the current APA format.
- Length: Approximately 8–10 typed, double-spaced content pages in Times New Roman, 12-point font, including the reference page. See the APA 7th Edition Example Paper [PDF].
- Title page: Develop a descriptive title of approximately 5–15 words. It should stir interest, yet maintain professional decorum. Ensure that your title page conforms to the current APA format.
- References: Include a minimum of six current, authoritative citations and references in the current APA format. See Evidence and APA for more information.
- Scoring guide: Please review the scoring guide for this assessment so that you understand how your faculty member will evaluate your work.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
- Competency 1: Analyze health care laws and regulations from a local, state, and federal level.
- Summarize the relevant health care compliance concepts that apply to a HIPAA privacy breach.
- Competency 3: Assess the importance of continuous readiness in the health care organization.
- Apply the seven essential elements of an effective compliance program to a HIPAA privacy breach.
- Recommend evidence-based actions to address a HIPAA privacy breach.
- Describe a health care, industry-approved, ethical decision-making framework.
- Competency 4: Explain how governing body and regulatory agency standards exercise oversight authority within a health care organizational setting.
- Provide a synopsis of the consequences to individual leaders and other internal stakeholders of not addressing a HIPAA privacy breach.
- Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with the expectations of health care professionals.
- Write a clear, concise, well-organized, and generally error-free workplace brief addressing a HIPAA privacy breach that is reflective of professional communication in the health care field.
Expert Solution Preview
Introduction:
The breach of privacy in a healthcare organization is a serious offense and requires immediate attention to avoid penalties and legal consequences. As a medical professor in charge of creating college assignments and answers for medical college students, I understand the importance of complying with federal, state, and local laws and regulations in the healthcare industry. In this workplace brief, I will address the breach of privacy that occurred in Vila Health’s community-based hospital and provide evidence-based recommendations to address the breach.
Background:
Vila Health is a medium-sized system of health operating facilities in Minnesota and Wisconsin. The privacy breach occurred when a Vila Health employee disclosed a patient’s protected personal health information without prior written authorization. A Vila Health supervisor instructed the employee to obtain pre-authorization for an upcoming surgical procedure and submitted confidential, protected healthcare information about the patient to the insurance company. The Member Services Representative at the insurance company contacted the Vila Health supervisor and indicated that further discussion of the matter without prior written consent from the patient is prohibited.
Privacy Breach – HIPAA Violation:
The privacy breach in Vila Health’s community-based hospital is a clear violation of HIPAA regulations. The relevant health care compliance concepts that apply to this privacy breach and HIPAA violation include federal, state, and local laws and associated regulations, disclosure, human resource concepts and laws, and industry and accrediting body standards. The HIPAA regulations require healthcare organizations to protect the confidentiality, integrity, and availability of patients’ protected health information (PHI). PHI includes information such as names, dates of birth, social security numbers, medical diagnoses, and treatment plans.
Seven Essential Elements of an Effective Compliance Program:
The seven essential components of an effective healthcare compliance program, as determined within the Federal Register, apply to the HIPAA breach in Vila Health’s community-based hospital. These components include:
1. Compliance standards and procedures
2. Compliance training
3. Effective communication
4. Monitoring and auditing
5. Enforcing standards through well-publicized disciplinary guidelines
6. Responding to detected offenses
7. Continuous improvement.
Privacy Breach Consequences:
The consequences of not taking immediate actions to address a privacy breach include patient safety, financial losses, and individual and organizational violations of the law. In the case of Vila Health’s community-based hospital, the employee who disclosed the patient’s protected personal health information without prior written authorization will face disciplinary action. The hospital will also face a potential fine of up to $50,000 per violation, and the employee may face imprisonment of up to one year for a HIPAA violation.
Evidence-Based Recommendations:
To resolve a HIPAA-related privacy breach, evidence-based recommendations include developing policies and procedures for PHI access, use, and disclosure, conducting regular HIPAA compliance training for employees, and implementing a privacy monitoring program. Human resource laws and professional codes of ethical conduct and standards must also be taken into account. Previous case precedents and current alleged healthcare legal violations should also be considered.
Ethical Decision-Making Framework for Healthcare Leaders:
An ethical decision-making framework is crucial for healthcare leaders to make decisions that are morally and ethically sound. The ACHE’s ethical decision-making framework includes identifying ethical issues, gathering information, identifying stakeholders, considering alternatives, choosing and justifying the best action, and implementing the decision.
Conclusion:
In conclusion, compliance with local, state, and federal healthcare and human resources laws is essential for healthcare leaders. Failure to comply with these laws and regulations can result in serious consequences for the organization and individuals involved. To address a breach of privacy and potential HIPAA violation in Vila Health’s community-based hospital, evidence-based recommendations must be developed and implemented, and an ethical decision-making framework must be used to make sound decisions that prioritize patient safety and confidentiality. Finally, healthcare leaders must continuously monitor for quality improvements and stay updated with emerging regulations and standards to ensure compliance.
