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The only reference you are required to use is “Contemporary issues in healthcare law and ethics – by Dean M. Harris”.
please follow these exact instructions and remember those essays need to be separated and define the word count on top of each essay.
Essay 1: – 600 Words
In March 2012, Mr. Tim Apple was a 67-year-old man who worked part-time at a grocery store in Triplet Falls, Idaho. Mr. Apple had health coverage through a Medicare Advantage plan offered through Green Shield Insurance. Mr. Apple was in generally good health for a man of his age?he had a good diet, exercised regularly, and had not touched a cigarette in 27 years.
On an evening in March 17, Mr. Apple sat down to watch a fishing show as he ate his dinner. He soon developed a splitting headache. Mr. Apple asked a neighbor to drive him to the emergency department at Community Hospital (?Community?), also in Triplet Falls, Idaho. He arrived at Community at approximately 9:30 p.m.
Community is a general service, not-for-profit, acute care hospital licensed by the state of Idaho. It also participates in the Medicare program. Community had arranged for 24-hour medical coverage of its emergency department through a contract with A+ Emergency Physicians, PLLC (?A+?). A+ employs Dr. Cucumber and several other physicians to staff Community?s emergency department.
Upon Mr. Apple?s arrival at Community?s emergency department, Mr. Apple explained that he had a splitting headache, and he was briefly examined by a nurse, Rose Orange. He was then examined by the physician on duty, Dr. Cucumber. Mr. Apple had no prior relationship with Dr. Cucumber.
According to the hospital?s written protocols for the emergency department, if an adult patient complained of a splitting headache and the patient did not appear to be intoxicated, the patient should be given a computed tomography (CT) scan of the head as soon as possible. Mr. Apple?s condition met these criteria. In addition to being Community?s protocol, this method of diagnosis was the ordinary emergency department practice of the hospitals in the area. However, some insurance plans had begun to refuse to pay for CT scans under these circumstances on the basis that they were medically unnecessary.
Dr. Cucumber looked over Mr. Apple?s admission information, and saw that he was enrolled in the Green Shield Medicare Advantage Plan. Based on Dr. Cucumber?s experience, Dr. Cucumber knew that the coverage Mr. Apple had through the Green Shield Medicare Advantage plan would not pay for a CT scan under these circumstances. Dr. Cucumber then asked Mr. Apple whether he was experiencing dizziness accompanying his splitting headache. Mr. Apple responded: ?Dizziness? No. Sometimes the pain is so splitting that I get a bit nauseous. But, no, I wouldn?t say I?m getting dizzy.?
Dr. Cucumber knew that Mr. Apple?s Green Shield plan would cover the CT scan if Dr. Cucumber indicated in Mr. Apple?s chart that he presented with symptoms of a splitting headache accompanied by dizziness. Although Mr. Apple verbally reported that he was not experiencing dizziness, based on Dr. Cucumber?s experience as a clinician in Idaho, Dr. Cucumber also knew that men of Mr. Apple?s age often underreported symptoms of discomfort.
Dr. Cucumber indicated in the chart that the patient presented with a splitting headache accompanied by dizziness. Dr. Cucumber then ordered the CT scan and Mr. Apple consented to the procedure after being informed of the medical risks and benefits. The hospital billed Mr. Apple?s insurance plan for the CT scan.
Nurse Orange had seen Mr. Apple?s chart and saw that Dr. Cucumber had reported that Mr. Apple presented with symptoms of dizziness?even though Nurse Orange clearly heard Mr. Apple tell Dr. Cucumber that he did not have such symptoms. Ever since Nurse Orange became aware several months ago that Dr. Cucumber was cheating on his wife of 20 years by having an affair with a hospital employee, Nurse Orange had suspected that Dr. Cucumber was a dishonest and unethical person. This incident with Mr. Apple?s chart confirmed her suspicions.
Nurse Orange contacted an attorney to pursue a qui tam (whistleblower) action under the federal False Claims Act against Dr. Cucumber, A+, and Community Hospital.
In 600 words or less, please address each of the following:
Discuss what Nurse Orange must prove in order for Dr. Cucumber, A+, and Community Hospital to be found liable under the False Claims Act. Please discuss the claims against each of these defendants individually.
What defenses could each of the defendants possibly assert? Please address such defenses as to each of the defendants individually.
What types of damages and penalties could be imposed in this case? What portion of any monetary award would Nurse Orange be entitled to? What additional monies may be awarded to Nurse Orange and/or her attorney(s)? Apart from monetary penalties/damages, what further action could the government take against a defendant found liable under the False Claims Act?
How would having an effective compliance program already in place benefit any of these defendants if a False Claims Act claim were brought against them?
Your response should focus on concepts related to this topic
Essay 2: 300 Words or less (45 Points)
In the Fact Scenario described above, please explain what you believe would be the most ethical action(s) for Dr. Cucumber to take in treating Mr. Apple. In this explanation, please:
Identify which ethical principle you believe is most applicable in determining what action(s) Dr. Cucumber should take and explain why.
Identify which ethical theory or viewpoint most justifies the action(s) you believe Dr. Cucumber should take and explain why.
Based on what you believe would be the most ethical action(s) for Dr. Cucumber to take, please briefly describe any additional action(s) Dr. Cucumber should take in order to minimize or mitigate potential legal risks or liability.
In grading your answer to this question, points will be awarded based on the quality of your analysis and explanation?not on the conclusion(s) that you reach. Your response should focus on concepts related to this topic
Essay 3: (400 Word Maximum)
Mud Point, Idaho is a city of approximately 30,000 residents on the north shore of Purple Pine Lake. In Mud Point, there is a non-profit, 40-bed community hospital called Mud Point General Hospital (MPGH). In addition to the 30,000 people residing in Mud Point, MPGH also serves the needs of an additional 15,000 individuals living in surrounding communities. In the area served by MPGH, approximately 1/3 of the primary care physicians are part of a for-profit medical group called Purple Pine Physicians (PPP), while the other primary care physicians in the area operate their own solo practices. There are also a few specialists in the area, all of whom own and operate their own practices.
Because of its nice views and low cost of living, Mud Point and the surrounding areas have become a popular retirement location. As such, there are currently 10,000 fee-for-service Medicare beneficiaries served by MPGH, and this figure is expected to grow in coming years. In light of this trend, the administrators at both MPGH and PPP are looking into creating a Medicare Accountable Care Organization (ACO) to serve the area. Specifically, MPGH and PPP are planning to create an ACO by forming a joint venture between MPGH and PPP, as well as making a few other changes. PPP is planning to double its number of primary care providers by buying up solo practices in the area. PPP is also planning on purchasing some of the specialist practices in the area. MGPH in turn, is planning on purchasing a small skilled nursing facility in the area and hiring several care coordinators. With this network of providers, MGPH and PPP believe that the MGPH/PPP joint venture may be effective in providing lower-cost, quality care as a Medicare ACO.
Based on the materials covered in class and in the assigned readings, please address the following questions
Please explain how MPGH?s and PPP?s proposed courses of action could give rise to certain antitrust issues. In doing so, please identify which of the federal antitrust laws MPGH?s and/or PPP?s proposed actions potentially run afoul. Your answer should also identify the analysis used by governmental authorities to review proposed mergers and explain its relevance to the facts at hand.
Please explain what an ACO formed by MPGH and PPP would need to accomplish in order to be financially viable. This explanation should entail a discussion of both the financial incentives and costs ACOs have.
Essays 4-6: – Answer only TWO of the following three
Please answer only two of the following three essays.
Essay 4: 300 Words
You are a health policy expert who often writes columns or articles in health industry trade journals on policy issues. The magazine Health Administrator Today recently approached you and asked you to write a very short piece (300 words) on the concept of ?community benefit? as it applies to hospitals with federal tax-exempt status.
Even though the intended audience is health facility administrators who are probably already familiar with the concept of ?community benefit,? your article should provide at least a short overview of what this term means and how hospitals can meet this community benefit requirement. Your article should also explain the additional requirements for tax-exempt hospitals under the Patient Protection and Affordable Care Act. The magazine editor informed you that the article must not be any longer than 300 words, and that it should not be any shorter than 250 words. You do not need to provide references to sources covered in class. However, your answer should not simply copy verbatim any other source (including assigned readings or PowerPoint slides). Your response should focus on concepts related to this topic.
Essay 5: 40 Points ? 300 Words or Less
As we discussed periodically throughout the class, nonprofit hospitals are required to undertake certain activities to benefit the community in order to justify their tax-exempt status. A local nonprofit hospital wants to use aggregate data contained in the medical records the hospital maintained as part of campaign to raise awareness about flu prevention before the next flu season. The proposed campaign is intended to be part of the hospital?s ?community benefit.?
Based on what we covered in class and the assigned readings, please address each of the following:
Please explain whether the flu prevention campaign could be considered a ?community benefit.?
Please explain whether the HIPAA Privacy Rule permits such usage of these health records, and why or why not.
If the HIPAA Privacy Rule does permit such usage of these health records, what must the hospital do to assure that they are properly de-identified?
Please limit your response to 300 words or less.
Essay 6: 300 Words
ABC Medical Clinic (?ABC?) is a physician owned medical practice that operates out of a large two-story office building that is owned by ABC. There is office space in the building that is currently vacant. Many of ABC?s patients are elderly individuals covered by Medicare. As is medically necessary, physicians will recommend that patients receive certain types of physical therapy. There are a variety of physical therapy providers in the area to which ABC?s physicians will refer patients when physical therapy is ordered as part of the treatment plan. One of these physical therapy providers is XYZ Physical Therapy Group (?XYZ?), which maintains an office several blocks away from ABC?s building.
Last week the owners of XYZ approached the owners of ABC and informed them that the lease on XYZ?s current office would be up in a few months, and that XYZ was interested in leasing the vacant space in ABC?s building. ABC?s owners are interested in leasing the space to XYZ, in part because it would make going to physical therapy much more convenient for many of ABC?s patients.
You are an attorney and ABC?s owners have asked you for advice on what potential risks this arrangement may pose in relation to the Anti-Kickback Statute (?AKS?). In answering this question, please explain the following:
What the AKS prohibits;
The purpose of the AKS;
What criteria the proposed lease should meet in order for ABC to avoid liability under the AKS.
Your response should focus on concepts related to this topic
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