医院法制环境(双语版).pdfVIP

Hospital Regulatory Environment 医院法规环境 Nancy M. Kane, DBA 企管博士 Professor of Management管理学教授 Major Sources of Hospital Regulation 医院法规的主要来源 •Federal Regulatory Sources联邦政府的法规来源 •Department of Health and Human Services 健康与人文服务部 •Internal Revenue Service国税局 •Department of Justice司法部 •State Regulatory Sources州政府的法规来源 •Departments of Public Health, Mental Health, Health and Human Services 公共卫生、心理卫生、健康与人文服务部 •Office of the Attorney General检察部 •Department of Environmental Protection 环境保护部 •Nongovernmental Regulatory Sources非政府法规来源 •Joint Commission on Accreditation of Healthcare Organizations (JCAHO)保健组织联合认证委员会 Major Federal Regulation主要的联邦法规: HIPAA • The Health Insurance Portability and Accountability Act of 1996 quadrupled the number of federal agents assigned to healthcare fraud 1996年健康保险流通与责任法案指出关于健康照护诈欺事件是联邦警 探人数的四倍 • In addition, the HIPAA Privacy Rule protects individual privacy with respect to the use and disclosure of individual’s identifiable health information by hospitals and other health providers, including the confidentiality of electronic medical records and billings 此外，HIPAA隐私规则保护个人隐私在于个人于医院及其它健康提供 者里可辨识健康信息的使用与揭露，其中包含电子医疗病例与账单的 隐密性 • The government’s estimated cost for compliance with the privacy provisions of HIPAA is in excess of $17 billion over ten years; private sector estimates are much larger (eg BCBSA - $42.8 Billion over five years)政府估计依附在HIPPA隐私条款的花费超过17兆于十 几年; 私人部分的估计更大(例如BCBSA-超过五年有42.8兆) Major Federal Regulation主要联邦法规:DHHS False Claims Act不实给付要求法 • “Perhaps the single biggest risk for hospitals” (Office of the Inspector General – OIG) 可能是医院单一最大风险(总检察长) • All claims and requests for reimbursement from Federal health care programs must be complete and accurate and must reflect