Complete the Business Transactions Resource and Compliance Matrix (Attached)Individually complete the matrix.Use only classroom materials to complete the matrix. This would include the textbooks, web links, and the Classroom law library.Write in complete sentences except for the law and code section, risk assessment, and role identification sections.Code citations should follow the following format:42 U.S.C. § 1920 (2021)Maryland Code § 29-405 (2021).Regulations should following the following format42 C.F.R. § 518 (2021)Code of Maryland Regulations (COMAR) 01.02.1985.01See Compliance Library directly on the left side of the classroom and review “People as Resources for health care compliance.”Take time to formulate good questions that will lead to a positive response.Look for creative solutions to comply with the law.Support your responses with strong reasons.
Week 2 and 3: Business Transactions
Additional Resources
Physician Licensing
?
?
?
?
?
Maryland Board of Physicians https://www.mbp.state.md.us/
Barton Assoc. State Physician Licensing Guide
https://www.bartonassociates.com/locum-tenens-resources/statephysician-licensing-guide
AMA Navigating state medical licensure https://www.amaassn.org/residents-students/career-planning-resource/navigating-statemedical-licensure
Interstate Medical Licensure Compact (IMLC) https://www.imlcc.org/
Federation of State Medical Boards (FSMB)
https://www.fsmb.org/uniform-application/
Contracts
?
?
?
?
Contracts and the Law https://www.findlaw.com/smallbusiness/businesscontracts-forms/contracts-and-the-law.html
Basic Guidelines for contracts and Contract Risk Management
https://rmas.fad.harvard.edu/basic-guidelines-contracts-and-contract-riskmanagement
How to Implement Risk Management in your contracts
https://www.contractlogix.com/contract-management/how-to-implementrisk-management-in-your-contracts/
Conlin, B. The Fundamentals of Contract Management. Business News
Daily. https://www.businessnewsdaily.com/4813-contractmanagement.html
Corporations Law
?
?
?
?
Certificate of Need
Maryland Code 5-505 Article of
Incorporation https://law.justia.com/codes/maryland/2013/articlegca/section-5-505/
A Legal Guide to Maryland Corporations & LLCs
http://www.lawgal.com/topics/CorpFlyer.pdf
Fisherman., S. How to Form a Corporation in Maryland
https://www.nolo.com/legal-encyclopedia/how-form-corporationmaryland.html
Courtnell, J. What is an Enterprise Document Management (EDM)
System? How to Implement Full Document Control. (Mar. 2, 2020)
https://www.process.st/enterprise-document-management/
?
CON-Certificate of Need State
Laws: http://www.ncsl.org/research/health/con-certificate-of-need-statelaws.aspx
?
NASHP 50-State Scan of State Certificate-or-Need Programs
https://www.nashp.org/50-state-scan-of-state-certificate-of-needprograms/
Maryland Health Commission – Essentials of the CON Process
•
https://mhcc.maryland.gov/mhcc/pages/hcfs/hcfs_con/hcfs_con.aspx
•
Conover. C. and Bailey J. Certificate of Need laws: a systematic review
and cost-effectiveness analysis BMC Health Serv. Res. 20:748 (2020) doi
10.1186/s12913-020-055631 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427974/
Antitrust Law Joint Venture Guidelines
?
?
?
?

15 USC 1 Monopolies and Combinations in Restraint of
Trade https://www.law.cornell.edu/uscode/text/15/chapter-1
FTC: Competition in the Health Care Marketplace https://eds-bebscohostcom.ezproxy.umgc.edu/eds/detail/detail?vid=18&sid=5c63c536-e1a84ff1-84a0405c582844ce%40sessionmgr103&bdata=JnNpdGU9ZWRzLWxpdmUm
c2NvcGU9c2l0ZQ%3d%3d#db=heh&AN=127279937
HHS OIG Special Advisory Bulletin: Contractual Joint Ventures (2003)
Special Advisory Bulletin on Contractual Joint Ventures (hhs.gov)
St. Luke’s Health System Ltd and Saltzer Medical Group
PA https://www.ftc.gov/enforcement/cases-proceedings/121-0069/stlukes-health-system-ltd-saltzer-medical-group-pa and 9th Circuit Court of
Appeals opinion at
http://cdn.ca9.uscourts.gov/datastore/opinions/2015/02/10/14-35173.pdf
Fraud and Abuse
?
?
?
A Roadmap for New Physicians: Fraud and Abuse
Laws: https://oig.hhs.gov/compliance/physician-education/01laws.asp
Comparison of Antikickback Statute and Stark Law: COMPARISON OF
THE ANTI-KICKBACK STATUTE AND STARK LAW* (hhs.gov)
State False Claims Act Reviews: https://oig.hhs.gov/fraud/state-falseclaims-act-reviews/index.asp
?
HHS OIG Measuring Compliance Program Effectiveness
https://oig.hhs.gov/compliance/compliance-resource-portal/files/HCCAOIG-Resource-Guide.pdf
Health Insurance Portability and Accountability Act (HIPAA) Business Associate
Agreements
?
?
?
?
Business Associates https://www.hhs.gov/hipaa/forprofessionals/privacy/guidance/business-associates/index.html
HHS Business Associate Contracts (Small Business Associate Agreement
Provisions (Jan. 25, 2013) https://www.hhs.gov/hipaa/forprofessionals/covered-entities/sample-business-associate-agreementprovisions/index.html
Stanger, Kim. Ensure you have Business Associate Agreements or Face
HIPAA Penalties Employee Benefit Plan Review 2016: 71(2):1112 https://eds-b-ebscohostcom.ezproxy.umgc.edu/eds/pdfviewer/pdfviewer?vid=9&sid=5c63c536e1a8-4ff1-84a0-405c582844ce%40sessionmgr103
What are the penalties for HIPAA violations? HIPAA Journal
https://www.hipaajournal.com/what-are-the-penalties-for-hipaa-violations7096/
Tax Law for non-profits
?
?
?
?
26 U.S.C. 501 Exemption from tax on corporations, certain trusts, etc.
https://www.law.cornell.edu/uscode/text/26/501
I.R.S. Exemption Requirements – 501( c)(3) Organizations
https://www.irs.gov/charities-non-profits/charitableorganizations/exemption-requirements-501c3-organizations
Provena Covenant Medical Center v. Department of Revenue: Illinois
Supreme Court Suggest New, Narrow Tests for Charity (Mar. 2010)
https://www.jonesday.com/en/insights/2010/03/iprovena-covenantmedical-center-v-department-of-revenuei-illinois-supreme-court-suggestsnew-narrow-tests-for-charity-care
IRS Compliance Guide for 501(c ) (3) Public Charities
https://www.irs.gov/pub/irs-pdf/p4221pc.pdf
Hill-Burton
?
?
Hill-Burton Free and Reduced-Cost Health Care
https://www.hrsa.gov/get-health-care/affordable/hill-burton/index.html
Providers Guide to the Hill-Burton Uncompensated Services Regulations
https://www.hrsa.gov/sites/default/files/hrsa/get-health-care/hill-burtonproviders-guide.pdf
Sarbanes Oxley Act and Conflict of Interest
?
?
?
?
Sarbanes-Oxley Act of 2002
https://www.govinfo.gov/content/pkg/COMPS-1883/pdf/COMPS1883.pdf
A Guide to the Sarbanes-Oxley Act https://www.soxlaw.com/index.htm
SOX Compliance Requirements and Overview
https://www.soxlaw.com/index.htm
Brown, J. Having an Effective Conflict of Interest Policy Should be a
High priority: There is no Better Time Than the Present to Review your
Practices. Journal of Health Care Compliance 2017, 19(6): 35-36.
https://eds-b-ebscohostcom.ezproxy.umgc.edu/eds/detail/detail?vid=18&sid=5c63c536-e1a84ff1-84a0405c582844ce%40sessionmgr103&bdata=JnNpdGU9ZWRzLWxpdmUm
c2NvcGU9c2l0ZQ%3d%3d#db=heh&AN=127279937
Corporate Practice of Medicine (CPOM)
·
·
Maryland 19-704 Corporate practice of Medicine
https://mhcc.maryland.gov/mhcc/pages/hcfs/hcfs_con/hcfs_con.aspx
State by State Analysis of the Corporate Practice of Medicine
https://docplayer.net/20220004-State-by-state-analysis-of-corporatepractice-of-medicine-and-physician-employment-addendum-c.html
Regulatory Compliance
?
?
?
HHS OIG: Practical Guidance for Health Care Governing Boards on
Compliance Oversight https://oig.hhs.gov/compliance/complianceguidance/docs/Practical-Guidance-for-Health-Care-Boards-onCompliance-Oversight.pdf
HHS OIG: A Toolkit for Health Care Boards
https://oig.hhs.gov/newsroom/video/2011/toolkit-handout.pdf
Top 8 ways to reach regulatory compliance. CIO
Insight. https://www.cioinsight.com/it-management/expert-voices/top-8ways-to-reach-regulatory-compliance.html
Business Transactions
Resource and Compliance Matrix
Name:
Date:
Health care business
situations
The Law and
Code Section
1. Your organization just hired
a physician from out of state.
The physician will need to
become licensed in your state
of Maryland. As an
administrator, you have been
asked to oversee the process
to ensure the physician obtains
a valid Maryland license to
practice medicine.
2. You were reviewing the new
physician contract and see that
the physician will be paid a flat
salary with bonuses from the
hospital for increasing hospital
admissions.
State licensing
law
Federal
Antikickback
Statute (AKS)
Legal
requirements and
Penalties for
non-compliance
with the Law
Risk
Role of
Assessment Person who
can be a
Low
resource for
Medium
compliance
High
(Give
(Give
reasons to
reasons to
support
support
your choice)
your rating)
A question you
would ask the
resource person to
help you better
know how to
comply with the
law
A managerial
action you would
take to comply
with the law
(Give reasons to
support your
action)
3. Your managed care
organization (MCO) wants to
build a new hospital and 2 new
rehabilitation centers in your
state of Maryland. You are
asked to spearhead the
project.
4. You oversee the medical
billing department. The billing
manager responsible for day to
day activities was out of the
office for 6 months on a
disability leave. The manager
has just returned and
discovered that the coders
billed everything at the highest
level of service whether there
was documentation to support
it or not during the 6 months
the manager was gone.
5. Your hospital wants to
expand and buy out a
physician group in a nearby
town. The physicians would
become employees of your
hospital. 75% of the physicians
in your town and the nearby
would be employed by your
hospital when the venture is
complete.
6.You are responsible for the
profit/loss statements for your
budget area each month. The
Vice President over your area
State
Certificate of
Need
Federal False
Claims Act
(FCA)
Notice of
Overpayment
Rules
Federal
Antitrust law
Joint Venture
Guidelines
Federal
Sarbanes
Oxley
Act (SOX)
just asked you to ”improve”
the numbers to show a profit
even though the numbers
show a loss. You have been
told that the VP owns 60% of
the shares of stock for your
public corporation.
7. You are an entrepreneur and
want to open up a home
health company in Maryland.
You want to be incorporated
under Maryland law and
operate as Home Care Inc.
8. You work for a family
practice physician clinic. Two
of the physician owners are
also part owners of a nearby
durable medical equipment
(DME) store and a clinical lab.
All physicians in the
organization regularly refer
patients to the DME store and
clinical lab.
9. Your hospital is a non-profit
organization and doesn’t pay
taxes. The billing company at
your hospital just sent word
that it sent 50 unpaid claims to
collections. You wonder if this
should be considered charity
care instead.
10. You work for a large health
insurance company. The
company wants to start a
Conflict of
Interest
State
Incorporation
Law
Federal
Physician SelfReferral Law
(Stark)
Federal
Internal
Revenue
Service (IRS)
tax law
Federal
Health
Insurance
disease management program
for its members by contracting
with a national pharmaceutical
to run the disease
management program.
Portability
and
Accountability
Act (HIPAA)
Business
Associate
Regulations

Purchase answer to see full
attachment