Developing mechanisms for reporting compliance violations.

Both the Federal Sentencing Guidelines and the Office of Inspector General's (OIG) Compliance Program Guidance for Hospitals can assist healthcare organizations in establishing a reporting system that encourages employees to report wrongdoing. One mechanism that is commonly used is the telephone hot line. Other mechanisms that can be used in conjunction with a hot line include a drop box or post office box, written or oral reports to supervisors, an open-door policy on the part of compliance personnel, and employee exit interviews. However the reporting system is set up, it should ensure confidentiality and a policy of nonretaliation to encourage the participation of all employees. Having a sound reporting system in place will enable healthcare organizations to investigate any alleged instances of noncompliance and take corrective action before the Federal government becomes involved.

Legal audits and investigations: a key component of healthcare corporate compliance programs.

In today's complex legal environment, healthcare organizations are increasingly implementing voluntary compliance programs as a means of avoiding severe penalties for violations of the law. The Office of the Inspector General has identified legal audits and investigations as key components of effective compliance programs. The author demonstrates the applicability of legal audits and investigations to healthcare organizations by examining the audit and investigation process from beginning to end. The author also examines the role of attorneys in legal audits and investigations, and explains how information communicated from the healthcare organization to its attorneys can be protected from disclosure. As this Article indicates, the monetary and human resource costs of such compliance audits and investigations are insignificant when compared to the potential costs of defending a legal action or paying monetary penalties.

Bridge to the future: nontraditional clinical settings, concepts and issues.

Healthcare restructuring in the wake of healthcare reform places greater emphasis on primary healthcare. Clinical education in acute care settings and existing community health agencies are not compatible with teaching basic concepts, principles and skills fundamental to nursing. Problems of clients in acute care settings are too complex and clients in the community are often too dispersed for necessary faculty support and supervision of beginning nursing students. Nontraditional learning settings offer the baccalaureate student the opportunity to practice fundamental skills of care and address professional skills of negotiation, assertiveness, organization, collaboration and leadership. An overview of faculty designed clinical learning experiences in nontraditional sites such as McDonald's restaurants, inner city churches, YWCA's, the campus community and homes are presented. The legal, ethical and academic issues associated with nontraditional learning settings are discussed in relation to individual empowerment, decision making and evaluation. Implications for the future address the role of the students and faculty as they interact with the community in which they live and practice.

Avoiding HMO liability for utilization review.

In this article, the author describes the potential liability of Health Maintenance Organizations for utilization review programs. Utilization review is used to determine whether certain medical treatment is necessary according to the standards of the HMO, and the HMO may decline to pay for treatments it deems unnecessary. If a doctor abstains from treatment because of this decision and the patient is harmed, the HMO may become the target of litigation. The author analyzes several recent cases and offers practical ideas for preventing and defending suits brought against HMO's for utilization review decisions.

Hill-Burton: the unfulfilled promise.

The poor and uninsured encounter numerous barriers to health care access. The Hill-Burton Act of 1946 required many hospitals to make their services available to all persons, yet ineffective enforcement has limited the utility of the act's requirements. Hill-Burton hospital audits have revealed widespread facility noncompliance. In light of these findings, alternative enforcement procedures should be considered.