Financial Relationships
The multiple financial conflicts of interest that can arise from referral sources, physicians, and hospitals working together can have a negative effect not just on the standard of care that patients receive but also on the overall cost of medical treatment and the reliability of the healthcare system. These dangers can take many forms, such as possible conflicts of interest, improper payments, kickbacks, and other types of self-dealing.
There is a conflict of interest when a physician or hospital has a financial relationship, such as an ownership interest, that could affect their decisions regarding patient care, referral sources, or other relevant topics, and that relationship could potentially benefit from those decisions. A physician or institution that has a financial relationship with a patient may make judgments based on the potential for economic benefit rather than on what is in the patient’s best interest. In addition to this, it may result in improper referrals, increased costs, and a decreased ability to get care.
Inappropriate payments, kickbacks, and other forms of self-dealing can be prohibited and can lead to both civil and criminal fines. This is in addition to conflicts of interest, which are also illegal. Inappropriate payments are those that are made for services that are either not given or are not medically necessary. In the healthcare industry, physicians and other professionals may receive cash or other incentives in the form of kickbacks in exchange for referrals or other services. These kinds of behaviors can lead to fraudulent and abusive behavior, both of which can be expensive for the healthcare professional as well as the patient.
Businesses need to have a robust and well-organized database in order to keep track of the financial links that exist between hospitals, physicians, and referral sources. This is because there are potential hazards involved with these types of partnerships. A database of this kind is essential if one is to verify that all involved parties comply with the relevant rules and regulations. In addition to this, it is necessary to guarantee that all appropriate parties have access to information that is both current and correct. When organizations have access to this kind of data, it makes it much simpler for them to recognize possible hazards, conflicts of interest, and inappropriate payments. In addition, the presence of a centralized database enables improved communication between the many stakeholders. It can contribute to the correct disclosure and monitoring of any financial links that may exist.
Organizations should, in addition to having a database to manage financial relationships, have an effective compliance policy in place to defend themselves against scrutiny and investigation. A thorough compliance program should include rules and procedures to ensure that any possible conflicts of interest are detected and resolved, as well as the disclosure and monitoring of any financial relationships that may exist between the parties involved. In addition, an efficient compliance program needs to incorporate training for employees on the applicable rules and regulations, as well as routine internal audits to identify and rectify any potential problems that may arise. Organizations are able to shield themselves from the possibility of being scrutinized and investigated if they have a solid and all-encompassing compliance program in place.
In conclusion, the financial relationships that exist between hospitals, physicians, and referral sources have the potential to have a major impact on the quality of patient treatment, the cost of healthcare, and the overall integrity of the healthcare system. As a consequence of this, businesses must maintain a comprehensive and well-organized database in order to monitor these connections, as well as an efficient compliance program in order to safeguard themselves against the possibility of harm. By ensuring that they have the appropriate controls in place, companies may guarantee that they comply with the relevant rules and regulations, thereby avoiding potentially expensive fines.
References
Compliance Officer’s Guidebook, 2nd Edition (2007), published in 2007. The firm of John Wiley and Sons, Inc.
Health Care Compliance Professional’s Manual, Fifth Edition (2012), published in 2012. AHLA stands for the American Health Lawyers Association.
A Guide for Compliance Officers on How to Detect and Prevent Fraud and Abuse in the Health Care Industry. (2009). Association of American Lawyers.
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Question 
As a compliance officer, it is important to have a good understanding of financial relationships within the organization you work for. Financial relationships can be affected by internal and external stakeholders, which is why it is necessary to have a strong, organized database to track financial relationships within an organization.
Financial Relationships
Write a 700- to 1,050-word paper that explains the following:
- The risks of financial relationships between hospitals, physicians, and referral sources
- The reasons for creating a database to track financial relationships
- How an effective compliance program can defend against scrutiny and investigation
Cite three reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality). At least one must be informed.