Professor Estrada is the Executive Vice President and general counsel at Scion Healthcare. She has been in the healthcare regulatory health law and compliance space for about 22 years as a lawyer and compliance professional. Professor Estrada teaches the Healthcare Industry Compliance course in the Master of Legal Studies in Compliance and Risk Management program.
Healthcare Compliance and Why It Is Important
Healthcare compliance is a large field and includes many areas of the healthcare industry related to the provision of medical devices and healthcare services for patients. The healthcare and medical industries are highly regulated because of the United States’ government-administered Medicare and Medicaid programs. Because of the government’s reliance on the healthcare industry, it has created many regulations and program requirements to protect patients and taxpayers.
Hospitals, pharmacies, medical providers, and related healthcare organizations must comply with these regulations or they risk being excluded from Medicare and Medicaid reimbursement programs.
The Centers for Medicare and Medicaid services create and promulgate the rules and regulations that healthcare industries and organizations must abide by, while the Department of Health and Human Services (HHS) enforces the regulations. The HHS has been increasingly aggressive since the mid-1980s. As a result, healthcare organizations have been compelled to create compliance programs.
Healthcare compliance programs are responsible for creating policies and procedures to identify, correct, and prevent non-compliant action. Increasingly, compliance teams not only help organizations to create best practices, but compliance programs also act as insurance policies to show there was no ill-intent should some laws be violated. In addition, it helps to shield organizations from potential penalties or criminal or civil liabilities.
The Driving Demand for Healthcare Compliance Professionals
Healthcare compliance is the fastest growing sector of our economy. The necessity of healthcare compliance makes the job market resistant to the effects of a recession.
The field is favorable for those seeking a second career. For example, nurses, therapists, auditors, and even former doctors currently work in healthcare compliance. The profession is also suitable for lawyers, people who have worked in risk management, and sales and marketing.
The skills needed to be successful in the healthcare compliance environment center around the ability to motivate and incentivize people to comply with regulations. Critical thinking skills are essential for the job as well as temperament, approach, and being comfortable with not having clear-cut answers.
The right temperament is based on not wanting to police people but instead being able to teach and encourage them. To learn more about how Professor Estrada describes the best model for compliance, watch the entire webinar.
Regardless of their background, healthcare compliance professionals need to be subject matter experts. The key risk areas that compliance programs focus on are reimbursement integrity, inducements, and patient protections.
- Reimbursement Integrity: The 60-day overpayment rule requires healthcare providers to return money they should not have received. The False Claims Act oversees investigations into overpaid money.
- Inducements: The Anti-Kickback Act and Physician Self-Referral Laws, or Stark Laws, ensure that physicians are not benefitting personally or financially from referrals.
- Patient Protections: HIPAA Privacy and Security protects patients’ sensitive medical information from being disclosed without the patient’s knowledge or consent. The Emergency Medical Treatment and Labor Act (EMTALA) requires that emergency room patients be stabilized and treated regardless of their ability to pay or whether or not they have insurance.
The Healthcare Industry Compliance Course
Professor Estrada points out that the Healthcare Industry Compliance course is not a law class. It focuses on the areas of prevention, detection, and correction and provides examples of each. The course allows students to develop guidance documents and controls regarding overseeing an investigation.
The online MLS program differs from a law degree because a law degree will teach you the laws and how to make arguments pertaining to those laws. The MLS program teaches you how to interpret and synthesize regulations. You’ll learn how to create policies, procedures, and compliance programs in an organization.
It is important to note that it’s not necessary to be a lawyer in order to be a good compliance officer. As a compliance officer, you will take an analysis from a lawyer, operationalize it, and help the organization navigate through the guidance provided by the lawyer.
What Makes the Healthcare Compliance MLS at Seattle University Different
One of the main points that set the Seattle U School of Law MLS program apart from other programs is our teaching style and focus on critical thinking and social justice. We push our students to create solutions and think about the impact those solutions can have. At times, the impact may be unintentional, but we ask the students to consider the consequences of the unintentional impacts some solutions may cause. The professors encourage candid conversations about sensitive topics that touch on legal issues and regulations.
Another differentiator is that Seattle U’s School of Law online program was up and running before the pandemic. We have the skills and expertise to provide the MLS program online. It allows us to take important conversations and critical thinking into an online space.
The MLS includes a solid legal writing program. You’ll leave with skills that will make you a healthcare compliance professional and polished writer, which is necessary when dealing with lawyers.
Seattle U’s Master of Legal Studies Program
Seattle U’s fully online Master of Legal Studies in Compliance and Risk Management program prepares its graduates to lead compliance efforts in any organization, regardless of industry. Students graduate with a commanding knowledge of law, legal analysis, and the frameworks used to identify, assess, and respond to risk.
Depending on professional goals and interests, students in the program can optionally choose to focus on financial compliance, healthcare compliance, corporate compliance, or data & cybersecurity compliance.To learn more about the program and our conversation with Professor Estrada and the Director of Graduate Studies, Kelli Rodriguez Currie, watch the full webinar recording below.