Legislation and Enforcement Matrix Template

This template provides an overview of various legislations and regulations enforced by different agencies in the healthcare industry. It includes information on the penalties for violating these regulations. The legislations covered in this template include the Health Insurance Portability and Accountability Act (HIPAA), False Claims Act (FCA), Patient Safety and Quality Improvement Act (PSQIA), Children’s Health Insurance Authorization Act, Affordable Care Act, and more.

Legislation and Enforcement Matrix Template
Enforcement
Agency
Legislation
Name/Date
Enacted
Brief Overview of
Regulation/Legislation
(Regulatory and
Legislative
Expectations) (5.5)
Penalties of Legislation
HHS Office for
Civil Rights (OCR)
enforces the
Privacy and
Security Standards
of HIPAA (Health
and Human
Services, 2010).
Health Insurance
Portability and
Accountability
Act (1986)
This act helps an
employee to remain in
the same health
insurance while
changing from one job
to another. This also
allows including new
changes in life like
marriage and children.
This act protects the
right of the employee.
Another key aspect of
this legislation is that it
makes it unlawful to
discriminate with
someone because of
their health condition.
(Health and Human
Services 2010)
The Enforcement Rule in
case of Civil penalty can
cause financial penalties
starting from 10,000 till
250,000 in case of
repeated violation to
50,000 to 1.5 million in
case of repeated violation.
The department of
Justice
False Claims Act
(1863)
Also known as the
Lincoln Law, the False
Claims Act is a federal
law that is applicable on
Violations of the FCA:
Treble damages between
$5,500 and $11,000.
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companies as well as
persons for taking
advantage of the
government. This act
also allows ‘whistle
blowing’ that is the
identity of the person
who helps in recognizing
the “relators” taking use
of the government.
(Helmer 2012)
The secretary of
health and human
services
Healthcare
Quality
Improvement act
1986
This act is a federal law
which is developed for
the development in the
quality of service in the
healthcare organization
by maintaining a
tracking system where
malpractices of the
physician are registered.
This is also called the
National Practitioner
data bank. This act helps
in fighting against
fraudulent activities that
are done against the
government. (Tehrani et
al. 2013)
The penalty for violation
of this legislation is
punished with a civil
money penalty of 10,000
each time a malpractice
has not been recorded.
HHS, agency for
healthcare research
and quality and
patient safety
organizations.
Patient Safety
and Quality
improvement act
2005
This act is shortly
termed as the PSQIA is
chiefly formed for the
protection of the
healthcare workers who
Civil money penalty is
imposed

are working in unsafe
working conditions. This
law helps in making
official record of
medical mistakes while
the patient’s data is
being protected.
(Middleton et al. 2013)
Secretary US
Department of
Health and Human
service
Children’s Health
Insurance
Authorization act
of 2009
This act is chiefly
targeting the children
who are belonging to the
low household income.
The client base that has
been disqualified before
has been taken into
consideration because of
this act. The
underprivileged children
are being advantaged
because of this act.
(Boulet et al. 2009)
The violation of this
program invites civic
penalties. Depending on
the type of violation starts
from 110 per day to
549,095 on each failure
IRA Internal
Revenue Services
Affordable Care
act of 2010
The affordable care act
was an initiative of
president Obama. This
act makes it mandatory
for all the people of the
country to apply for
health insurance
coverage. Any
organizations with more
than 200 employees are
liable to pay their
employee this health
The employers who violate
the affordable care act are
liable to fine of 100 to
36,500 per day per
employee

insurance. (Protection &
Act 2010)
NCBI Hospital
readmission
reduction program
(HRRP)
The national Hospital
readmission reduction
program is basically
aimed at improving the
service of the hospitals
by ensuring that the
readmission of the
patients to the hospital.
(Joynt & Jha 2013)
Financial penalties are
dependent on each case.
However the evidences are
for the case is
controversial in nature.
Centre for
Medicare and
Medicaid services
(CMS),
Department of
health and human
Services (HHS)
Medicaid This act was introduced
in 1965 by President
Johnson. It is meant for
the low income groups
in USA. Its reach has
grown over the period of
time and currently 70
million American
citizens. 50 per cent of
the expense is spending
by the Medicaid in the
hospitals. (Fox &
McManus 2001)
The violation of the
Medicaid is likely to be
punished with civil
monetary penalties from
10 thousand to 100
thousand in fines for each
count of violation.
References
Boulet, S. L., Boyle, C. A., & Schieve, L. A. (2009). Health care use and health and functional impact of developmental disabilities
among US children, 1997-2005. Archives of pediatrics & adolescent medicine, 163(1), 19-26.

Fox, H. B., & McManus, M. A. (2001). A national study of commercial health insurance and medicaid definitions of medical
necessity: what do they mean for children?. Ambulatory Pediatrics, 1(1), 16-22.
Health and Human Services. (2010). HIPAA Enforcement. Retrieved July 30, 2010, from
http://www.hhs.gov/ocr/privacy/hipaa/enforcement/index.html
Helmer Jr, J. B. (2012). False Claims Act: Incentivizing Integrity for 150 Years for Rogues, Privateers, Parasites and Patriots. U. Cin.
L. Rev., 81, 1261.
Joynt, K. E., & Jha, A. K. (2013). Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction
Program. Jama, 309(4), 342-343.
Middleton, B., Bloomrosen, M., Dente, M. A., Hashmat, B., Koppel, R., Overhage, J. M., ... & Zhang, J. (2013). Enhancing patient
safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. Journal of the
American Medical Informatics Association, 20(e1), e2-e8.
Protection, P., & Act, A. C. (2010). Patient protection and affordable care act. Public law, 111(48), 759-762.
Tehrani, A. S. S., Lee, H., Mathews, S. C., Shore, A., Makary, M. A., Pronovost, P. J., & Newman-Toker, D. E. (2013). 25-Year
summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank. BMJ Qual
Saf, 22(8), 672-680.