Below is an in-depth overview of the courses and seminars in the Health Care Compliance (HCC) Online graduate certificate program. Students apply to the program online at Pitt Online »
In order to earn credit for each course for this certificate, students must earn a minimum grade of C (2.0). To earn the certificate, a cumulative GPA of B (3.0) is required.
2062 Introduction to the Legal System for Health Care and Compliance
(3 credits) | Professors Mary Crossley and Mary Nell Cummings
Good compliance decision-making depends on a clear understanding of the legal framework that regulates the health care industry. This course will explore aspects of tort, contract, corporate, and administrative law against a backdrop of the business of health care and compliance needs. For example, students will learn fundamental tort concepts while discussing malpractice issues and will learn basic concepts of corporate law while examining shifting alliances in the health care market. Students will also gain an understanding of administrative law by examining the authority of federal regulators and their influence on how health care is delivered.
2061 Legal Aspects of Health Care Compliance (3 credits)
| Professors Tina Hershey and Jessica Ellel
This course will examine the substantive law that generates most compliance risk issues against a backdrop of recent enforcement actions. It will cover the compliance program elements, fraud and abuse laws (the False Claims Act, the Anti-Kickback Statute, Stark), conditions of participation, coding and billing, documentation, medical necessity, cost reports, internal investigations, the attorney-client privilege, CMS/State Medicaid contractors, HIPAA/HITECH privacy & security, and OIG guidances.
2968 Effective Compliance Program Development and Skills (3 credits)
| Professor Barbara Vimont
This course focuses on the fundamentals required to develop and maintain an effective compliance program. Students will study the seven elements of a successful compliance program in practical detail and will learn best practices for compliance programs. Specifically, this will include learning how best to design and implement compliance oversight and committees, practicing policy drafting, and exploring the most effective ways to educate and train and compliance. This will also include developing an excellent understanding of audit, investigation, and corrective action skills and strategies.
2969 Professional Judgment and Ethics, the Canvas of Compliance (3 credits)
| Professor Linn M. Swanson
Health care organizations can face a broad array of ethical issues and often the chief compliance officer is called on to publicize and monitor the organization’s code of ethics, vision, and values, as well as oversee the training of employees. In health care compliance, ethical issues can be especially challenging. Health care organizations are also businesses and the tension between business decisions and health decisions creates many of the topics we will discuss in this ethics course. This course will cover organizational ethics, mission and values, professional judgment, core values and managing conflict, and health care ethics and business decisions.
Students will self select their areas of study in this course and will choose three subject matter Seminars. In addition, each student will work individually to complete a capstone paper in their area of professional interest. The Seminars, which are taught by industry experts, are:
- Hospitals and Providers (Instructor: Swanson): This seminar will provide an overview of the compliance function in a hospital as well as in a large provider’s office. It will look at challenges and best practices in implementing and measuring compliance with Medicare conditions of participation and payment, survey and certification requirements, HIPAA, Stark, anti-kickback, professional relations, coding obligations and guidelines, and quality.
- Advanced Hospitals and Providers (Instructor: Swanson): This seminar will build on the Hospitals and Providers seminar and look at real world examples of federal enforcement activities, what went wrong in the compliance program implementation and how things could have been done differently. It will also address topics such as managing internal and governmental investigations and managing up, dealing with business leaders, CEOs, and politically sensitive situations.
- Privacy (Instructor: Maruca): The focus of this seminar will be the privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Environmental and Clinical Health (HITECH). Students will obtain a full understanding of what it means for a health care organization to be HIPAA compliant, how to monitor and measure HIPAA/HITECH compliance, how to develop effective compliance programs, training, risk assessment, and how best to utilize a privacy officer and a privacy and security infrastructure to minimize risk and ensure full HIPAA compliance across a complex organization.
- Advanced Privacy (Instructor: Maruca): This seminar will examine the interplay between HIPAA and other federal and state health privacy laws and the application and enforcement of those laws in a variety of health care settings. The class will address differences in state and federal law. The class will also address detection, analysis and responses to unauthorized disclosures, security incidents and HIPAA breaches. This class will look beyond HIPAA at technology and innovation, at the requirements for electronic health record certifications, and the challenges to a goal of portable health records.
- Health Care Quality (Instructor: Collins): Patient quality measures and achievements are growing in importance in the compliance profession. This seminar will provide an overview of the key components of, and importance of quality in the realm of patient safety, while incorporating techniques to continuously improve and transform a healthcare system. We will explore critical healthcare quality issues at the organizational and microsystem levels, and detail current strategies, tactics, and methods for understanding quality. Students will discuss foundational healthcare quality principles, and look at practical tools necessary for measuring quality, improving healthcare performance, and promoting transparency of clinical pathways and outcomes.
- Risk Assessments (Instructor: Sullivan): An effective compliance program is tailored to a company's risk. Compliance risk assessments also serve to protect and defend companies. In fact, a company's approach to compliance risk asessment was identified by the Department of Justice as a foundational consideration when evaluating whether to bring charges against a company. With that in mind, this seminar focuses on practical approaches to conducting a compliance risk assessment in the health care setting. Students will learn how to develop a risk framework, and different approaches to scoring company risk. This will include everything from building a risk register to prioritizing and reporting out on top systematic risk assessment process.
- Compliance in Research (Instructor: Odwazny): This seminar will address the fundamental ethical issues that are the driving force behind research rules and regulations. Students will evaluate how to create effective compliance programs that address issues in basic human subject research, animal research, the responsible use of research results, responsible conduct of research and conflicts of interest.
- Life Sciences (Instructor: Cummings): This seminar will provide an overview of key sources of law that cover the approval, manufacturing and marketing of prescription drugs and devices. Students will study policies and practices designed to ensure effective compliance with these laws, especially as it relates to safety, efficacy, kickback risks, and off-label marketing.
- Compliance for Insurers (Instructor: Phillips): This seminar will examine the key compliance issues health insurers face in connection with their business models. Students will examine challenges and best practices in implementing and measuring compliance with the Affordable Care Act and other federal and state requirements, understanding and preparing for government program compliance audits, and other unique obligations of payers in today’s health care environment.