Health care organizations continually face challenges from various regulatory and government agencies while also being bound by Managed Care Organization (MCO) standards.

  1. Two key reform factors that will need to be addressed by future health care workers or leaders based on the video “College of Nursing and Health Care Professions: Do We Know What Our Future Is?” are:

a) The need for a patient-centered care model: The video highlights the shift from a provider-focused model to a patient-centered care model, which requires health care workers and leaders to prioritize patients’ needs and preferences. The model demands increased patient involvement and participation in decision-making and an emphasis on patient outcomes.

b. Technology integration and innovation are essential. The video explores how technology is integrated in healthcare. This can help improve patient outcomes, communication and access, and increase accessibility to care. The future leaders and healthcare workers will have to know how to use technology to enhance patient care.

My future vision for healthcare is based on my commitment to MCO standards. Management of healthcare organizations aims to increase patient satisfaction and reduce costs. MCO standards allow healthcare providers to ensure they deliver high quality, affordable care. MCO standards encourage accountability as they require healthcare providers to report quality outcomes and measures.

  1. The Affordable Care act (ACA) has several provisions regarding provider compliance with laws governing fraud, waste and abuse. The following are the requirements for health care providers to follow the ACA.

a) Developing compliance programs and implementing them: To prevent fraud, waste and abuse, the ACA mandates that providers have compliance programs. It should contain policies and procedures as well as training and education. Monitoring and auditing are also important. Mixon and his colleagues. Mixon et al. (2017) discovered that compliance programs could significantly lower the chance of fraud or abuse.

b) Employee screening and contractor screening: To ensure they do not get excluded from the federal health care program, the ACA mandates that providers screen contractors and employees. Checks for criminal history and licensure should all be part of the screening. A study by Ghanem et al. Ghanem et al. (2018) discovered that employee screening could reduce fraud and abuse.

c. Reporting and Returning Overpayments: The ACA mandates that providers report and return any overpayments made within sixty days after identification. The provider should have a process in place to detect and investigate possible overpayments and ensure prompt reporting and returns. A study by Kocot et al. 2016 study by Kocot et al.


Ghanem, K. G., Gibbons, R. V., Young, B. E., & Lai, L. D. (2018). Screening employees is a critical step to prevent health care fraud or abuse. Journal of Health Care Compliance 20(1): 47-57.

Kocot, S. L., Dresang, L. T., & Shugarman, L. R. (2016). Reported and returned overpayments by health care providers: An examination of regulations, guidelines, best practices, and other relevant information. Rand Health Quarterly 6, 3, 6.

Mixon, A. S., Gomillion, A. B., McNeil, C. R., & Reilly, C. A. (2017). Compliance programs’ effectiveness in protecting Medicare beneficiaries from fraud, waste and abuse. Health Care Management Review, 42(2) :146-156

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