ASIPP Ethics Questions

Question 1

1866. The new JCAHO standards require which of the following:
      A. The use of intravenous morphine
      B. Frequent assessment of a patient’s pain
      C. Successful treatment of a patient’s pain
      D. Recording of the physician’s satisfaction
      E. Demonstrated use of the analgesic ladder algorithm

Answer 1

1866. Answer: B

Question 2

1867. A young adult is in rehabilitation after suffering a closed
      head injury and a fracture of the femur in an automobile
      accident. Which of the following psychometric
      assessments would be most useful in the detection of
      brain damage?
      A. Thematic Apperception Test (TAT)
      B. Bender-Gestalt Test
      C. California Personality Inventory
      D. Minnesota Multiphasic Personality Inventory (MMPI)
      E. Millon Behavioral Health Inventory (MBHI)

Answer 2

1867. Answer: B
      Explanation:
      (Kaplan, p 201-203.)
      The Bender-Gestalt Test can be useful in the assessment
      of maturation and of brain damage. Various atypical
      responses to the Rorschach cards (e.g., poor form
      responses) also have been found to be related to
      brain damage. The Bender-Gestalt Test consists
      of nine test figures that a subject is asked to copy;
      difficulties in this easy task often are indicative of brain
      dysfunction. Neither the Thematic Apperception Test nor
      the California Personality Inventory has been found to be
      a sensitive indicator of cerebral damage. The MMPI tests a
      wide range of personality factors and the MBHI is a
      psychodiagnostic inventory of personality, coping style,
      and symptoms for the physically ill. Other than a few
      cognitive factors, neither is adequate for the detection of
      brain damage. Another frequently used test for brain
      damage is the Halstead-Reitan Battery of
      neuropsychological tests.
      Source: Ebert 2004

Question 3

1868. Informed consent
      A. Is a tool that physicians utilize to avoid litigation, ensuring
      best outcomes.
      B. Requires the patient’s family or signifi cant other to be
      aware of physician comments.
      C. Is binding in circumstance such as surgery where other
      procedures must be performed.
      D. A tool for the physician to explain risk complication options
      to procedure and review with the patient the risk
      and reward of procedure.
      E. In any format (implied, oral, written, general) is equivalent
      in meeting criteria required in any situation

Answer 3

1868. Answer: D

Question 4

1869. Written consent
      A. Is considered the same as general consent.
      B. A written consent addresses individual treatment with
      inherent risk and reward.
      C. A written consent is always binding, and may be signed
      by immediate family members.
      D. Is the least common type of consent obtained.
      E. A written consent is inferior to implied consent.

Answer 4

1869. Answer: B

Question 5

1870. Choose the correct statement related to Fraud and
      Abuse.
      A. The Anti-kickback Statue allows a clinical lab to increase
      its Medicare business by offering to perform certain
      tests for free.
      B. Under Stark physician self-referral rules, a clinical lab
      that receives Medicare referrals from a physician practice
      may provide the doctors with free offi ce equipment
      solely to store information regarding patient specimens.
      C. It is legal for a clinical lab to write off charges for a physician’s
      managed care business in exchange for referrals
      of Medicare non-managed care patients.
      D. The clinical labs are not required to ensure that they have
      access to the supporting documentation of physicians
      who order services from them.
      E. A clinical lab may alter a physician’s order without his or
      her (or authorized individual’s) consent in order to bill
      Medicare more correctly.

Answer 5

1870. Answer: B
      Explanation:
      A. A supplier cannot offer to perform tests at a discounted
      rate or for free in order to induce the ordering of Medicare
      tests.
      Penalties include a felony conviction, up to a $25,000
      fi ne and/or fi ve years in prison, plus possible exclusion
      from Medicare, Medicaid or other federal health care
      programs.
      In addition, as added by the Balanced Budget Act of
      1997, a convicted provider also could be hit with a civil
      money penalty of up to $50,000 for each act, plus damages
      of three times the amount of the kickback, whether or not
      a portion of the kickback was legal.
      B. Equipment rental is a key concept under both the Anti-
      Kickback Statue and the stark II regulations, in one case
      because appropriate rentals may be protected under a safe
      Harbor and in the other because they may be protected
      under an exception. According to Stark, physicians should use supplies
      provided at no cost by a lab for that lab only and not
      accept more supplies than they will use.
      For example, if a physician’s offi ce tends to send about
      400 blood tests a year to a particular lab, the number of
      items or supplies accepted from the lab should be
      commensurate with the expected volume of tests.
      If not, the receipt of these items or supplies could
      createa fi nancial relationship within the meaning of
      the stark law.
      Items provided must be used solely to collect, store,
      process or transport specimens in order to avoid stark
      violations.
      Specialized equipment such as disposable or reusable
      aspiration or injection needles and snares are not solely
      collection or storage devices.
      Computers and fax machines, although also used to
      store data, are not viewed as solely collection or storage
      devices.
      The Anti-kickback Statute takes a different stance on
      free equipment.
      Whenever a lab offers or gives a referral source
      anything of value that’s not paid for at fair market value,
      OIG draws the inference that the thing of value is offered
      to induce the referral of business.
      By fair market value, OIG means value for general
      commercial purposes.
      However, in the health care context, fair market value
      also must refl ect an arms-length transaction unadjusted to
      include the additional value that one or both parties might
      attribute to the referral of business between them.
      Under the anti-kickback law, an arrangement that
      would normally violate the law is protected if it fi ts into a
      safe harbor. The Equipment Rental Safe Harbor is
      designed to give providers guidance on how to comply
      with the law when renting equipment from entities to
      which physicians refer. Arrangements must meet the
      following 6 standards:
      Leases must be in writing and signed by the parties.
      The lease covers all equipment leased between the
      parties and specifi es the equipment it covers.
      If the lease gives the renter access to the equipment for
      only periodic intervals rather than full-time use, the lease
      must specify exactly the schedule of the intervals and their length,
      The lease must be for a term of at least one year.
      The aggregate rent for the lease must be set in advance,
      must be at fair market value, and can’t be linked to
      referrals or other business generated between the parties.
      The amount of equipment rented is not greater than is
      reasonable for the commercial purpose of the rental.
      C. Managed care plans might require a physician or other
      provider to use only the lab with which the plan has
      negotiated a fee schedule. In these situations, the plan
      usually will refuse to pay claims submitted by other labs.
      The provider, however, may use a different lab and may
      wish to continue to use that lab for non-managed care
      patients. In order to keep the provider as a client, the lab
      that doesn’t have the managed care contract may agree to
      do the managed care work free of charge.
      The legality of these types of agreements under the
      Anti-Kick back Statue depends in part on the kind of
      contractual relationship between the managed care plan
      and its providers.
      Under the terms of many managed care contracts, a
      provider will get a bonus or other payment.
      For proper utilization managed care plans threaten
      fi nancial penalties if the provider’s utilization of services
      exceeds present levels.
      When a lab agrees to write off charges for a physician’s
      managed care work, the physician may receive a fi nancial
      benefi t from the managed care plan because of the
      appearance the utilization of tests has been reduced.
      In cases in which providing services for free results in a
      benefi t to the provider, the Anti Kick-back Statue is
      involved.
      If free services are offered or accepted in return for the
      referral of Medicare, Medicaid or other state health care
      program business, both the lab and the physician may be
      violating the statute.
      There is no exception in the law or safe harbor
      regulation that gives immunity to any party involved in
      this kind of activity because the Medicare or Medicaid
      programs don’t get the benefi t of these free services.
      D. While OIG recognizes that labs don’t treat patients or
      make medical necessity determinations and that physicians
      may order any of a wide range of tests they feel are
      appropriate for their patients, it nonetheless says that there
      are steps labs can and should take to make sure that they
      bill only for tests that meet government reimbursement
      rules. One such step is communicating to physicians that
      the claim will be paid only for services that are covered,
      reasonable and medically necessary.
      On request, a lab should also be able to give
      documentation
      supporting the medical necessity of a service billed to a
      government program, such as requisition forms that have
      diagnosis codes. Alternatively, the lab must be able to get
      this supporting documentation from the physician who
      ordered the test, an authorized person on the physician’s
      staff or another person authorized by law to order tests.
      OIG states that labs are in a unique position to give
      referring physicians information on Medicare rules
      governing medical necessity, especially on which specifi c
      tests (such as screening tests) don’t meet Medicare rules.
      In OIG’s opinion, labs can and should give physicians such
      advice.
      E. A clinical lab may not alter a physician’s order without
      consent.

Question 6

1871. Ethical dilemmas for the delivery of healthcare include
      A. The issue of rigidity in medication delivery
      B. The need to consider the emotional or social aspect of
      the pain patient
      C. Biopsychosocialeconomic impact of chronic pain
      D. Patient’s relationship with his or her close relatives
      E. Financial issues

Answer 6

1871. Answer: D

Source: Raj, Pain Review 2nd Edition

Question 7

1872. Which of the following is not an appropriate strategy for
      helping patients make healthcare decisions?
      A. If the patient’s situation is not emergent emphasize they
      do not have to decide immediately on a treatment option.
      B. Have paper & pens available for the patient to take
      notes.
      C. Provide intellectually appropriate articles explaining the
      patient’s condition and treatment options.
      D. Provide your patients with a list of websites you think are
      reliable and contain helpful information.
      E. Describe the treatment options in esoteric terms.

Answer 7

1872. Answer: E

Source: Weinberg M, Board Review 2004

Question 8

1873. Which of the following are appropriate strategies for
      helping patients make healthcare decisions?
      A. Provide patients with a list of support groups so they can
      hear what treatment options other patients have chosen
      and what benefi ts & burdens they have experienced.
      B. Ask the patient about their “decision-making model.”
      C. Try to have the patient’s surrogate present at all signifi -
      cant conversations.
      D. Ask the patient to develop a list of those activities that
      gives their life meaning so you can discuss their illness
      and the benefi ts & burdens of the various treatment options
      within the context of their everyday life.
      E. All of the above.

Answer 8

1873. Answer: E

Source: Weinberg M, Board Review 2004

Question 9

1874. The ethical basis of pain medicine involves:
      A. intellectual domains that engage theoretical, empirical
      and contextual knowledge
      B. practical domains that utilize particular skills, together
      with the subtleties of medicine as ‘art’
      C. appropriate balance of technologic application, objectivity
      and subjectivity
      D. all of the above

Answer 9

1874. Answer: D
      Explanation:
      The ethical practice of pain medicine is the enactment of
      the role of the physician as both a therapeutic and moral
      agent. As such, the physician must utilize intellectual skills
      that engage distinct types and ways of knowledge, practical
      skills and subtle, somewhat more esoteric capacities in
      enabling medicine as an art and science. This includes
      balancing objective information (gained through
      technologic means) and subjective knowledge of the
      patient as a person to determine what should be done to
      render the most appropriate therapeutics.
      (Giordano J. On knowing: The use of knowledge and
      intellectual virtues in practical pain management. Practical
      Pain Management 2006; 6(3): 66-69)
      Source: Giordano J, Board Review 2006

Question 10

1875. Medical ethics can best be described as
      A. Proper conduct in patient relations
      B. Proper care of the patient
      C. Proper appearance of the physician when fi rst encountering
      the patient
      D. Proper documentation of the examination of the patient
      E. Proper billing practices

Answer 10

1875. Answer: A

Source: Raj, Pain Review 2nd Edition

Question 11

1876. Ethics can be defi ned as:
      A. a set of morals that are based upon the beliefs of a group
      of people
      B. a consensus of right and just behaviors
      C. the formal, critical study of morality
      D. all of the above

Answer 11

1876. Answer: C
      Explanation:
      Ethics is the study of moral affi rmations, actions and
      patterns of behavior that refl ect these foundations in
      individuals and groups (Giordano J. Moral agency in pain
      medicine: Philosophy, practice and virtue. Pain Physician
      2006; 9: 41-46)
      Source: Giordano J, Board Review 2006

Question 12

1877. This form of euthanasia involves a patient who asks for
      a life-sustaining intervention to be withheld or withdrawn.
      A. Voluntary Active Euthanasia
      B. Voluntary Passive Euthanasia
      C. Involuntary Passive Euthanasia
      D. Involuntary Active Euthanasia
      E. Physician Assisted Suicide

Answer 12

1877. Answer: B

Source: Weinberg M, Board Review 2004

Question 13

1878. The Oregon Death with Dignity Act requires the following,
      EXCEPT:
      A. The diagnosis and prognosis must be confi rmed by a
      second physician.
      B. The patient must be informed of alternatives to assisted
      suicide, including hospice.
      C. The patient must sign a waiver releasing the physician
      from all liability.
      D. Physicians must report the provision of a lethal prescription
      to the Health Department
      E. Physicians must request, but cannot require, the patient
      to notify their family

Answer 13

1878. Answer: C

Source: Weinberg M, Board Review 2004

Question 14

1879. The reasonable person standard requires patients to be
      provided with the following information, except:
      A. The (suspected) diagnosis
      B. All reasonable treatment alternatives, including doing
      nothing
      C. A description of reasonably foreseeable burdens for each
      treatment alternatives, including doing nothing
      D. A description of reasonably foreseeable benefi ts treatment
      alternatives, including doing nothing
      E. An explanation of all theoretical risks.

Answer 14

1879. Answer: E

Source: Weinberg M, Board Review 2004

Question 15

1880. When can you give medical information about a patient
      to another person or entity other than the patient?
      A. Work Comp Carrier
      B. Malpractice lawyer who is suing you
      C. Life insurance agent
      D. Patient’s employer
      E. Patient’s ex wife

Answer 15

1880. Answer: A

Question 16

1881. This form of euthanasia involves a patient who has
      lost decision-making capacity and has not expressed
      end-of-life treatment preferences. The patient is given
      something with the explicit intention to cause death.
      A. Voluntary Active Euthanasia
      B. Voluntary Passive Euthanasia
      C. Involuntary Passive Euthanasia
      D. Involuntary Active Euthanasia
      E. Physician Assisted Suicide

Answer 16

1881. Answer: D

Source: Weinberg M, Board Review 2004

Question 17

1882. Some ethical and bioethical problems include all of the
      following except
      A. Ways to care for indigent patients who seek treatment
      B. Relationship between the caregiver and the patient
      C. Dealing with patients who are compliant
      D. Dilemma of spiraling healthcare costs
      E. Dealing with managed care

Answer 17

1882. Answer: C

Source: Raj, Pain Review 2nd Edition

Question 18

1883. This form of euthanasia involves a patient who has lost
      decision-making capacity, does not have an Advance
      Directive and has not expressed end-of-life treatment
      preferences. Life-sustaining interventions are withheld
      or withdrawn from the patient based on, ideally,
      what “we” believe the patient would have wanted.
      A. Voluntary Active Euthanasia
      B. Voluntary Passive Euthanasia
      C. Involuntary Passive Euthanasia
      D. Involuntary Active Euthanasia
      E. Physician Assisted Suicide

Answer 18

1883. Answer: C

Source: Weinberg M, Board Review 2004

Question 19

1884. This form of euthanasia involves a patient asking for
      an intervention to end their life. The patient is given
      something with the explicit intention to cause death.
      A. Voluntary Active Euthanasia
      B. Involuntary Passive Euthanasia
      C. Involuntary Active Euthanasia
      D. Physician Assisted Suicide

Answer 19

1884. Answer: A

Source: Weinberg M, Board Review 2004

Question 20

1885. Which of the following activities and statements are accurate:
      A. The Office of Inspector General (OIG) always considers
      a standing order from a physician to a clinical lab to be
      acceptable documentation for medical necessity.
      B. An independent lab may submit a claim for a clinical lab
      test before results are returned from the reference lab
      that performed the test.
      C. A clinical lab may bill Medicare for services certified by a
      physician who owns the lab.
      D. A clinical lab may submit claims for reimbursement
      under certain conditions, even when the lab thinks that
      the tests may be denied.
      E. A clinical lab may alter a physician’s order without his or
      her (or authorized individual’s) consent in order to bill
      Medicare more correctly.

Answer 20

1885. Answer: D
      Explanation:
      A. Standing orders are allowed when they’re part of an
      extended course of treatment, but OIG says that in the
      past, too often they have led to abusive practices. Standing
      orders by themselves aren’t usually acceptable
      documentation that tests are reasonable and necessary.
      B. The False Claims Act has been violated when a provider
      does any of the following:
      Knowingly presents a false claim for payment or
      approval to an offi cer or employee of the U.S. government
      or armed forces.
      Conspires to defraud the government by having a false
      claim allowed or paid.
      A claim, submitted prior to receipt of the results, could not
      be based on qualifi ed clinical lab services because the
      independent lab would not have been able to determine
      whether the test was performed meaningfully, for example,
      whether the specimen was adequate or the results were
      valid. This would be a direct violation of the False Claims
      Act.
      C. Clinical lab services are one of the 10 health care
      services specifi cally designated by Stark for which
      physicians cannot make referrals to entities with which
      they or family members have a relationship. In fact, clinical
      lab services were the fi rst health care service designated by
      Stark in 1989.
      D. The Centers for Medicare & Medicaid Services (CMS)
      allows laboratories to submit claims in limited instances
      when the lab thinks the test may be denied. Such instances
      include but aren’t limited to the following:
      When a benefi ciary has signed an Advance Benefi ciary
      Notice (ABN); or
      When the benefi ciary requests the provider submit the
      claim.
      When ABNs are used, the lab should include modifi er GA
      on the claim, which indicates that the benefi ciary has
      signed an ABN.
      When a patient asks the provider to submit the claim, the
      lab should note on the claim its belief that the service is
      non-covered and that it is being submitted at the
      benefi ciary’s insistence.
      E. Lab compliance policies should make sure that all
      claims for testing services submitted to Medicare or other
      federally funded health care programs are accurately and
      correctly identify the services ordered by the physician or
      authorized person and performed by the lab.

Question 21

1886. A code of medical ethics that includes fundamental elements
      of the patient-physician relationship and principles
      of medical ethics involving professional responsibility
      and obligation of physicians is published by
      A. American Board of Medical Specialties
      B. American Medical Association
      C. International Association for the Study of Pain
      D. Offi ce of Health and Human Services
      E. Government Accountability Offi ce

Answer 21

1886. Answer: B

Source: Raj, Pain Review 2nd Edition

Question 22

1887. Other than the Netherlands, Physician Assisted Suicide
(PAS) is legally permitted in:
1. Switzerland
2. Belgium
3. Germany
4. Oregon

Answer 22

1887. Answer: E (All)

Source: Weinberg M, Board Review 2004

Question 23

1888. True statements regarding participation in a clinical or
      research study include:
1889. To determine whether your patients qualify for the
      study, you may review their medical records with the
      help of a drug company researcher, without any restrictions
      under HIPAA.
1890. It is not necessary to enter into a business associate
      agreement with the company performing the research
      to sign on as an investigator.
1891. A physician participating in a research study using
      his patients may not contact them to determine their
      interest in the project without a business associate
      agreement.
1892. Under HIPAA regulations, a research participant patient
      is entitled to see the information before or after the end
      of the study based on the research protocol.

Answer 23

1888. Answer: C (2 & 4)
      Explanation:
1889. The government recognizes that sponsors need such
      data to determine whether they conduct a statistically valid
      study.
      But, HIPAA requires that the physician and a
      researcher draw up a business associate agreement.
      The agreement must specify that the sole purpose of the
      review is to prepare a research protocol or similar
      preliminary document, that no protected information will
      be removed from the physician’s offi ce to another location,
      and that the review is the necessary fi rst step in fulfi lling
      the goals of the research.
1890. If a physician is performing the study with a
      pharmaceutical company, he does not require a business
      associate agreement.
      Even though the physician is performing a function on
      behalf of the drug company, it is not the physician’s
      business associate because the pharmaceutical company is not performing a function on behalf of the physician.
      Covered entities are limited to health plans, clearing
      houses, and providers that conduct one or more HIPAA
      transactions electronically.
      However, the physician needs a contract that spells out
      the terms of participation in the research study, including
      payments for services rendered.
1891. Under HIPAA, physician or physician’s employees may
      contact patients to ask whether they are interested in
      participating in a research study.
      However, if someone else – like an independent
      researcher, etc., contacts the patients, HIPAA
      requirements must be met.
      HIPAA
      requirements include that before someone other than the
      physician or a member of the physician’s staff contacts a
      patient, the physician must enter into a business associate
      contract with this person, obtain proper patient
      authorization, or ask an Institutional Review Board to
      waive the normal patient-authorization requirement.
1892. The patient may suspend his or her rights at any time
      until the end of the research.
      However, if a patient consents to this suspension
      beforehand, the patient is also entitled to know that
      patient rights will be reinstated upon completion of
      the study.

Question 24

1889. Some of the communication issues faced by health care providers in terminal patients include?
1890. Diagnosis and prognosis
1891. Advanced directives and do-not-resuscitate(DNR)
      orders
1892. Spiritual needs
1893. Symptom Management

Answer 24

1889. Answer: E (All)

Source: Reddy Etal. Pain Practice: Dec 2001, march 2002

Question 25

1890. Contents of an informed consent include:
1891. Risk complication and option and potential benefi ts of
      described treatment.
1892. A signature from the patient, family member, or power
      of attorney that is designated by the patient to sign on
      their behalf.
1893. Invalid if incompetent or intellectually/medically impaired
      patient’s sign.
1894. Valid if the patient signs while sedated as long as they
      were aware of the consent prior to sedation.

Answer 25

1890. Answer: A (1, 2, & 3)

Question 26

1891. General consent
1892. Allows the physician or surgeon to operate in the
      patient’s best interest.
1893. Is utilized in emergency situations.
1894. Is utilized as family members or designated individuals
      when necessary to proceed in the patient’s best
      interest.
1895. Is the same as a written consent.

Answer 26

1891. Answer: A (1, 2, & 3)

Question 27

1892. The term malingering may be used to describe the following
      situations:
1893. Fabrication of symptoms and signs
1894. Continuing complaint of disability after the physical
      cause has ceased to exist
1895. Magnifi cation of symptoms and signs
1896. Unconscious ascription of pain to a cause associated
      with potential gain

Answer 27

1892. Answer: A (1, 2, & 3 )
      Explanation:
      Malingering can be defi ned as the conscious alteration of
      health for gain. Malingering can manifest itself in a variety
      of ways.
      There may be: Pretension, in which no
      physical illness exists and the patient willfully fabricates
      symptoms and signs:
      Exaggeration, in which symptoms and signs are magnifi ed;
      Perseveration, which is a continuing complaint after the
      physical cause of the disability has ceased to exist; or
      Allegation, in which a true disability is present, but the
      patient fraudulently ascribes it to a cause associated with
      potential gain.
      Source: Kahn CH, DeSio JM. PreTest Self Assessment and Review. Pain Management. New York, McGraw-Hill, Inc.,
      1996.

Question 28

1893. Which of the following include opioid withdrawal signs
in the pregnant woman ?
1. Pupillary dilatation
2. Watery eyes
3. Runny nose
4. Piloerection

Answer 28

1893. Answer: E (All)
Explanation:
Opioid withdrawal signs in the pregnant women include
the following:
Pupillary dilatation
Lacrimation
Rhinorrhea
Piloerection
Nausea
Vomiting
Diarrhea
Abdominal cramps
Chills
Hot fl ashes
Myalgias
Arthralgias
Muscle cramps
Twitching
Yawning
Restlessness
Irritability
Insomnia

Question 29

1894. The following statements are some of the functions of a
      medical record.
1895. A medical record indicates quality of care
1896. Promotes continuity of care among physicians
1897. Provides clinical data for research
1898. Increases audit exposure and malpractice liability

Answer 29

1894. Answer: A (1, 2, & 3 )
Explanation:
A medical record serves the following functions and
provides benefi ts
1. Indicates quality of care
2. Promotes continuity of care among physicians
3. Provides clinical data for research
4. Reduces audit exposure
Other Functions:
Keeps practitioner out of prison
Supports “medical necessity”
Reduces medical errors & professional liability exposure
Facilitates claim review
Supports insurance billing
Provides clinical data for education

Question 30

1895. Select the accurate statements.
1896. A local nursing home, hires a consulting fi rm to put
      together a defense in an elder abuse case. An attorney
      engaged for this purpose would be considered a business
      associate and an agreement is required.
1897. Ambulatory Surgery Centers, Inc. discloses PHI to a
      health plan for payment purposes. A business associate
      agreement is not required.
1898. A medical malpractice insurer is given PHI by an insured to provide a malpractice risk assessment of a case. An
      attorney engaged for this purpose would be considered
      a business associate and an agreement is required.
1899. None of these entities are considered business associates.

Answer 30

1895. Answer: A (1, 2, & 3)
      Explanation:
1896. A local nursing home, hires a consulting fi rm to put
      together a defense in an elder abuse case. Yes, an attorney
      engaged for this purpose would be considered a business
      associate and an agreement is required.
1897. Ambulatory Surgery Centers, Inc. discloses PHI to a
      health plan for payment purposes. No, this disclosure is
      for the benefi t of the health plan, not the covered entity,
      and therefore a business associate agreement is not
      required.
1898. A medical malpractice insurer is given PHI by an
      insured to provide a malpractice risk assessment of a case.
      Yes, an attorney engaged for this purpose would be
      considered a business associate and an agreement is
      required.
1899. Entities described in 1 & 3 are considered business
      associates.

Question 31

1896. Which of the following are true regarding informed
      consent?
1897. Consent must be given freely
1898. The consent must be witnessed
1899. The person must be capable of giving consent
1900. The majority of states require consent forms

Answer 31

1896. Answer: A (1,2, & 3)
      Explanation:
      Most states do not require a consent form. What is
      required is informed consent.
      Source: Raj P, Practical Management of Pain, 3rd Ed.

Question 32

1897. The Oregon Death with Dignity Act requires which of
      the following before allowing a physician to write a
      prescription for a lethal medication?
1898. The patient is at least 18 and a resident of Oregon.
1899. The patient has decision-making capacity.
1900. The patient is terminally ill.
1901. The patient has to make two verbal requests to his/her
      physician separated by at least 15 days and then provide
      the request in writing.

Answer 32

1897. Answer: E (All)

Source: Weinberg M, Board Review 2004

Question 33

1898. The following statements are true about communication
      in end of life?
1899. Communication among health care professionals is key
      to successful delivery of health care to patients
1900. Emotional and psychological needs of dying patients is
      well proven
1901. Physicians tend to be overoptimistic is prognosticating
1902. Patients who are informed about their prognosis over
      the telephone or in the recovery room tend to be dissatisfied.

Answer 33

1898. Answer: E (All)

Source: Reddy Etal. Pain Practice: Dec 2001, march 2002

Question 34

1899. A physician practice that owns a Fluoroscopy unit leases
      it to a hospital on a per-procedure basis for patients
      referred by the practice. It is necessary for the lease to
      meet the following criteria:
1900. The payment per-unit is at fair market value at inception.
1901. The payment does not change during the lease term in
      any way that takes into account the volume or value of
      referrals among the parties.
1902. The payment does not take into account any other business,
      including private pay business, generated by the
      referring physician.
1903. The payment takes into consideration the number of
      patients referred to PhysicalTherapy in the hospital.

Answer 34

1899. Answer: A (1, 2, & 3)
      Explanation:
      An exception to the Stark Law permits certain time-based
      or unit-of-service-based payments, even when the
      physician receiving the payment has generated the
      payment
      through a designated health service (DHS) referral, as
      long as the individual payment for each unit refl ects FMV
      and does not change during the course of the agreement
      based on the level of referrals or other business
      generated.
      In order for an arrangement to satisfy the fair market value
      compensation exception to the Stark Law, the following
      conditions must be met:
      The agreement must be in writing, signed by the parties
      and cover only identifi able items or services.
      The items or services must be specifi ed, and the
      agreement must cover all items and services to be
      provided by the physician or family member to the
      entity, or refer to any other agreement for items or
      services between the parties.
      The agreement must specify the time frame for the
      arrangement, which can be for any period and contain a
      termination clause.
      The parties, however can enter into only one
      arrangement for the same items or services
      during the course of a year.
      An arrangement for more than one year can be renewed
      any number of times if the terms and compensation for
      the same items or services don’t change.
      The agreement must specify the compensation.
      The compensation or method for determining it must be
      set in advance, must be consistent with fair market value,
      and not determined in a manner that takes into account
      the volume or value of referrals or other business
      generated by the referring physician.
      The agreement must involve a transaction that is
      commercially reasonable and furthers the legitimate
      business purposes of the parties.
      The agreement must not violate the Anti-Kickback statute
      or any federal or state law or regulation Governing billing
      or claims submission
      The services to be performed under the arrangement must
      not involve the counselling or promotion of a business
      arrangement or other activity that violates a state or
      federallaw.

Question 35

1900. Use or disclosure of a patient’s protected health information
      (PHI) without the patient’s authorization is
      permitted for the following purposes:
1901. To treat the patient even though the patient is not having
      an emergency.
1902. To get payment from the patient’s insurance
1903. Research Activities.
1904. To perform certain administrative, fi nancial, legal, and
      quality improvement activities.

Answer 35

1900. Answer: E (All)
      Explanation:
      Providers may use or disclose a patient’s PHI without the
      patient’s authorization to treat the patient even though the
      patient is not having an emergency, to get payment from
      the patient’s insurance; or to perform certain
      administrative, fi nancial, legal, and quality improvement
      activities.
      To avoid interfering with an individual’s access to quality
      health care or the effi cient payment for such health care,
      the Privacy Rule permits a covered entity to use and disclose protected health information, with certain limits
      and protections, for treatment, payment, and health care
      operations activities.” Most administrative, fi nancial,
      legal, and quality improvement activities are considered to
      be health care operations
      Treatment’ generally means the provision, coordination, or
      management of health care and related services among
      health care providers or by a health care provider with a
      third party, consultation between health care providers
      regarding a patient, or the referral of a patient from one
      health care provider to another.
      Health care operations’ including administrative, fi nancial,
      legal, and quality improvement activities of a covered
      entity that are necessary to run its business and to support
      the core functions of treatment and payment
      Covered Entities may use or disclose PHI without patient
      authorization if the covered entity has fi rst obtained
      waiver from an IRB as long as the waiver complies with
      the specifi cations contained in the Privacy Rule

Question 36

1901. True statements with regards to non-compliance with
      Stark Law include the following scenario:
1902. Three hospitals set up separate corporations to establish
      a clinical laboratory, with each hospital contributing
      $100,000 capital, signing for debt on an equal basis,
      owning 1/3 equity and each referring all inpatients and
      outpatients to lab.
1903. A physician group sets up imaging center in a mall, with
      lease for space is based on % of revenue generated
1904. A hospital wants to lure a high referring physician. It offers
      to make her Chair of the medical staff if she admits
      all her patients to the hospital. The physician agrees
      and does so.
1905. A physician enters into contract with nursing home.
      This contract provides that for every patient referred,
      the physician receives a gift valued at $50, up to a maximum
      of 6 gifts per year

Answer 36

1901. Answer: C (2 & 4)
      Explanation:
1902. Stark applies only to physician referrals, not to referrals
      by hospitals.
1903. Assuming that Designated Health Services (DHS)
      patients will be referred, the “lease” exception would need
      to be met. This exception requires payments not to vary
      based upon referrals. However, under this example,
      payments would vary based on referrals.
1904. It might implicate the kickback law, but it would not
      violate Stark so long as the requirements of the personal
      services exception are met
      Payments are FMV
      Not based on referrals
      Written contract is for at least one year
      Bona fi de services are provided
1905. The exceptions to the Stark Law specifi cally require that
      payments not vary based upon referrals.

Question 37

1902. Choose the options that fi t the “medical staff incidental
      benefi ts” exception to the Stark Law.
1903. A hospital provides free, on-campus parking for physicians
      and staff while they are working at the hospital.
1904. A hospital provides free meals to physicians that see
      more than 10 patients a day.
1905. A hospital provides a doctor’s lounge, which is available
      to all members of the medical staff.
1906. A hospital wants to attract physicians by providing
      drinks and dinners once a week, at a cost of over $50
      per person.

Answer 37

1902. Answer: B (1 & 3)
      Explanation:
      There is an exception to the Stark Law for compensation
      in the form of items or services (not including cash or cash
      equivalents) from a hospital to a member of its medical
      staff when the item or service is used on the hospital’s
      campus, and all of the following conditions are met.
      The compensation is provided to all members of the
      medical staff practicing in the same specialty without
      regard to the volume or value of referrals or other
      business generated between the parties.
      Except with respect to identifi cation of medical staff on a
      hospital Web site or in hospital advertising, the
      compensation is provided only during periods when the
      medical staff members are making rounds or performing
      other duties that benefi t the hospital or its patients.
      The compensation is provided by the hospital and used by
      the medical staff members only on the hospital’s
      campus.The compensation is reasonably related to the
      provision of, or designated to facilitate directly or
      indirectly the delivery of, medical services at the hospital.
      The compensation is of low value (that is, less than $25)
      with respect to each occurrence of the benefi t (for
      example, each meal given to a physician while he or she
      is serving patients who are hospitalized must be of
      low value).
      The compensation is not determined in any matter that
      takes into account the volume or value of referrals or other
      business generated between the parties.
      The compensation arrangement does not violate the Antikickback
      Statute or any federal or state law or regulation
      governing billing or claims submission.

Question 38

1903. Records may be released:
1904. By a court order
1905. To patient’s family after death
1906. The patient
1907. The employer

Answer 38

1903. Answer: B (1 & 3)

Question 39

1904. True statements regarding confi dentiality of medical
      records include which of the following?
1905. The payer of worker’s compensation claims has rights to
      all records upon request.
1906. Any agent acting on behalf of the Centers for Medicare
      and Medicaid Services may have access at any time to
      medical records of patients reimbursed by Medicare.
1907. Private indemnity insurance companies must obtain
      express written consent from the patient prior to reviewing
      the medical record.
1908. Release of mental health records may require special
      consent even though they are integrated into the general
      medical record.

Answer 39

1904. Answer: E (All)
      Explanation:
1905. Worker’s compensation claimants must allow access to
      medical records any time they are requested by the payee.
1906. Agent(s) on behalf of the Centers for Medicare and
      Medicaid Services have access to medical records of any
      patient receiving Medicare benefi ts.
1907. Private insurers
      must ask the permission of the patient to view the medical
      records.
1908. Mental health records, even though they may
      be part of the medical record, may not be released without
      the specifi c consent of the patient in many states.
      It is important to clarify what laws are in effect regarding
      mental health records in your particular state. If specifi c
      consent is required, unauthorized release of mental health
      records may result in damages against the clinic or
      physician involved.
      Source: Anastasio J. Am Med Rec Assoc 1990; 61:52-61.
      Griffi th, Med Staff Couns 1991; 5:31-37.

Question 40

1905. Minors have limited privacy rights that must be weighed
      against their parents need to know health information
      to make an informed decision. When balancing these
      competing interests, consider:
1906. How will violating their privacy affect your future relationships
      with healthcare providers?
1907. Did they ask that their privacy be respected?
1908. Is there a possibility the child could be harmed if the
      parents are informed?
1909. Only the parent’s preferences

Answer 40

1905. Answer: A (1, 2, & 3)

Source: Weinberg M, Board Review 2004