ASIPP Ethics Questions Flashcards
1
Q
- 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
A
- Answer: B
2
Q
- 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)
A
- 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
3
Q
- 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
A
- Answer: D
4
Q
- 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.
A
- Answer: B
5
Q
- 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.
A
- 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.
6
Q
- 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
A
- Answer: D
Source: Raj, Pain Review 2nd Edition
7
Q
- 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.
A
- Answer: E
Source: Weinberg M, Board Review 2004
8
Q
- 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.
A
- Answer: E
Source: Weinberg M, Board Review 2004
9
Q
- 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
A
- 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
10
Q
- 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
A
- Answer: A
Source: Raj, Pain Review 2nd Edition
11
Q
- 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
A
- 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
12
Q
- 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
A
- Answer: B
Source: Weinberg M, Board Review 2004
13
Q
- 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
A
- Answer: C
Source: Weinberg M, Board Review 2004
14
Q
- 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.
A
- Answer: E
Source: Weinberg M, Board Review 2004
15
Q
- 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
A
- Answer: A
16
Q
- 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
A
- Answer: D
Source: Weinberg M, Board Review 2004
17
Q
- 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
A
- Answer: C
Source: Raj, Pain Review 2nd Edition
18
Q
- 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
A
- Answer: C
Source: Weinberg M, Board Review 2004
19
Q
- 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
A
- Answer: A
Source: Weinberg M, Board Review 2004
20
Q
- 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.
A
- 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.
21
Q
- 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
A
- Answer: B
Source: Raj, Pain Review 2nd Edition
22
Q
1887. Other than the Netherlands, Physician Assisted Suicide (PAS) is legally permitted in: 1. Switzerland 2. Belgium 3. Germany 4. Oregon
A
- Answer: E (All)
Source: Weinberg M, Board Review 2004
23
Q
- True statements regarding participation in a clinical or
research study include: - 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. - It is not necessary to enter into a business associate
agreement with the company performing the research
to sign on as an investigator. - 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. - 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.
A
- Answer: C (2 & 4)
Explanation: - 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. - 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. - 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. - 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.
24
Q
- Some of the communication issues faced by health care providers in terminal patients include?
- Diagnosis and prognosis
- Advanced directives and do-not-resuscitate(DNR)
orders - Spiritual needs
- Symptom Management
A
- Answer: E (All)
Source: Reddy Etal. Pain Practice: Dec 2001, march 2002
25
Q
- Contents of an informed consent include:
- Risk complication and option and potential benefi ts of
described treatment. - A signature from the patient, family member, or power
of attorney that is designated by the patient to sign on
their behalf. - Invalid if incompetent or intellectually/medically impaired
patient’s sign. - Valid if the patient signs while sedated as long as they
were aware of the consent prior to sedation.
A
- Answer: A (1, 2, & 3)
26
Q
- General consent
- Allows the physician or surgeon to operate in the
patient’s best interest. - Is utilized in emergency situations.
- Is utilized as family members or designated individuals
when necessary to proceed in the patient’s best
interest. - Is the same as a written consent.
A
- Answer: A (1, 2, & 3)
27
Q
- The term malingering may be used to describe the following
situations: - Fabrication of symptoms and signs
- Continuing complaint of disability after the physical
cause has ceased to exist - Magnifi cation of symptoms and signs
- Unconscious ascription of pain to a cause associated
with potential gain
A
- 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.
28
Q
1893. Which of the following include opioid withdrawal signs in the pregnant woman ? 1. Pupillary dilatation 2. Watery eyes 3. Runny nose 4. Piloerection
A
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
29
Q
- The following statements are some of the functions of a
medical record. - A medical record indicates quality of care
- Promotes continuity of care among physicians
- Provides clinical data for research
- Increases audit exposure and malpractice liability
A
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
30
Q
- Select the accurate statements.
- 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. - Ambulatory Surgery Centers, Inc. discloses PHI to a
health plan for payment purposes. A business associate
agreement is not required. - 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. - None of these entities are considered business associates.
A
- Answer: A (1, 2, & 3)
Explanation: - 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. - 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. - 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. - Entities described in 1 & 3 are considered business
associates.
31
Q
- Which of the following are true regarding informed
consent? - Consent must be given freely
- The consent must be witnessed
- The person must be capable of giving consent
- The majority of states require consent forms
A
- 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.
32
Q
- The Oregon Death with Dignity Act requires which of
the following before allowing a physician to write a
prescription for a lethal medication? - The patient is at least 18 and a resident of Oregon.
- The patient has decision-making capacity.
- The patient is terminally ill.
- 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.
A
- Answer: E (All)
Source: Weinberg M, Board Review 2004
33
Q
- The following statements are true about communication
in end of life? - Communication among health care professionals is key
to successful delivery of health care to patients - Emotional and psychological needs of dying patients is
well proven - Physicians tend to be overoptimistic is prognosticating
- Patients who are informed about their prognosis over
the telephone or in the recovery room tend to be dissatisfied.
A
- Answer: E (All)
Source: Reddy Etal. Pain Practice: Dec 2001, march 2002
34
Q
- 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: - The payment per-unit is at fair market value at inception.
- 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. - The payment does not take into account any other business,
including private pay business, generated by the
referring physician. - The payment takes into consideration the number of
patients referred to PhysicalTherapy in the hospital.
A
- 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.
35
Q
- Use or disclosure of a patient’s protected health information
(PHI) without the patient’s authorization is
permitted for the following purposes: - To treat the patient even though the patient is not having
an emergency. - To get payment from the patient’s insurance
- Research Activities.
- To perform certain administrative, fi nancial, legal, and
quality improvement activities.
A
- 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
36
Q
- True statements with regards to non-compliance with
Stark Law include the following scenario: - 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. - A physician group sets up imaging center in a mall, with
lease for space is based on % of revenue generated - 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. - 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
A
- Answer: C (2 & 4)
Explanation: - Stark applies only to physician referrals, not to referrals
by hospitals. - 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. - 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 - The exceptions to the Stark Law specifi cally require that
payments not vary based upon referrals.
37
Q
- Choose the options that fi t the “medical staff incidental
benefi ts” exception to the Stark Law. - A hospital provides free, on-campus parking for physicians
and staff while they are working at the hospital. - A hospital provides free meals to physicians that see
more than 10 patients a day. - A hospital provides a doctor’s lounge, which is available
to all members of the medical staff. - A hospital wants to attract physicians by providing
drinks and dinners once a week, at a cost of over $50
per person.
A
- 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.
38
Q
- Records may be released:
- By a court order
- To patient’s family after death
- The patient
- The employer
A
- Answer: B (1 & 3)
39
Q
- True statements regarding confi dentiality of medical
records include which of the following? - The payer of worker’s compensation claims has rights to
all records upon request. - 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. - Private indemnity insurance companies must obtain
express written consent from the patient prior to reviewing
the medical record. - Release of mental health records may require special
consent even though they are integrated into the general
medical record.
A
- Answer: E (All)
Explanation: - Worker’s compensation claimants must allow access to
medical records any time they are requested by the payee. - Agent(s) on behalf of the Centers for Medicare and
Medicaid Services have access to medical records of any
patient receiving Medicare benefi ts. - Private insurers
must ask the permission of the patient to view the medical
records. - 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.
40
Q
- 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: - How will violating their privacy affect your future relationships
with healthcare providers? - Did they ask that their privacy be respected?
- Is there a possibility the child could be harmed if the
parents are informed? - Only the parent’s preferences
A
- Answer: A (1, 2, & 3)
Source: Weinberg M, Board Review 2004
