C11- Healthcare Law Flashcards
How is common law created?
The judiciary system interpreting previous legal decisions regarding a case.
When legislature creates laws what is it called?
Statutes
Rules and regulations are created by?
Having both common law and statutes interpreted by administrative agencies
What does civil law focus on?
Wrongful acts against individuals and organizations based on contractual violations
What are torts?
Category of wrongful acts, in civil law, which may not have a preexisting contract
Criminal law is concerned with?
actions that are illegal based on court decisions. Ex-Medicaid and medicare fraud
Medical malpractice is?
improper or negligent treatment of a patient by a provider which results in injury, damage, or loss
To prove medical malpractice what must be shown?
- A professional duty owed to the patient
- Breech of such duty
- Injury caused by breech
- Resulting damages
Healthcare torts?
Negligence- intentional act of omission (withholding care) or Intentional torts- assault and battery of invasion of privacy (surgery without consent)
Defensive medicine happens when?
providers order more tests than necessary to protect themselves from lawsuits
Factors for increase in malpractice claims?
-Voluntary hospitals are no longer exempt from suits
-Employers have to take responsibility for employees
-informed consent concept has expanded
Standard of care is what type of standard?
State or national
Most common criminal violation in healthcare industry?
Healthcare fraud
How much money does the Medicare Fraud Strike Force recover for every $1 spent?
$4 (centerpiece is False Claims Act)
False Claims Act (FCA)/Lincoln law
1863, originally passed to protect the government against defense contractors during Civil War amended with a focus on healthcare fraud
3 ways a physician can establish a relationship with patient
-Contractual relationship: care for pop
-Express contract: patient under mutual agreement
-Implied contract: physician gives advice for treatment
Contractual relationship
Contractual right to admission: hospital contracted to treat
certain members of the org
(HMO or managed care contract)
If patient withdraws from provider?
they no longer are obliged to follow-up
Hill-Burton Act of 1946
Healthcare consumer law
Federal grants provided to states to ensure 4.5 beds per 1,000 people
Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986
HC Consumer Law
Requires Medicare entities to provide ER care for a life-threatening condition if that entity provides dedicated ER services
CHIP
Provide coverage for low-income children whose family income exceeds Medicaid requirements
Benefits Improvement and Protection Act of 2000 (BIPA)
Added coverage for preventive and therapeutic services and increased federal funding to state programs
Antitrust law
protect consumer by ensuring market driven by competition
Sherman Act of 1890
prohibits monopolies market division (fixing who offers what), tying (only one product if you buy another), boycotts (HC refusing to deal with outside of group), and targets price fixing among competitors
Clayton Act
Restrictions on hospital mergers (Hart-Scott-Rodino Antitrust Improvement Act 1976, amendment mergers must notify DOJ and FTC before final decision) and acquisitions also allows individuals to sue 3x actual damages+legal costs
Provider is responsible for discussing 3 things with patient for informed consent?
- The diagnosis if it has been established
- The nature of a proposed treatment or
the operation, including the risks and benefits,
any alternatives, and the risks and benefits
of the alternatives - The risks and benefits of not agreeing to the
procedure or treatment
Statutory consent
Presumes in medical emergency a reasonable person would consent to lifesaving procedure
2 legal standards constitute informed consent
Reasonable patient standards (information need’s) and reasonable physician standards (given information)
Patient Self-Determination Act of 1990
requires hospitals, nursing homes, home
health providers, hospices, and managed care
organizations that provide services to
Medicare- and Medicaid-eligible patients to
supply information on patient rights to patients
upon admission.
Patient Bill of Rights
states that the patient
has the right to all information from his provider
regarding any testing, diagnoses, and treatment
False Claims Act of 1995
imposes
criminal penalties on anyone who tries to
present fictitious claims for payment to the
the federal government (incentive whistleblowers)
Fraud Enforcement and Recovery Act of 2009 (FERA)
Further strengthens FCA
-broader range of transactions
-more stringent federal sentencing guidelines for HC fraud
Civil Rights Act, 1964
Punishment discrimination and sexual harassment
Civil Rights Act, 1991
This act enables individuals to
receive both punitive damages, which are damages
that punish the defendant, and compensatory
damages for financial or psychological harm.
-amendment prohibits diversity quotas
Age Discrimination in Employment Act
Protects 40 and older
Affirmative action plan
outlines the
employer’s standard on recruitment and hiring to
increase the diversity of the company’s
workforce. Plan is created to correct past
discrimination in a company.
ADA- essential functions versus reasonable accommodation
Essential functions: are job duties that must
be performed to be a satisfactory employee
Reasonable accommodation: refers to
employers that take reasonable action to
accommodate a disabled individual, such as
providing special computer equipment or
furniture to accommodate a physical
limitation. The reasonable accommodation
should not cause undue financial hardship
to the employer.
Employee Retirement Income Security
Act of 1974 (ERISA)
It protects employees because it forbids
employers from firing an employee so that
they cannot collect under their medical
coverage.
Consolidated Omnibus Budget
Reconciliation Act of 1986 (COBRA)
an
amendment to ERISA, was passed to protect
employees who lost or changed employers so
they could keep their health insurance if they
paid 102% of the full premium.
-prevented job lock because of fear
Health Information Technology for
Economic and Clinical Health Act of 2009
this act
amends HIPAA by requiring stricter notification
protocols for breach of any patient information.
-applies HIPAA to any health plan associates
Family Medical Leave Act of 1993
(FMLA)
requires employers with 50 or
more employees within a 75-mile radius
who work more than 25 hours per week
and who have been employed more than 1
year to provide up to 12 work weeks of
unpaid leave, during any 12-month period,
for employees to provide care for a family
member or themselves.
Lilly Ledbetter Fair Pay Act of 2009
(FPA)
provides protection for
unlawful employment practices related to
compensation discrimination
Equal Employment Opportunity Commission (EEOC)
An individual who thinks they are being discriminated against can file with EEOC. Attempts to use conciliation or negotiation to resolve before the court. 100 or more employees employers must file report. provides discrimination education
Families First Coronavirus Response Act
This
law responded to the growing health and
economic crises with provisions for paid sick
leave, free testing, and expanded
unemployment benefits
The Corona Virus Aid, Relief, and Economic
Security (CARES) Act
The $2.2 trillion
economic package focused on the healthcare
industry, employers, and telehealth services.
2020 Paycheck Protection Program and
Health-care Enhancement Act
provided
funding for hospitals, COVID-19 testing, and
small businesses
2021 American Rescue Plan
Funds targeted to homelessness, state and local
governments, enhanced tax credits, unemployment
benefits, COVID-19 testing, contact tracing, and
school support
