Part II: The Legal Environment Key Concepts & Practice Question Flashcards
What are the reasons that a physician’s license may be revoked?
(1) conviction of a crime,
(2) unprofessional conduct,
(3) personal or professional incapacity.
To order a non-narcotic prescription, what must a provider have?
(1) a state license
(2) a NPI
In what year did electronic prescribing methods begin appearing in clinics?
2004
The passage of which act led to an increase push for providers to adopt EMR’s
American Recovery and Reinvestment Act of 2009
Which part of medicare requires drug plans participating in the new prescription benefit to support electronic prescribing?
Medicare Part D
What type of drugs are on Schedule I of The Controlled Substances Act?
drugs of high potential for abuse and that have no currently accepted
medical use
drugs used by physicians only for purposes of research
What type of drugs are on Schedule II of The Controlled Substances Act?
drugs that have current accepted medical use in the United States, but with severe restrictions;
drugs that have a high potential of abuse that may lead to severe psychological or physical
dependence
drugs that require physicians to use a special order form
What type of drugs are on Schedule III of The Controlled Substances Act?
drugs that have less potential for abuse than substances in schedules I and II
drugs that have accepted medical use for treatment in the United States, but abuse may lead
to moderate or low physical dependence or high psychological dependence
What type of drugs are on Schedule IV of The Controlled Substances Act?
drugs that have a lower potential for abuse than those in schedule III
drugs that have accepted medical use in the United States, but their abuse still may lead to limited physical or
psychological dependence
What type of drugs are on Schedule V of The Controlled Substances Act?
drugs that have less potential for abuse than drugs in schedule IV and their abuse may be
limited to physical or psychological dependence
What is a script doctor?
A doctor who freely and excessively prescribes potentially dangerous drugs.
When was HIPAA passed by congress and when did it become effective?
Passed by congress (1996)
Effective (2003)
What are the 3 things that HIPAA requires?
(1) standardization of electronic client health data, administrative data, and financial data
(2) unique health identifiers for employees (NPIs);
(3) security standards to protect individually identifiable health information, past, present, or future
What does the “Privacy Rule” protect?
all individually identifiable health information, which is called protected health information (PHI).
Providers must provide clients with a notice of their privacy practices, which must include the right to:
- Restrict use of PHI
- Request confidential communication
- Inspect and obtain a copy of the PHI
- Request any amendment to the PHI
- Receive an accounting of PHI disclosures
When were Medicare and Medicaid both established?
1965
What is the purpose of The Healthcare Reform Act of 2010?
to make health care available to as many Americans as possible
What did the Affordable Care Act of 2010 require the Department of Health and Human Services to do?
issue new regulations to implement a new Patient Bill of Rights
What are the protections The Affordable Care Act and the new Patient Bill of Rights offer for consumers?
(1) No preexisting condition exclusions for children under age 19 years
(2) No arbitrary rescissions (cancellations) of insurance coverage
(3) No lifetime limits on coverage
(4) Restricted annual dollar limits on coverage
(5) Protection of the client’s choice of doctors
(6) Removal of insurance company barriers to emergency department services
What does “no pre existing conditions exclusions” mean?
health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition”
What is a lifetime limit?
the maximum dollar benefit an individual may receive under a health insurance policy or plan
What are annual dollar limits?
a dollar limit on their yearly spending for your covered benefits
What are the most common contracts in health-care?
Implied
What is an example of an implied contract?
a client complains of a sore throat and the provider does a throat culture to diagnose and treat the ailment
What are the 4 D’s of professional negligence?
Duty, Derelict, Direct cause, Damages
What does the Duty in professional negligence mean?
Duty exists when the provider–client relationship has been established.
What does the Derelict in professional negligence mean?
The client must prove that the provider failed to comply with the standards required and dictated by the profession
What does the Direct cause in professional negligence mean?
implies that any damage or injuries that resulted from the provider’s breach of duty were directly related to that breach and no other acts or circumstances could have caused the problem
What does the Damage cause in professional negligence mean?
compensation provided for injuries suffered by the client
What type of compensation is most common in medical professional liability cases?
monetary
What can monetary compensation include?
be actual/ compensatory damages
exemplary/ punitive damages.
What are actual or compensatory damages?
damages that compensate the client for injuries sustained and nothing more.
These include past medical care, loss of wages, and future medical care
What are Exemplary or punitive damages?
compensation that punishes the defendant and awards the client for pain, suffering, and mental anguish
What does the doctrine of res ipsa loquitor mean?
the thing speaks for itself or obvious negligence
What does the doctrine of res ipsa loquitor relate to in healthcare?
cases of foreign bodies being left in clients, instruments slipping during surgical procedures, burns from heating modalities, and injury to a portion of the client’s body outside the field of treatment.
What does the doctrine of respondeat superior mean?
let the master answer
What does the doctrine of respondeat superior relate to in healthcare?
Physicians and providers are responsible for the negligent actions of their employees
When does vicarious liability occur?
When the doctrine of respondeat superior may extend to a hospital or HMO that employs providers and their assistants, thus making the institution liable for negligent acts of their employees or agents even if the organization was not at fault in any way.
What are the 6 things good insurance policies have?
(1) what the insurer will pay,
(2) effective policy dates,
(3) the power of the insurer in obtaining legal counsel,
(4) the power of the insurer in seeking a settlement,
(5) what costs are covered,
(6) how payment is to be made.
What should the professional liability insurance policy specify?
monetary limits for each claim
How can physicians reduce the cost of professional liability insurance?
By limiting their practice and refusing to perform certain surgeries or procedures
What is the difference between arbitration and mediation?
In mediation, there is no third party
What does The Office of the Inspector General (OIG) suggests that a medical practice’s focus is on?
quality client care is enhanced with the adoption of a voluntary compliance program.
What does a good OIG compliance program have?
(1) written policies, procedures, and standards for major areas of the clinic/practice
(2) the name of a compliance officer to monitor and enforce the compliance plan
(3) open lines of communication so that employees feel comfortable reporting any unsafe activities
What is whistle blowing?
When an employee reports any unsafe or illegal acts/ conditions at their workplace
What takes precedence over the constitutional law?
The Constitution, federal law, and treaties
What has the highest judicial authority?
The Constitution
Where did Common law emerge from?
customs, the ways things were done over time in England and in France.
What are some other names for common law?
judge-made law or case law
What is common law?
a body of law based on judicial decisions that attempts to apply general principles to specific situations
What are the similarities and differences between statutory and common law?
they have the same force however, common law is not enacted by the legislature
Who enacts statutory law?
Congressional and state legislative bodies
What are publications containing statues called?
codes
What is another name for statutory law?
legislative law
What is an example of statutory law relating to healthcare?
medical practice act
What is the purpose of the Medical Practice Act?
it defines and outlines the practice of medicine in a given state.
If there is a conflict between a federal and state law, what mandates that the federal governs?
The Constitution
What is the type of statutory law gives administrative agencies the power to enact regulations that also have the force of law.?
Administrative Law
What are some examples of Administrative Law?
Workers’ compensation boards, Medicare, Medicaid, and licensing and accrediting bodies
What does probate law oversee?
the distribution of a person’s estate upon death
What do small claim’s courts allow?
the provider or the provider’s representative to file action against a client for an unpaid or delinquent account
What year did Congress pass NCVIA?
1986
What is the purpose of the NCVIA?
to address concerns about vaccine supply, safety, liability & to create the National Vaccine Injury Compensation Program (NVICP)
What is the purpose of the NCVIP?
to compensate those injured by vaccine on a no-fault basis
What are the parts in the trial procedure in order?
1) Jury is selected
2) Arraignment
3) Opening statements
4) Direct examination
5) Cross examination
6) Deliberation
7) Verdict
What happens during direct examination?
When the plaintiff’s attorney begins examining the defendant
What happens during cross examination?
The defendant’s attorney answers questions
In a criminal case what must the state prove?
That the defendant is guilty beyond a reasonable doubt
In a civil case what must the plaintiff prove?
That the defendant is guilty due to a preponderance of evidence
When did the CDC assume responsibility for the collection and publication of data concerning nationally notifiable diseases?
1961
When did Edward Jenner develop the smallpox vaccine?
1790
What must each parent receive before their child can be vaccinated?
Vaccine Information Statement (VSI)
What does a VSI contain?
Who & who shouldn't get the vaccine Vaccine description Risks What to do in case of severe reaction National Vaccine Injury Compensation phone number and website
What are providers who administer vaccines required by law to record in each persons health record?
Type of vaccine Date the vaccine was given Dose/Route/Site Manufacturer and lot number of vaccine Vaccine administrators initials
Why was the vaccine injury table created?
To identify those injured by vaccines and due compensation
What is it called when evidence is gathered prior to a trial?
Discovery
