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Seminar II > Professional Issues In Physical Therapy > Flashcards

Professional Issues In Physical Therapy Flashcards

1
Q

What is a statute?

A

Formal written enactment of a legislative authority
that governs a country, state, city, or county which , typically commands or prohibits something, or
declares policy; supported by a written rule or regulation

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2
Q

Who enacts statutes?

A

Governing bodies (Congress or a state legislature) enact statues.

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3
Q

True or false; only the federal government can enact a statute

A

False- so can state

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4
Q

Who makes regulations?

A

Developed by government agencies

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5
Q

What is a regulation?

A

● a rule controlling the practices of individuals or organizations under the authority of the agency

● supports, clarifies, and further defines the terms of a statute and/or develops procedures for the agency

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6
Q

True or false- IRS, OSHA, and FDA are examples of statutes

A

False- regulations

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7
Q

True or false- The New York State Education Department is operated at the state level

A

True

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8
Q

__________ is Developed through decisions of courts or judges (called case law), rather than through legislative statutes or executive action

A

Common law

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9
Q

Negligence is governed by _____________.

A

common law

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10
Q

True or false- In a civil law case, if convicted, the defendant may only pay monetary damages to the plaintiff.

A

True

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11
Q

Most common grounds for civil action are ____________ and ____________.

A

negligence and malpractice

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12
Q

True or False; in criminal law, litigation of criminal statutes are filed by the plaintiff.

A

False- it is always filed by the government

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13
Q

What is negligence?

A

Failure to act in a reasonable and prudent manner

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14
Q

What is malpractice?

A

A special type of negligence, that is, the failure of a professional, a person with specialized education and training, to act in a reasonable and prudent manner.

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15
Q

What is criminal negligence?

A

Act is deemed so reckless that the action results in serious injury or death to the patient

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16
Q

What is gross negligence?

A

Reckless act that reflects a conscious disregard for the patient’s welfare. May be putative damages awarded.

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17
Q

Negligence and medical malpractice falls

under the law of ______

A

Torts

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18
Q

What does Tort law define?

A

Tort law defines what constitutes a legal

injury and establishes the circumstances under which one person may be held liable for another’s injury

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19
Q

What are the four elements of negligence?

A
  1. DUTY OWED: Owed a duty of care to the patient
    (a legal obligation imposed on an individual requiring that they adhere to a reasonable standard of care while performing any acts that could foreseeably harm others).
  2. DUTY VIOLATED: breach of duty (i.e., did not meet the
    circumstances as compared to what another practitioner would do)
  3. CAUSATION: this breach caused an injury
  4. COMPENSABLE DAMAGES
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20
Q

What is the difference between negligence and malpractice?

A

Intent

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21
Q

What is beneficence?

A

● actions that promote the well-being of others.
● placing the patient in a protective environment, in the
belief that the patient is compromised and cannot act in his own best interest at the moment.
● At times, the concept of autonomy and beneficence conflict .

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22
Q

What is non-malifecence?

A

it is more important not to harm your patient, than to

do them good.

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23
Q

What is professional misconduct?

A

Failure of a licensed professional to meet expected standards of practice

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24
Q

What happens if you’re convicted of professional misconduct?

A

● Fine (up to $10,000 for each violation)
● Reprimand (by OP or Board of Regents)
● Required remedial professional education
● Probation, suspension or revocation of license

25
Q

What do you call: The study of the general nature of morals and of the specific moral choices to be made by a person; moral philosophy.

A

Ethics

26
Q

What do you call: principles of right and wrong as they govern standards of general, professional, or other types of behaviors?

A

Morals

27
Q

Rank these by their difficulty to solve: Issue, Problem, Dilemma

A

Dilemma- decision making for a pt with terminal cancer

Issue- politics

Problem- blackboard isnt working

28
Q

What are the elements of an ethical issue?

A

Agent/ actor

Conduct

Effect/consequence

29
Q

True or false; the most ethical solution is always the best legal solution

A

False

30
Q

Fraud, abuse, and waste results in…

A

● Overutilization of services Increased costs for payers
● Corruption of medical decision making
● Unfair competition
● Harm to patient

31
Q

What is abuse?

A

Abuse is an act conducted where a provider is not entitled to and for which the provider has not intentionally misrepresented facts to obtain payment

32
Q

Fraud, abuse or waste?

Billing services that are not medically necessary

A

Abuse

33
Q

Fraud, abuse or waste?

Unbundling services and billing

A

Abuse

34
Q

Fraud, abuse, or waste?

Billing services that do not meet professionally recognized standards

A

Abuse

35
Q

What is fraud?

A

intentional deception or misrepresentation that a person makes to gain a benefit to which they are not entitled

36
Q

Fraud, abuse or waste?

Knowingly billing for services not furnished

A

Fraud

37
Q

Fraud, abuse, or waste?

Knowingly altering claims forms to receive more
payment

A

Fraud

38
Q

Fraud, abuse, or waste?

Falsifying documentation

A

Fraud

39
Q

What is waste?

A

incurring unnecessary costs as a result of deficient management practices, systems, or controls

40
Q

Fraud, abuse, or waste?

Duplication of services already provided elsewhere

A

Waste

41
Q

Fraud, abuse, or waste?

Spending on services that lack evidence of producing
better outcomes compared with less- expensive alternatives

A

Waste

42
Q

What is the False Claims Act?

A

Prohibits the knowing submission of false claims
or the use of a false record or statement for
payment to Medicare or Medicaid

43
Q

What is the possible outcome of being charged under the False Claims Act?

A

● Monetary penalties of between $5,500 and $11,000 per claim, plus 3 times the damages sustained by
the government

● License sanctions and exclusion from federal Program

44
Q

Whistle blowers can receive up to ____% of what the government takes back for violations of the False Claims Act.

A

30%

45
Q

What is the Anti-kickback Statue?

A

Prohibits anyone from “knowingly and willfully”
offering or receiving a form of payment in return for
referring a patient to another provider for services or
items covered by Medicare and Medicaid

46
Q

What are the penalties under the Anti-Kickback Statue?

A

prison sentences, fines, and penalties up to $50,000 per kickback and 3 times the amount of the remuneration.

47
Q

What is another name for the Physician Self- referral law?

A

Stark law

48
Q

What is the Physician Self- referral law?

A

Prohibits physician referrals for certain
health care services (eg, physical therapy) when there is a financial relationship with an entity unless an exception applies.

49
Q

What are the penalties for violation of the Stark law?

A

● The government has the authority to exclude providers from participation in federal health care programs, such as Medicare and Medicaid.

● Excluded providers may not bill for treating patients, and their employers may not bill for their services.

50
Q

When the federal government pays for services for Medicare and Medicaid beneficiaries, federal
_______ and ______ laws apply

A

Fraud and abuse

51
Q

What is the most common problem Medicare finds with documentation?

A

Missing or incomplete plan of care

52
Q

True or false; small gifts to patients are legal.

A

True

53
Q

True or false; Providing free services to patients or waiving coinsurance and deductibles is generally prohibited as it may influence a patient to receive your services

A

True

54
Q

What is the exception to the prohibition of waving coinsurance and deductibles for patients?

A

There is an exception for financially needy patients

55
Q

True or false; A PT may collect out-of-pocket payment from a Medicare beneficiary for a service that Medicare would cover

A

False

56
Q

What kind of penalties may a practitioner face if the federal trade commission issues a cease-and-desist order, prohibiting further use of the ad and may require correction and the practitioner keeps advertising?

A

Civil (cash) penalties

57
Q

True or false; The Americans with Disabilities Act requires employers to make any necessary modifications, as needed, to their policies, practices, and procedures to accommodate persons with disabilities

A

False; reasonable modifications

58
Q

Under federal law, unwelcome sexual advances, sexual favors, or other verbal or physical conduct
of a sexual nature constitute harassment when…

A

● submission is an implied or overt requirement to continued employment or advancement

● or it has the purpose or effect of unreasonably interfering with work performance or creating an intimidating, hostile, or offensive working environment

59
Q

What are the factors of sexual harassment?

A

● Psychological harm or injury
● Frequency and severity of harassment
● Conduct is physically threatening, humiliating or merely offensive
● Interferes with work performance

Seminar II (4 decks)

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