Quiz #2: chapter 5 Flashcards
Criminal law
The body of statutory and common law that deals with crime and the legal punishment of criminal offenses.
Crime
Social harm defined and made punishable by law.
Misdemeanor
Offense punishable by less than 1 year in jail and/or fine.
Felony
Imprisonment in a state or federal prison for more than 1 year.
Objectives of criminal law
- maintain public order and safety
- protect individuals
- use punishment as a deterrent
- provide for criminal rehabilitation
Criminal procedure
- arrest
- complaints filed with court
- grand jury
- indictment
Arraignment
Formal reading of the accusatory instrument. Describes a variety of documents accusing a defendant of an offense. Setting of bail.
Pretrial conference
Meeting purposes of deliberation. Plea bargaining time. If no disposition reached, the case is set for trial.
Criminal trial
Consistent process consisting of several steps. Standard proof beyond a reasonable doubt. Requires unanimous jury decision. Types in healthcare.
Healthcare fraud
- false claims act
- anti-kickback statue
- ethics in patients referral act
- stark law
- HIPAA
Office of inspector general
- protect the integrity of HHS programs
- impose monetary penalties
- exclude providers from participation in Medicare and Medicaid programs.
Patient abuse
The mistreatment or neglect of individuals who are under the care of a healthcare organization. Takes many forms.
Criminal negligence
Reckless disregard for the safety of others.
Murder
Share common characteristics of setting, circumstance, and psychopathology. Detection is difficult.
Theft
- cost millions annually
- patient valuables
- staff valuables
- supplies
- medical equipment
Indictment
The official charging instrument accusing the defendant of criminal conduct.
Types of criminal trials in healthcare
- identity theft
- fraud
- falsification of records
- misuse and theft of drugs
- patient abuse
- murder
The false claims act of 1986
Prohibits knowingly presenting, or causing to be presented, to the government a false claim for payment; knowlingly making, using, or causing to be made or used a false record or statement to get a false claim paid or approved by the government; conspiring to defraud the government by getting a false claim allowed or paid; and knowingly making, using, or causing to be made or used a false record to avoid or decrease an obligation to pay or transmit property to the government.
Anti-kickback statute of 1987
Provides for criminal penalties for certain acts impacting Medicare and state healthcare reimbursable services and prohibits certain solicitations or receipt of remuneration. It penalizes anyone who knowlingly and willfully solicits, receives, offers, or pays anything of value as an inducement in return for: referring an individual to a person for the furnishing or arranging for the furnishing of any item or service payable under the Medicare or Medicaid programs; and purchasing, leasing, or ordering or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item payable under the Medicare or Medicaid programs.
Ethics in patient referral act of 1989
Prohibits physicians who have ownership interest or compensation arrangements with a clinical laboratory from referring Medicare patients to that laboratory and requires all Medicare providers to report the names and provider numbers of all physicians or their immediate relatives with ownership interests in a provider entity.
The health insurance portability and accountability act of 1996 (HIPAA)
Provides new criminal and civil enforcement tools and funding dedicated to the fight against healthcare fraud and a coordinated national framework for federal, state, and local law enforcement agencies; the private sector; and the public to fight healthcare fraud. It requires the U.S. attorney general and the U.S. secretary of the department of health and human services (DHHS), acting through the office of inspector general (OIG), to establish national healthcare fraud and abuse control program.
Forms of patient abuse
- physical
- psychological
- medical
- financial
