Deck 3: Legal Issues

Question 1

A patient's family and friends may have access to a patient's personal health record under certain circumstances.

Answer 1

True

Question 2

incorrect imprisonments are admissions that occur against a patient's will.

Answer 2

False

Question 3

The Centers for Medicare and Medicaid Services (CMS) administer programs for the prevention and control of communicable and vector-borne diseases and other preventable conditions.

Answer 3

False

Question 4

The Commission on Accreditation of Rehabilitation Facilities (CARF) accredits programs and services in medical rehabilitation, assisted living, behavioral health, adult day care, and employment and community services.

Question 5

The plaintiff initiates the lawsuit; the defendant is the person sued by the plaintiff.

Question 6

Civil law is generally defined as that part of the law that includes criminal law.

Question 7

A health care facility publishes a newsletter that contains the number of patients served by geographic area. This a violation of HIPAA rules of privacy and confidentiality.

Question 8

The term "separation of powers" refers to the division of power between the different court systems.

Question 9

One of the main reasons for HIPAA regulations is to combat waste, fraud, and abuse.

Question 10

Health information records are the health care provider's legal document of patient care.

Question 11

Business associates as defined under the Privacy Rule would include health plans, health care clearinghouses, and health care providers.

Question 12

The Centers for Medicare and Medicaid Services (CMS) are located within the U.S. Department of Health and Human Services.

Question 13

One main reason for the discipline's complexity is the influence of external forces on health information management.

Question 14

Health information systems play a primary role in the delivery of health care.

Question 15

Laws may also be created by the legislative branches of federal and state governments; these are referred to as constitutional law.

Question 16

Record retention policies are the general principles determining the length of time that health records must be maintained by the health care provider.

Question 17

The protections afforded by the HIPAA administrative simplification provisions establish a floor of protections, allowing states and localities the ability to enact more stringent protections.

Question 18

The AOA is the most widely known accrediting body in health care.

Question 19

HIPAA regulations are still in the implementation phase. In 2008, the enforcement and penalty phase will begin.

Question 20

A health information manager may ignore a subpoena, but not a court order, if they determine it would be a breach of confidentiality.

Question 21

Assault refers to a threat that does not involve physical contact.

Question 22

A subpoena duces tecum is best defined as

A) A judge's ruling which authorizes disclosure that would otherwise be prohibited by statute and regulation.
B) A command issued by a court or other authorized official to appear and/or present certain documents and other items.
C) A command to produce books, documents, and other physical items.

Question 23

HIPPA is an acronym for which of the following?

A) Health Insurance Portability and Accountability Act
B) Health Information Portability and Accounting Action
C) Health Information Probability and Accountability Act
D) Health Insurance Potential and Achievement Act

Question 24

Medical abandonment claims are among the oldest intentional tort claims in the health care context.

Question 25

A patient requests to see his health care record. Which is the best answer as to the rights of the patient?

A) The patient's health care information falls within the sole province of the health care provider.
B) The patient must contact the DHHS to access this information.
C) The patient possesses the right of access to his own information.
D) The patient has limited rights to access his information as protected by the HIPAA Privacy Rule.

Question 26

Which of the following statements is most accurate regarding the use of electronic patient information?

A) HIPAA encourages the increased use of electronic patient information.
B) Recent regulations are making it increasingly difficult to increase the use of electronic patient information.
C) Lawsuits have increased with the use of electronic patient information.
D) The cost of electronic patient information systems do not appear to justify the increased cost.

Question 27

A patient is brought to the emergency room after crashing into a tree with his automobile. He is comatose. Which of the following statements best describe the protocol for treatment?

A) No treatment can be rendered until a family member signs a consent.
B) He can be declared incompetent due to the circumstances of the accident and treatment can be given.
C) There are special circumstances in this situation that allow for treatment to be given.
D) Advance directives must be reviewed prior to treatment to determine the patient's preferences for treatment.

Question 28

Which of the following statements is most accurate about filing an appeal?

A) Only a defendant can file an appeal.
B) It asks a higher court to review the activities in the trial court to determine if an error occurred.
C) Only a plaintiff can file an appeal.
D) It asks an administrative body to review the activities in the trial court to determine if an error occurred.

Question 29

Which of the following statements is the most accurate about the concepts of privacy and security?

A) Security is defined as the right to be left alone and the right to control personal information.
B) Privacy and security are two separate but related concepts.
C) Privacy and security are used interchangeably as no distinction is made between the concepts.
D) Privacy is defined as the obligation of the health care provider to maintain information in a manner that will not permit dissemination beyond the health care provider.
E) The concepts arose from the Hippocritical Oath.

Question 30

Which of the following statements are most accurate in regards to record retention policies?

A) Health record content must be retained for a minimum of 7 years.
B) Record retention policies can vary from state to state.
C) Accrediting bodies determine the final guidelines for record retention policies.
D) State regulatory bodies determine the final guidelines for record retention policies.

Question 31

A breach of contract involves the failure of the parties to a contract to perform according to the contract's terms.

Question 32

HIPPA provides DHHS with several layers of authority. Which of the following is part of this designated authority?

A) ability to specify the medical and administrative code sets
B) empowered to require use of national identification systems
C) may specify the types of measures required to protect the security and privacy of personally identifiable health information
D) a & b
E) a, b, & c

Question 33

Occupational Safety and Health Administration's (OSHA) purpose is to assure safe working conditions so that human resources are preserved.

Question 34

When a plaintiff is granted a money award, which is the most likely to occur as the next step?

A) file a discovery document
B) file a writ of execution
C) submit a deposition
D) schedule a pretrial conference

Question 35

A physician's brother owns and operates a local clinical laboratory and has asked his brother to help him out by referring patients to him when he orders lab work. Is this legal?

A) No, this is called physician self-referral.
B) Yes, this is called physician self-referral.
C) Yes, as long as the brother does not do the actual collection of the lab work.
D) No, as this violates the upcoding rules.

Question 36

Intentional torts refers to civil wrongs committed by persons who lack the intent to do something wrong.

Question 37

Which is the most accurate statement about the Privacy Rule and the Security Rule?

A) The Privacy Rule establishes the concept of protected health information.
B) The Privacy Rule and Security Rule are interchangeable terms.
C) They apply only to insured individuals.

Question 38

A patient is being scheduled for abdominal surgery. What type of consent would be required before the operation?

A) implied
B) informed
C) express

Question 39

Mr. Z., a hospitalized patient, refuses to follow Dr. Johnson's orders after surgery. Dr. Johnson informs the patient that she will no longer be his physician. Is there grounds for filing a lawsuit? If so, under which theory of liability?

A) No, there are no grounds for a legitimate lawsuit in this situation.
B) Yes, a lawsuit could be filed as an intentional tort called medical abandonment.
C) Yes, a lawsuit could be filed as a nonintentional tort called medical abandonment.
D) No, this comes under the JCAHO regulations and a claim could be filed with them for medical abandonment.

Question 40

Fraud and abuse are very prevalent in the United States. What percentage of the nation's annual health care expenses are attributable to fraudulent activities?

A) less that 5%
B) 15-20%
C) 25-30%
D) over 50%

Question 41

A durable medical equipment business offers to pay a physical a specified amount for each referral. What statute would be violated with this agreement?

A) safe harbor
B) physician self-referral
C) upcoding
D) antikickback

Question 42

What is commonly referred to as the process for authorizing?

A) Use and Disclosure
B) Release of Information
C) Access and disclosure of PHI
D) Confidentiality of PHI

Question 43

___________ prosecute(s) civil and criminal law violations and, through its Antitrust Division, oversees the mergers of health care entities.

A) Centers for Medicare and Medicaid Services
B) Department of Health and Human Services
C) Department of Justice

Question 44

Match the term with its definition.
judicial decisions that interpret relevant constitutional provisions, federal or state statutes, regulations and/or previous court decisions

A)constitutional law
B)statutory law
C)ordinances
D)administrative law
E)executive orders
F)common law

Question 45

A patient requests an accounting of disclosures made by the health care provider. The health care provider has ____________________ days to act upon the request.

Question 46

Match the term with its definition.
prescribed courses of action which arise from law, principle, or custom

A)law
B)regulations
C)rules
D)requirements
E)standards

Question 47

In 1976, what agency was created to help combat fraud and abuse?

A) Department of Health and Human Services
B) Office of Inspector General
C) Federal Bureau of Investigation
D) Defense Criminal Investigative Service

Question 48

Match the term with its definition.
principles established by authorities, prescribing or directing certain action or forbearance from action

A)law
B)regulations
C)rules
D)requirements
E)standards

Question 49

A program that ensures the use of effective internal controls to promote adherence to applicable local, state, and federal laws and regulations.

A) Compliance
B) Quality Assurance
C) Rules and Regulations

Question 50

An employee notices that upcoding is being done by her department. When she reports this to the appropriate authority, she would be called a(n) ____________________ ____________________.

Question 51

The knowing transfer or use, without lawful authority, of the identity of another person with the intent to commit, aid, or abet any unlawful activity that constitutes a violation of federal, state, or local law is known as ____________________ ____________________.

Question 52

Match the term with its definition.
criteria established as a basis for comparing matters such as quantity, quality, value, or weight

A)law
B)regulations
C)rules
D)requirements
E)standards

Question 53

Match the term with its definition.
considered necessary, obligatory, or demanded as a condition

A)law
B)regulations
C)rules
D)requirements
E)standards

Question 54

CIA stands for ____________________ ____________________ ____________________. It is a written agreement that specifies the rules of conduct to be followed to remedy the fraud and abuse found, plus any monitoring and reporting requirements.

Question 55

____________ are principles established by authorities prescribing or directing certain actions or forbearance from actions.

A) Standards
B) Regulations
C) Rules
D) Requirements

Question 56

___________recognizes that patients may wish to restrict the uses and disclosures of their PHI and allows them to do so at the time of receipt of the "Consent to the Use and Disclosure" document.

A) HIPAA Security Rule
B) Covered Entity Rule
C) HIPAA Privacy Rule
D) Protected Health Information Rule

Question 57

Match the term with its definition.
prescribed by the controlling authority, which has binding legal force

A)law
B)regulations
C)rules
D)requirements
E)standards

Question 58

__________ are criteria established as a basis for comparing matters such as quantity, quality, value, or weight.

A) Standards
B) Regulations
C) Rules
D) Requirements

Question 59

Which law enforcement agency(ies) is/are responsible for fraud and abuse investigations?

A) Office of Inspector General of DHHS
B) Postal Inspection Service
C) Federal Bureau of Investigation
D) Defense Critical Investigative Services
E) All of the above

Question 60

___________ refers to conflicts between the government and private parties or between two or more branches of government.

A) Private Law
B) Civil Law
C) Criminal Law
D) Public Law

Question 61

Match the term with its definition.
pattern of practices or customs which are unsound or inconsistent with ethical business, fiscal, or health care practices or customs

A)fraud
B)abuse
C)waste
D)upcoding
E)unbundling

Question 62

Match the program with its function.
encourages Medicare beneficiaries and others, including health care professionals, to report suspected cases of fraud and abuse

A)Healthcare Fraud and Abuse Control Program
B)Medicare Integrity Program
C)Beneficiary Incentive Program
D)Medicaid Fraud and Abuse National Initiative
E)Healthcare Fraud and Abuse Data Collection Program

Question 63

Match the term with its definition.
laws which arise from the actions of municipal bodies such as boards of aldermen and city councils

A)constitutional law
B)statutory law
C)ordinances
D)administrative law
E)executive orders
F)common law

Question 64

Match the term with its definition.
considered superior or supreme above laws arising from other sources

A)constitutional law
B)statutory law
C)ordinances
D)administrative law
E)executive orders
F)common law

Question 65

CMS (Centers for Medicare and Medicaid Services) has granted deeming authority to JCAHO. What does deeming authority mean?

Question 66

If the scenario given above, where a neighbor verbally threatens you, now escalates to the neighbor pushing you to the ground, which type(s) of laws (private, public, criminal, civil) are involved and why?

Question 67

A local health care facility reports that their costs have risen since they initiated the transition from paper to electronic patient information. HIPAA's administrative simplification effort was predicted to have an effect of decreasing costs. What would you infer from this information?

Question 68

Match the term with its definition.
issued by the chief executive at either the federal or state level and are used to interpret or implement a provision of a constitution or law

A)constitutional law
B)statutory law
C)ordinances
D)administrative law
E)executive orders
F)common law

Question 69

Match the term with its definition.
practice of submitting separate bills as a way to maximize reimbursement

A)fraud
B)abuse
C)waste
D)upcoding
E)unbundling

Question 70

Match the term with its definition.
intentional deception of another to that person's detriment

A)fraud
B)abuse
C)waste
D)upcoding
E)unbundling

Question 71

Match the program with its function.
designed to reduce payment errors and protect and strengthen the Medicare Trust Fund

A)Healthcare Fraud and Abuse Control Program
B)Medicare Integrity Program
C)Beneficiary Incentive Program
D)Medicaid Fraud and Abuse National Initiative
E)Healthcare Fraud and Abuse Data Collection Program

Question 72

Match the term with its definition.
submitting a billing code for a higher level of reimbursement than was actually rendered

A)fraud
B)abuse
C)waste
D)upcoding
E)unbundling

Question 73

Match the term with its definition.
laws created by the legislative branches of federal and state governments

A)constitutional law
B)statutory law
C)ordinances
D)administrative law
E)executive orders
F)common law

Question 74

List three examples of individual identifiers that are protected under HIPAA.

Question 75

Match the term with its definition.
decisions and regulations issued by government agencies, which are charged with interpreting statutory law

A)constitutional law
B)statutory law
C)ordinances
D)administrative law
E)executive orders
F)common law

Question 76

Match the program with its function.
operates jointly between the Department of Justice and the Office of Inspector General of DHHS

A)Healthcare Fraud and Abuse Control Program
B)Medicare Integrity Program
C)Beneficiary Incentive Program
D)Medicaid Fraud and Abuse National Initiative
E)Healthcare Fraud and Abuse Data Collection Program

Question 77

Match the program with its function.
creation of a national health care fraud and abuse database

A)Healthcare Fraud and Abuse Control Program
B)Medicare Integrity Program
C)Beneficiary Incentive Program
D)Medicaid Fraud and Abuse National Initiative
E)Healthcare Fraud and Abuse Data Collection Program

Question 78

You have a disagreement with your neighbor and the neighbor verbally threatens you. Is this an example of assault? Why or why not? Is this an example of battery? Why or why not?

Question 79

Match the term with its definition.
squandering of resources or use of resources without gain or advantage

A)fraud
B)abuse
C)waste
D)upcoding
E)unbundling

Question 80

Match the program with its function.
involves a partnership with the various state Medicaid agencies and their respective Attorney General offices

A)Healthcare Fraud and Abuse Control Program
B)Medicare Integrity Program
C)Beneficiary Incentive Program
D)Medicaid Fraud and Abuse National Initiative
E)Healthcare Fraud and Abuse Data Collection Program