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Health Care Delivery > C11- Healthcare Law > Flashcards

C11- Healthcare Law Flashcards

(48 cards)

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1
Q

How is common law created?

A

The judiciary system interpreting previous legal decisions regarding a case.

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2
Q

When legislature creates laws what is it called?

A

Statutes

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3
Q

Rules and regulations are created by?

A

Having both common law and statutes interpreted by administrative agencies

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4
Q

What does civil law focus on?

A

Wrongful acts against individuals and organizations based on contractual violations

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5
Q

What are torts?

A

Category of wrongful acts, in civil law, which may not have a preexisting contract

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6
Q

Criminal law is concerned with?

A

actions that are illegal based on court decisions. Ex-Medicaid and medicare fraud

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7
Q

Medical malpractice is?

A

improper or negligent treatment of a patient by a provider which results in injury, damage, or loss

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8
Q

To prove medical malpractice what must be shown?

A
  1. A professional duty owed to the patient
  2. Breech of such duty
  3. Injury caused by breech
  4. Resulting damages
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9
Q

Healthcare torts?

A

Negligence- intentional act of omission (withholding care) or Intentional torts- assault and battery of invasion of privacy (surgery without consent)

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10
Q

Defensive medicine happens when?

A

providers order more tests than necessary to protect themselves from lawsuits

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11
Q

Factors for increase in malpractice claims?

A

-Voluntary hospitals are no longer exempt from suits
-Employers have to take responsibility for employees
-informed consent concept has expanded

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12
Q

Standard of care is what type of standard?

A

State or national

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13
Q

Most common criminal violation in healthcare industry?

A

Healthcare fraud

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14
Q

How much money does the Medicare Fraud Strike Force recover for every $1 spent?

A

$4 (centerpiece is False Claims Act)

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15
Q

False Claims Act (FCA)/Lincoln law

A

1863, originally passed to protect the government against defense contractors during Civil War amended with a focus on healthcare fraud

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16
Q

3 ways a physician can establish a relationship with patient

A

-Contractual relationship: care for pop
-Express contract: patient under mutual agreement
-Implied contract: physician gives advice for treatment

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17
Q

Contractual relationship

A

Contractual right to admission: hospital contracted to treat
certain members of the org
(HMO or managed care contract)

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18
Q

If patient withdraws from provider?

A

they no longer are obliged to follow-up

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19
Q

Hill-Burton Act of 1946

A

Healthcare consumer law
Federal grants provided to states to ensure 4.5 beds per 1,000 people

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20
Q

Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986

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A

HC Consumer Law
Requires Medicare entities to provide ER care for a life-threatening condition if that entity provides dedicated ER services

21
Q

CHIP

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A

Provide coverage for low-income children whose family income exceeds Medicaid requirements

22
Q

Benefits Improvement and Protection Act of 2000 (BIPA)

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A

Added coverage for preventive and therapeutic services and increased federal funding to state programs

23
Q

Antitrust law

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A

protect consumer by ensuring market driven by competition

24
Q

Sherman Act of 1890

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A

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

25
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
26
Provider is responsible for discussing 3 things with patient for informed consent?
1. The diagnosis if it has been established 2. The nature of a proposed treatment or the operation, including the risks and benefits, any alternatives, and the risks and benefits of the alternatives 3. The risks and benefits of not agreeing to the procedure or treatment
27
Statutory consent
Presumes in medical emergency a reasonable person would consent to lifesaving procedure
28
2 legal standards constitute informed consent
Reasonable patient standards (information need's) and reasonable physician standards (given information)
29
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.
30
Patient Bill of Rights
states that the patient has the right to all information from his provider regarding any testing, diagnoses, and treatment
31
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)
32
Fraud Enforcement and Recovery Act of 2009 (FERA)
Further strengthens FCA -broader range of transactions -more stringent federal sentencing guidelines for HC fraud
33
Civil Rights Act, 1964
Punishment discrimination and sexual harassment
34
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
35
Age Discrimination in Employment Act
Protects 40 and older
36
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.
37
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.
38
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.
39
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
40
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
41
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.
42
Lilly Ledbetter Fair Pay Act of 2009 (FPA)
provides protection for unlawful employment practices related to compensation discrimination
43
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
44
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
45
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.
46
2020 Paycheck Protection Program and Health-care Enhancement Act
provided funding for hospitals, COVID-19 testing, and small businesses
47
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
48

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