Professional Issues In Physical Therapy

Question 1

What is a statute?

Answer 1

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

Question 2

Who enacts statutes?

Answer 2

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

Question 3

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

Answer 3

False- so can state

Question 4

Who makes regulations?

Answer 4

Developed by government agencies

Question 5

What is a regulation?

Answer 5

● 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

Question 6

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

Answer 6

False- regulations

Question 7

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

Answer 7

True

Question 8

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

Answer 8

Common law

Question 9

Negligence is governed by _____________.

Answer 9

common law

Question 10

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

Answer 10

True

Question 11

Most common grounds for civil action are ____________ and ____________.

Answer 11

negligence and malpractice

Question 12

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

Answer 12

False- it is always filed by the government

Question 13

What is negligence?

Answer 13

Failure to act in a reasonable and prudent manner

Question 14

What is malpractice?

Answer 14

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.

Question 15

What is criminal negligence?

Answer 15

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

Question 16

What is gross negligence?

Answer 16

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

Question 17

Negligence and medical malpractice falls

under the law of ______

Answer 17

Torts

Question 18

What does Tort law define?

Answer 18

Tort law defines what constitutes a legal

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

Question 19

What are the four elements of negligence?

Answer 19

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

Question 20

What is the difference between negligence and malpractice?

Answer 20

Intent

Question 21

What is beneficence?

Answer 21

● 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 .

Question 22

What is non-malifecence?

Answer 22

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

do them good.

Question 23

What is professional misconduct?

Answer 23

Failure of a licensed professional to meet expected standards of practice

Question 24

What happens if you’re convicted of professional misconduct?

Answer 24

● 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

Question 25

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.

Answer 25

Ethics

Question 26

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

Answer 26

Morals

Question 27

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

Answer 27

Dilemma- decision making for a pt with terminal cancer Issue- politics Problem- blackboard isnt working

Question 28

What are the elements of an ethical issue?

Answer 28

Agent/ actor Conduct Effect/consequence

Question 29

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

Answer 29

False

Question 30

Fraud, abuse, and waste results in...

Answer 30

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

Question 31

What is abuse?

Answer 31

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

Question 32

Fraud, abuse or waste? Billing services that are not medically necessary

Answer 32

Abuse

Question 33

Fraud, abuse or waste? Unbundling services and billing

Answer 33

Abuse

Question 34

Fraud, abuse, or waste? Billing services that do not meet professionally recognized standards

Answer 34

Abuse

Question 35

What is fraud?

Answer 35

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

Question 36

Fraud, abuse or waste? Knowingly billing for services not furnished

Answer 36

Fraud

Question 37

Fraud, abuse, or waste? Knowingly altering claims forms to receive more payment

Answer 37

Fraud

Question 38

Fraud, abuse, or waste? Falsifying documentation

Answer 38

Fraud

Question 39

What is waste?

Answer 39

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

Question 40

Fraud, abuse, or waste? Duplication of services already provided elsewhere

Answer 40

Waste

Question 41

Fraud, abuse, or waste? Spending on services that lack evidence of producing better outcomes compared with less- expensive alternatives

Answer 41

Waste

Question 42

What is the False Claims Act?

Answer 42

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

Question 43

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

Answer 43

● 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

Question 44

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

Answer 44

30%

Question 45

What is the Anti-kickback Statue?

Answer 45

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

Question 46

What are the penalties under the Anti-Kickback Statue?

Answer 46

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

Question 47

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

Answer 47

Stark law

Question 48

What is the Physician Self- referral law?

Answer 48

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

Question 49

What are the penalties for violation of the Stark law?

Answer 49

● 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.

Question 50

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

Answer 50

Fraud and abuse

Question 51

What is the most common problem Medicare finds with documentation?

Answer 51

Missing or incomplete plan of care

Question 52

True or false; small gifts to patients are legal.

Answer 52

True

Question 53

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

Answer 53

True

Question 54

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

Answer 54

There is an exception for financially needy patients

Question 55

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

Answer 55

False

Question 56

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?

Answer 56

Civil (cash) penalties

Question 57

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

Answer 57

False; reasonable modifications

Question 58

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

Answer 58

● 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

Question 59

What are the factors of sexual harassment?

Answer 59

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