MEDICAL ETHICS, LAW, AND COMPLIANCE

Chapter 2

Chapter 2 2

Medical Ethics, Law, and Compliance Learning Objectives

Define medical ethics, bioethics, and etiquette. State three functions of medical practice acts. Discuss the legal responsibilities of physicians. Describe the ways to ensure the proper transfer

of information. State the purpose of a medical compliance plan

and three ways the assistant can help the practice be compliant.

List the safeguards against litigation.

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Key Terms Abandonment Arbitration Assault Authorization Battery Bioethics Compliance Contributory

negligence

Defensive medicine Deposition Ethics Etiquette Express consent Fraud Good Samaritan act Health Insurance Portability

and Accountability Act (HIPAA) Implied consent

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Key Terms (cont’d)

Informed consent Liability Licensure Litigation Malpractice Medical practice acts Registration Release of information

Settlement Statute of limitations Subpoena Summons

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Medical Ethics Ethics are the standards of

conduct that grow out of one’s understanding of right and wrong Each profession usually has written

policies or codes These statements of right or wrong hold

members of the profession to a high degree of competency

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Medical Ethics (cont’d)

Hippocratic Oath First statement governing the conduct of

physicians AMA Code of Ethics requires

physicians to Practice high standards of patient care Respect patients’ rights Treat patients with compassion Safeguard patient confidences

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Medical Assistant’s Ethical Responsibility

AAMA Code of Ethics and Creed Based on AMA code Medical assistant acts as agent of physician

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Bioethics Ethics of treatment, medical

technology, and procedures Spurred by advances in science, rapid

development in technology, and new treatments

Issues Abortion, moment of death, patients’

rights, genetic engineering Living will

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Moral Values Concepts of what is good

Terms such as “compassion,” “honesty,” and “responsibility”

Physician must put benefit of patient first Moral values are often contained within state

laws Violence to children must be reported in

many states

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Etiquette Behavior and customs that are

standards for what is considered good manners or mark the courteous treatment of others Dressing appropriately Using proper forms of address Greeting visitors cheerfully Using good telephone techniques Observing the use of polite phrases

Basis for good communication

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The Right to Practice States govern the practice of

medicine with medical practice acts These acts

Define “medical practice” Explain who must be licensed Set rules for obtaining a license State the duties imposed by the license State grounds for revocation List statutory reports to be sent to

government These acts also protect users of

health care services

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Medical Law

Licensure granted by each state Educational requirements Examinations Reciprocity Endorsement through National Board of

Medical Examiners Relicensure (annually or every other year)

Continuing education requirements

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Medical Law (cont’d) Certified Specialization American Board of Specialties “Board Certified”

Additional academic in-hospital training as a resident

Comprehensive certification examination

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Medical Law (cont’d)

Narcotics Registration Enables physicians to write drug

prescriptions DEA permit

Renewed annually

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The Physician’s Practice Contractual relationship

Implied or express contract Physician is legally required to

Possess the skill/learning held by a reputable physician

Act for the benefit of the patient Preserve confidentiality Act in good faith Perform to the best of his/her ability Advise against unwise or unnecessary treatment Advise when condition is beyond scope of his/her

competency

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The Physician’s Practice (cont’d)

Physician is not legally required to Accept all who seek his/her services Restore patients to condition prior to illness Obtain recovery for all patients Guarantee successful results Know all possible reactions of patients to various

medicines Be free from errors in complex cases Possess the maximum amount of education Continue care after patient discharges

him/herself

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Patient’s Responsibilities Give necessary information to allow

for correct diagnosis Follow the physician’s instructions

and treatment Generally cooperate with physician Pay for all services rendered

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Consent Implied consent

Not stated outright Routine treatment only

Express consent Oral or written Persons incapable of giving consent may be

treated in an emergency

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Consent (cont’d)

Informed consent Illness or problem has been explained in

understandable language Options for treatment, along with their

benefits and risks, have been explained Physician’s prognosis is clearly stated

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Consent (cont’d)

Competent to give consent Legal age and of sound mind

Parents give consent for children Some minors (for example, in military

service or if married or divorced) may give consent in certain cases

Pregnancy tests and prenatal care Diagnosis and treatment of sexually transmitted

diseases Diagnosis and treatment of alcohol or drug abuse

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Medical Liability Legal responsibility for actions or

nonactions and their consequences Responsible for patients Responsible for

Safety of employees Safety of premises

Defensive medicine

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Malpractice Improper care or treatment of a

patient Despite vigilance on part of

physician Accidents can happen during treatment Patients can become dissatisfied with care

Patient may file lawsuit to prove injury

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Termination by Physician End of the physician/patient

relationship Usually due to patient’s stated intention to go

to another physician, OR Patient does not follow treatment instructions Patient fails to pay for services rendered

Physician must notify patient in writing Allow enough time for patient to obtain a new

provider

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Abandonment Opposite of termination

Physician does not continue to treat or follow up with patient

Good documentation Essential to prove that the physician did not

abandon the patient

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Assault and Battery Assault is the clear threat of injury Battery is bodily contact without

permission Procedures done without consent Procedures beyond the scope of consent

Physician acting in a grave emergency

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Fraud Intentionally dishonest practice that

deprives others of their rights Falsifying qualifications or licensure False statement about the benefits of a drug

or treatment Filing false insurance claims

Penalties vary by state License can be revoked

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Litigation Bringing of lawsuits against the

physician Steps in litigation

Summons is sent to person being sued (defendant)

Subpoena orders all documentation relevant to case be delivered to the courts

Deposition (sworn statement) is made outside of court

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Response to Litigation Accurate documentation is critical Contributory negligence by patient

Documentation to show that patient refused tests, did not follow treatment, etc.

Alternatives to trial Settlement between plaintiff (patient) and

physician’s insurance company Arbitration by a neutral third party

Statute of limitations Sets time limit for initiating a lawsuit Varies by state

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Good Samaritan Act Protects physician from liability for

civil damages resulting from providing emergency care Minor variations by state

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Medical Communications Final privacy rule

Federal law that requires patients to give consent to share information needed to carry out treatment or to submit insurance claims

Patients must also provide authorization for specific items not covered by general consent

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Medical Communications (cont’d)

Release of Information Form Written form Must contain

Name of facility releasing information Name of facility requesting information Patient’s name, address, and date of birth Specific dates of treatment Description of information to be released Signature of patient (or parent/guardian) Date signed

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Confidentiality To help ensure confidentiality

Avoid speaking about patients’ treatments, records, finances, etc.

Never leave messages, other than requests for call backs, on answering machines

Keep documents from view; shred documents

Keep computerized documents secure

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Confidentiality (cont’d)

Exceptions Physicians must file statutory reports for

Births Deaths Abuse Wounds resulting from violence Occupational illnesses Communicable diseases Food poisoning

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Electronic Transmissionof Information

Fax Confirm receipt of fax

E-mail Do not use e-mail for confidential

information Health Insurance Portability and

Accountability Act (HIPAA) Regulates how electronic patient information

is stored and shared

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Medical Compliance Plans Voluntary plan to reduce risk of

accusations of fraud/abuse in submitting insurance claims OIG/HHS Compliance Program Guidance for

Individual and Small Group Physician Practices

Documentation Improper inducements,

kickbacks, self-referrals

Risk areas Coding and billing Reasonable and

necessary services

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Medical Compliance Plans (cont’d)

Aim to prevent submission of erroneous claims or unlawful conduct involving federal health care programs

Seven basic elements

Written policies and procedures

Designation of a chief compliance officer

Training and education programs

Effective line of communication

Auditing and monitoring Well-publicized

disciplinary directives Prompt corrective action

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Medical Assistant’sRole in Compliance

Central role in ensuring compliance Accurate data entry Increased accuracy of documentation Timely filing and storing of records Prompt reporting of errors or instances of

fraudulent conduct

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Safeguards AgainstLitigation

Maintain confidentiality Promote effective communication

between medical assistant and physician, patient, employees

Keep complete and accurate records Be safety conscious

Chapter 2 39

Quiz

Matching

Implied consent

Fraud

Malpractice

Assault

Bioethics

Improper care or treatment of a patient.

Clear threat of injury.

Intentional commission of dishonest act.

Ethics of treatment, technology, and procedures.

Permission that is not stated outright.

Chapter 2 40

Critical Thinking

Explain the items covered by medical practice acts.

Each state’s medical practice acts define “medical practice,” explain who must be licensed, set rules for obtaining a license, state the duties imposed by the license, state the grounds for revocation, and list statutory reports that must be sent to governmental agencies.