ࡱ> - bjbj D:}+f f 8LA~]]sssbbbhjjjjjj$g FbbbbbssbFsshbhRX8s`LT0N O.O<8O8bbbbbbbbbbbbbbObbbbbbbbbf o:  Fundamentals of Law for Health Informatics and Information Management Second Edition Check Your Understanding Chapter Answers CHAPTER 1 Check Your Understanding 1.1 A hybrid record is refers to record that is totally electronic. False An electronic health record can be managed across more than one healthcare organization. True Confidentiality refers to the right to be left alone. False HITECH widens the scope of privacy and security protections under HIPAA. True Privileged communication is a legal concept designed to protect the communication between two parties. True Check Your Understanding 1.2 Ownership of a health record generated by a doctor on a patient belongs to the patient. False A custodian of records is responsible for certifying that a record is what it purports to be. True When a patient refuses treatment he or she is exercising the ethical principle of beneficence. False In a malpractice case, a professional code of ethics may be used as a benchmark for what should be acceptable practice by a healthcare professional. True The ethical principle of nonmaleficence refers to making sure rules are fairly and consistently applied to all. False CHAPTER 2 Check Your Understanding 2.1 Private law defines rights and duties between individuals and the government. False Statutes are enacted by legislative bodies. True Administrative law is created by court decisions. False Persuasive authority occurs when a court looks to another courts decision for guidance, even if it is not required to do so. True Under the theory of stare decisis, a higher court must look to the decision of a lower court. False Check Your Understanding 2.2 Jurisdiction is a territory of legal control. True The U.S. Congress is a bicameral model. True Federally, ultimate executive branch power rests with the President. True Under the theory of separation of powers, each branch of government is given expanded powers. False Judicial disputes may arise from constitutional challenges to existing laws. True Check Your Understanding 2.3 Appellate courts hear appeals on final judgments of trial court decisions. True An opinion is the written argument of one of the parties in a lawsuit. False Courts of limited jurisdiction hear cases pertaining to a particular subject matter. True Diversity jurisdiction enables parties from different states to engage in a lawsuit in federal court. True In mediation, a third party makes a final decision about a dispute between parties. False CHAPTER 3 Check Your Understanding 3.1 Procedural law encompasses a courts rules that guide a lawsuit. True Class action lawsuits proceed for groups of consumers. True A cross-claim is a claim by a defendant against a plaintiff. False Joinder involves bringing an outsider into a lawsuit as a codefendant. True Notification of a lawsuit occurs through service. True Check Your Understanding 3.2 Discovery allows parties in a lawsuit to use strategies to obtain information held by other parties. True Admissibility refers to evidence that parties can obtain during the pretrial period. False A deposition does not occur under oath. False Authentication is verification of a records validity. True An independent mental examination may not be requested as a type of discovery. False Check Your Understanding 3.3 A subpoena is another name for a court order. False In most cases, a subpoena for health records must be accompanied by patient authorization. True Written objections to subpoenas may be made in a motion to quash. True A subpoena duces tecum primarily seeks an individuals testimony. False Material should always remain in a health record that has been subpoenaed, even if that material was not requested in the subpoena. False Check Your Understanding 3.4 Cases are rarely settled before they reach trial. False Judicial search warrants are more likely to be used to obtain health records in criminal cases than in civil cases. True A pro se plaintiff is one who represents himself during litigation. True An expert witness is called to testify based on her own observations of the situation that prompted the lawsuit. False A bench trial is a trial without a jury. True Check Your Understanding 3.5 In civil cases, the burden of proof is beyond a reasonable doubt. False Noneconomic compensatory damages have been targeted as a cause of rising professional malpractice insurance premiums. True The legal system does not allow photocopies of health records to be admitted into evidence. False The party that appeals a lower courts decision is the appellee. False Garnishment is a court-ordered collection of money damages that is awarded to the plaintiff through a set-aside of the defendants wages. True CHAPTER 4 Check Your Understanding 4.1 Health information is important as evidence in many types of civil and criminal cases. True In state court, a states rules of evidence will determine whether a piece of information is discoverable. True Electronically stored information is now obtained more frequently through discovery than it was in the past. Electronic discovery includes computer forensics. True E-mail can generally not be sought as part of the electronic discovery process. False Check Your Understanding 4.2 The Federal Rules of Civil Procedure were amended in 2006 to address the discovery of electronic data. True Under the Federal Rules of Civil Procedure, court-imposed sanctions are not permitted if a party fails to provide electronically stored information lost as the result of a good-faith operation. True In general, documents must be produced in response to a subpoena as they are kept in the usual course of business. True A hybrid record is a fully electronic record. False A legal hold requires the preservation of both paper and electronic records. True Check Your Understanding 4.3 Spoliation is the accidental destruction of evidence. False Organizations with electronic information should develop guidelines to identify where information may be hidden or not readily apparent. True Relevant evidence will always be admitted into evidence. False Circumstantial evidence requires reasoning to prove a fact. True Testimonial and documentary evidence may be combined during a trial. True Check Your Understanding 4.4 The best evidence rule prohibits the use of a duplicate record in lieu of the original. False Much documentation in the health record is hearsay. True The business records exception often enables health records to be admitted as evidence. True The physician-patient privilege is used to encourage full disclosure of relevant information by patients to their physicians. True It is the physician who holds the physician-patient privilege. False Check Your Understanding 4.5 Incident reports are created for patient treatment purposes and should be a part of the health record. False State law may protect incident reports from being admitted into evidence. True Peer review involves activities undertaken to ensure the provision of quality care. True Plaintiffs commonly attempt to discover and admit peer review records into evidence during negligence cases against health care providers. True The physician-patient privilege may be waived when a party claims damages by the physician and puts his physical or mental condition at issue. True CHAPTER 5 Check Your Understanding 5.1 A tort is a civil wrong. True Battery is an intentional tort that involves nonconsensual contact with the plaintiff. True Assault is an intentional tort that involves nonconsensual contact with the plaintiff. False The law provides exceptions to false imprisonment liability where involuntarily hospitalized patients pose harm to themselves or others. True Intentional infliction of emotional distress is a tort that results in extreme emotional distress to the plaintiff. True Check Your Understanding 5.2 Negligence is the second most common basis for medical malpractice lawsuits, following intentional torts. False The standard of care is what an individual is expected to do or not do in a particular situation. True Misfeasance is the failure to act per ones duty and according to ordinary prudence. False The two types of causation are actual and proximate. True Punitive damages punish the wrongdoer for tortious conduct that was committed. True Check Your Understanding 5.3 Per the doctrine of res ipsa loquitur, an inference or presumption of the defendants negligence is permitted. True Contributory negligence completely bars recovery by a plaintiff whose conduct contributed to the plaintiffs injury. True Assumption of the risk is a viable defense by physicians in most medical malpractice cases. False Per the theory of corporate negligence, a hospital is liable for the torts of its employees. False Per the theory of respondeat superior, a hospital is liable in its own right to the patients it serves. False Check Your Understanding 5.4 The doctrine of strict liability is most common in products liability cases. True Libel is written defamation. True Fiduciary duty is the obligation to act in the best interest of another party. True To successfully claim breach of confidentiality, a plaintiff must establish that the defendant had a duty not to disclose the information. True Good Samaritan statutes encourage good-faith emergency assistance by providing immunity if ordinary negligence is committed by those who assist in medical emergencies. True Check Your Understanding 5.5 A statute of limitations places time limits on certain claims. True A tolled statute of limitations is one that has been delayed or suspended. True Wrongful acts committed in the healthcare environment can lead only to civil liability. False Diminishing returns on insurers investments is believed to be a contributing factor to the medical malpractice insurance crisis. True Collateral source payments are payments received by plaintiffs from sources other than the defendant. True CHAPTER 6 Check Your Understanding 6.1 The owners of a corporation are generally shielded from personal liability for the debts of the corporation, although the corporation itself can sue and be sued. True Piercing the corporate veil enables the owners of a corporation to be shielded from liability for wrongdoing committed through the corporation. False Fiduciary duty includes the duty of loyalty and the duty of responsibility. True A not-for-profit corporation is prohibited from making money. False A healthcare organization may not form as a partnership. False Check Your Understanding 6.2 A hold harmless clause may provide for compensation by one individual to another. True A breach of contract judgment always requires monetary compensation. False An acceptance of an offer reflects a meeting of the minds regarding the contract terms. True To be valid, a contract must be in writing. False Mistake of fact is a potential defense for nonperformance of a contract. True Check Your Understanding 6.3 Antitrust violations are generally governed by individual state laws. False All restraints of trade are per se antitrust violations. False Medical staff credentialing can lead to antitrust concerns. True There are nine safety zones in health care that the federal government will generally not challenge as antitrust violations. True The Sherman Act is the oldest of the three major federal antitrust statutes. False Check Your Understanding 6.4 Economic credentialing is the granting of medical staff privileges based on quality of care indicators. False Antitrust claims are only valid if they relate to an entire group of individuals who have been denied privileges at a healthcare organization. False A group boycott is a per se antitrust violation. True Courts uphold all non-compete agreements in order to protect the livelihood of organizations that an employee or contractor leaves for other opportunities. False The number of procedures performed by a provider may be linked to clinical performance and quality issues when determining medical staff privileges. True CHAPTER 7 Check Your Understanding 7.1 A person must give permission to receive medical treatment through express consent. True Informed consent should include alternatives to the proposed treatment or procedure. True The law permits a presumption of consent during emergency situations. True The Genetic Information Nondiscrimination Act (GINA) applies to any entity that has the potential to make a decision about a person based on that persons genetic information. False Compound authorizations combine informed consent with authorization for the use and disclosure of a research subjects health information. True Check Your Understanding 7.2 Unless it is designated as durable, a power of attorney is only effective when the principal has capacity. True A durable power of attorney for healthcare decisions expresses an individuals wishes to limit treatment measures when specific health-related diagnoses or conditions exist and the individual cannot communicate on his own behalf. False The Patient Self-Determination Act requires hospitals that are Medicare providers to document in the health record whether an individual has an advance directive. True The Uniform Anatomical Gift Act permits an anatomical gift by any person designated to make decisions about a decedents remains. True The technical process for executing a living will is standardized nationally. False Check Your Understanding 7.3 A competent adults right to refuse consent to medical treatment applies even when the treatment is lifesaving. True In right-to-die cases, courts will balance an individuals right to self-determination against the interest of the state. True The Uniform Health-Care Decisions Act suggests that in the absence of a surrogate, a spouse be the first person to make healthcare decisions on behalf of an individual who has lost mental capacity. True An emancipated minor is one who has not been afforded legal status as an adult. False State laws generally allow minors to seek medical treatment for sexually transmitted diseases without parental consent. True Check Your Understanding 7.4 Battery is the usual basis of a claim for which an individual did not give consent for a procedure that was performed. True The basis for a lack of informed consent claim is generally negligence. True A treating provider should delegate the informed consent process to another person. False General consent allows healthcare providers to provide routine noninvasive services. True Both written and oral consent should be documented in an individuals health record. True CHAPTER 8 Check Your Understanding 8.1 Health records using a combination of paper and electronic formats are hybrid records. True The most important purpose of the health records is to provide proof of services for reimbursement. False The health record is not permitted to serve as an organizations business record. False There are both federal and state versions of the Uniform Photographic Copies of Business and Public Records as Evidence Act. True The custodian of the legal health record is responsible for collecting, protecting, and archiving the record. True Check Your Understanding 8.2 Patient appears to be anxious is an example of good documentation in the health record. False Charting for a block of time is recommended because it saves time. False Medical staff bylaws must state the categories of personnel who are authorized to accept physician orders. True Professional conclusions of individual practitioners should be documented in the health record so that they agree with one another. False A jury may be permitted to infer provider negligence based on missing or incomplete information in the health record. True Check Your Understanding 8.3 Authentication refers to the ability to verify the source of an entry in the health record. True Author initials are prohibited as an authentication mechanism in the health record. False Metadata provides information about an entrys content, including date and time of creation. True A countersignature signifies review and evaluation of the actions and documentation of another provider. True Auto-authentication is favored by the Joint Commission because it is an efficient authentication tool. False Check Your Understanding 8.4 A Joint Commission-accredited organization may use any abbreviation in health record documentation as long as it is explained in a facility-wide key or legend. False Illegibility has been reduced through the presence of EHRs. True Incorrect information in the health record should be obliterated so that it cannot be confused with the updated, corrected information that is placed in the record. False A late entry in the health record should not be identified as such because it may lead to negligence liability. False Version management is how an organization handles numerous versions that may exist of a document. True Check Your Understanding 8.5 A computer systems print function provides additional challenges for organizations with EHRs. True A patients personal health record is a business record. False A master patient index is a directory of patient-identifying information. True Statutes of limitations may not be considered when establishing a health record retention schedule. False When establishing a health record retention schedule, an organization must retain all records for the same period of time. False Check Your Understanding 8.6 Health record disposition includes transferring records from paper to an optical imaging system. True When a physician closes a practice, all health records should be destroyed immediately to protect the privacy of patient information. False Data in a health record needs to be kept forever. False Degaussing a hard drive involves neutralizing it with a magnetic field as a method to erase patient information. True When an e-mail message is deleted, it is eliminated from an organizations electronic system. False CHAPTER 9 Check Your Understanding 9.1 The Privacy Rule resides in the administrative simplification provision of Title II of HIPAA. True The HITECH Act of the ARRA of 2009 made significant changes to the HIPAA Privacy Rule. True The FOIA was enacted to address the privacy of health information. False Drug and alcohol abuse treatment records have received protection under federal law. True The Conditions of Participation regulate only providers who receive funds from the Medicare and Medicaid programs. True Check Your Understanding 9.2 A CE needs only consider its employees when evaluating HIPAA compliance within the organization. False The HITECH Act has strengthened BA requirements regarding compliance with the Privacy Rule. True In part, information must be individually identifiable to meet the definition of PHI. True Deidentified information receives Privacy Rule protection. False A BA is anyone who might have access to a CEs PHI. False Check Your Understanding 9.3 Under the Privacy Rule, a personal representative must be treated the same as the individual regarding the use and disclosure of the individuals PHI. True By definition, a DRS includes billing records. True A hospital employees pre-employment physical examination is in his personnel file in Human Resources; this report is PHI. False A university with a medical center is a hybrid entity under the Privacy Rule. True Some of the Privacy Rules requirements are relaxed or removed where PHI is needed for purposes of TPO. True Check Your Understanding 9.4 The HIPAA consent explains an individuals rights and the CEs legal duties with respect to PHI. False Per the HIPAA Privacy Rule, patient authorization is required for the use or disclosure of PHI unless it meets an exception whereby authorization is not required. True Although an individual must verbally agree to be included in a facility directory, written authorization is not required. True One of the 12 public interest and benefit exceptions to the authorization requirements is disclosure to organ procurement agencies. True Incidental disclosures do not require an individuals written authorization. True Check Your Understanding 9.5 Under no circumstance should health records from other facilities be made a part of an organizations DRS. False The minimum necessary principle applies to disclosures made for TPO purposes. False An individual has the right of access to her psychotherapy notes. False Per HITECH, an accounting of disclosures will be required in the future for TPO disclosures made by covered entities with EHRs. True Complaints about alleged Privacy Rule violations must be submitted to the covered entity. False Check Your Understanding 9.6 The threshold for required media notification in the event of a privacy breach is 300 affected individuals. False All activities that meet the HIPAA definition of marketing must receive prior written authorization from the individual. False The breach notification requirement is new under HITECH. True Fundraising activities that target individuals based on diagnosis require prior authorization. True A conditioned authorization may be allowed by ARRA in certain situations. True Check Your Understanding 9.7 The Privacy Rule provides a floor, or minimum, of privacy requirements. True Breach notification is one type of mitigation under the Privacy Rule. True In order to simplify processes, individuals may be required to waive their rights under the Privacy Rule to obtain treatment or benefits eligibility. False Under HITECH, state attorneys general may bring civil actions in federal district court on behalf of residents believed to have been negatively affected by a HIPAA violation. True Enforcement of the Privacy Rule will continue to operate exclusively on a complaint-based system. False CHAPTER 10 Check Your Understanding 10.1 The Security Rule requires CEs to ensure the integrity and legality of patient information. False The goal of the Security Rule is to ensure that patient information is protected from unauthorized access, alteration, deletion, and transmission. True CMS is the enforcement agency for the Security Rule. False CEs can decide to comply with only the Privacy Rule and dont have to comply with the Security Rule. False Only healthcare providers are required to comply with the Security Rule. False Check Your Understanding 10.2 The Security Rule contains provision that CEs can ignore. False The Security Rule is completely technical and requires computer programmers to address. False The Security Rule contains both required and addressable standards. True The Security Rule contains encryption specifications that all CEs must comply. False The Conditions of Participation restrict payment to providers who are not compliant with the Security Rule. False CHAPTER 11 Check Your Understanding 11.1 Internal security breaches are far more common than external breaches. True The Medical identity theft and Assumption Deterrence Act of 1998 make it a federal crime to commit an act of medical identity theft. True Medical identity theft includes the use of a patients financial information to purchase goods or services even if they are not medical in nature. False Healthcare organizations are excluded from the definition of creditor under FACTA. False Red flags are used to help a healthcare provider detect medical identity theft. True Check Your Understanding 11.2 CBAC is less stringent than RBAC. False Biometric identifiers signify something that the user knows. False An audit trail is a record that shows when a particular user accessed a computer system. True Employee nondisclosure agreements are particularly important for employees who work in remote locations or telecommute. True Employee training programs are not necessary to protect the security of PHI. False Check Your Understanding 11.3 Data encryption ensures that data transferred from one location on a network to another is secure from eavesdropping or data interception. True An organizations firewall limits external Internet users from accessing portions of the healthcare network, but it does not limit internal users from accessing portions of the Internet. True Facsimile machines provide a highly secure method of communication. False E-mail related to patient care should be kept separate from the patient medical record. False Disaster recovery and contingency plans related to ePHI are nice to have but not necessary. False CHAPTER 12 Check Your Understanding 12.1 Ownership of a health record has traditionally been granted to the patient. False A competent adult may wish to appoint another person to be his or her personal representative. True A minor who is emancipated must still have his or her parents authorize for disclosure of health information. False A noncustodial parent has the right to access the healthcare information of their minor children subject to other mitigating circumstances related to the minors rights to access. True Attorneys have automatic access to patient information because they are an officer of the court. False Check Your Understanding 12.2 HIPAA does not distinguish highly sensitive health information from other types of health information. False Privilege statutes legally protect confidential communications between provider and patient related to diagnosis and treatment from disclosure during civil and some criminal misdemeanor litigation. True The duty to warn obligation enables a physician to disclose information to a third party who may be the victim of harm perpetrated by a patient. True For a substance alcohol and drug abuse program to be in compliance with the Privacy Rule the authorization of disclosure of information should include specific elements required by the Privacy Rule. True Health records of HIV/AIDS patients should be clearly marked as such. False Check Your Understanding 12.3 Title I of GINA allows for health plans to use genetic for insurance premium-setting decisions. False Title II of GINA focus on employment and put restrictions on employers for using genetic information to make employment decisions. True Most states deem adoption records as confidential and only allow release of such records with a court order. True An adoptees birth record is restricted in order to protect the biological parent(s) unless both parties have agreed to have their identities disclosed in a mutual consent registry. True Courts will decide if an adoptee may access the health information of his or her biological parents for health risk purposes. True Check Your Understanding 12.4 In absence of a legal executor or administrator of an estate a surviving spouse or other descendent my access the health records of the deceased patient. True The Freedom of Information Act along with open records laws including public records or sunshine laws requires that federal or state entities make information generated in the normal course of business including health information public and subject to access by whoever requests the information. False An employer is entitled to information about an employees medical work fitness but not to a diagnosis or other specific health details. True The Patriot Act of 2001 and the Homeland Security Act of 2002 allow unauthorized access to PHI upon request in order to protect the country. True The Electronic Record Express initiative sponsored by the Social Security Administration to process disability claims does not require patient authorization for release of PHI. False Check Your Understanding 12.5 Documents not considered part of the legal health record for example like correspondence, incident reports, and information about other family members should be released as part of the LHR. False Proof of a requesters relationship to a patient must be verified before health information is released to the requester. True A request for any and all information on a patient should be honored without question as long as the authorization form is signed by the patient. False Health organizations and providers may charge a reasonable fee as set by state law for copying health records in response to a request for patient information. True HIPAA requires that for the purpose of accounting of disclosures only PHI that has been released electronically or in writing must be accounted for. False CHAPTER 13 Check Your Understanding 13.1 State required reporting laws are an exception to the doctrine of preemption. True When information is released to meet state required reporting laws, the release does not have to be included in the facilitys accounting of disclosures. False Central registries are covered by and must adhere to the requirements of HIPAA. False Abuse of the elderly is limited to financial exploitation of an elder persons assets. False Physical abuse is usually the only type of maltreatment that must be reported under child abuse reporting laws. False Check Your Understanding 13.2 The attending physician usually has responsibility for filing the death certificate. False Reporting of notifiable diseases without the patients authorization is allowed under the public interest and benefit exception under HIPAA. True National hospital quality measures data may only be released to the QIO or the CDAC with a signed authorization from the patient. False Every hospital receiving reimbursement from Medicare for implantable cardiac defibrillators must submit data to the American College of Cardiologists National Cardiovascular Data Registry. True Federal law requires that a hospital notify the designated organ procurement organization (OPO) in a timely manner regarding specified organ donors who die in the hospital or for whom death is imminent. True Check Your Understanding 13.3 Information included in state registries is considered public information. False Immunization registries are different from other state registries because they allow access by the individuals included in the registry or their representatives, such as parents. True Transplant registries may include data about organ donors as well as organ recipients. True Implant registries are frequently developed in response to highly publicized cases of harm resulting from implants to provide for easier notification of individuals affected. True Statewide cancer registries are frequently required to report data to the National Center for Health Statistics. False CHAPTER 14 Check Your Understanding 14.1 Risk management focuses on an organizations financial liability. True Quality and risk management programs have evolved concurrently. True A hospitals strongest legal defense is the doctrine of charitable immunity. False Darling vs. Charleston Community Memorial Hospital is a landmark case that extended negligence liability to hospitals. True A 1999 report by the Institute of Medicine concluded that very few preventable errors lead to patient deaths in hospitals. False Check Your Understanding 14.2 A review of patient complaints can assist in the risk identification process. True Establishing the frequency or severity of a particular loss occurring is part of the risk treatment process. True A claims management program should include the retention of all insurance policies. True An incident report should be completed by an individual who investigated a situation and determined its cause. False Incident reports are protected from discovery in all states. False Check Your Understanding 14.3 Patient non-compliance with medical advice should not be documented in the health record because it might upset the patient. False A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. True All medical errors are sentinel events. False Joint Commission accredited organizations are expected to complete a root cause analysis following a sentinel event. True National Patient Safety Goals are optional standards that an organization may choose to meet in order to receive a special designation from the Joint Commission. False Check Your Understanding 14.4 Patient-centered care is one of 10 objectives recommended by the Institute of Medicine in 2001 as central to the U.S. healthcare system. False The American Hospital Associations Patient Bill of Rights is now the Patient Care Partnership, which focuses on patient expectations, rights, and responsibilities. True The Hill-Burton Act is federal legislation, passed in 1946, that provided hospitals money for construction and modernization. True EMTALA was passed by Congress to combat transfer and discharge of patients, and refusal to treat, based on inability to pay. True In addition to recognizing patient rights, many hospitals have adopted codes of patient responsibility. True Check Your Understanding 14.5 The National Practitioner Data Bank collects malpractice and disciplinary action information on physicians. True The Medicare Conditions of Participation encourage restraints in the interest of patient safety. False Quality Improvement Organizations provide consultation and quality improvement resources to a wide range of providers. True The Leapfrog Group consists of organizations that are responsible for purchasing healthcare coverage for employees. True Pay for performance provides incentives to healthcare providers to deliver high-quality care. True CHAPTER 15 Check Your Understanding 15.1 Healthcare abuse relates to a false representation of fact. False Billing for services never rendered is one of the most common types of healthcare fraud. True Unbundling is a billing practice preferred by payers. False A Corporate Integrity Agreement is a voluntary compliance program adopted by a healthcare organization. False Although desirable, correct documentation in the health record is not necessary to support billing. False Check Your Understanding 15.2 The False Claims Act targets anyone who knowingly submits false claims to a private insurance company. False A qui tam action involves whistleblowers who file a complaint alleging fraud against the government. True The False Claims Act utilizes a knowing standard, which includes acting in deliberate ignorance. True The Federal Anti-Kickback Statute targets those who pay, solicit or receive payment in exchange for business that will be reimbursed by a federal healthcare program. True Under the CMP law, a hospital may be excluded from the Medicare program if its wrongdoing caused harm to an HHS program. True Check Your Understanding 15.3 The Stark Law prohibits physicians from ordering certain health services for Medicare patients from entities in which the physician or immediate family member has a financial relationship. True A purpose of antitrust laws is to discourage marketplace competition. False In its definition of referral, the Stark Law excludes a request by a radiologist for diagnostic radiology services. True State healthcare fraud and abuse laws apply to all payers. True The Deficit Reduction Act of 2005 made compliance programs voluntary rather than mandatory. False Check Your Understanding 15.4 Fraudulent billings practices are a major compliance risk area for healthcare organizations. True A claim that is resubmitted based on a patient complaint is not a false claim because it was not initiated by the healthcare provider. False Sending a duplicate claim each month to a payer until it is paid is an acceptable billing practice. False CPT codes that should not be billed together are listed in Medicares Correct Coding Initiative. True Medicare deems all services to be medically necessary if they are ordered by a patients attending physician. False Check Your Understanding 15.5 A corporate code of conduct expresses an organizations commitment to ethical behavior. True A corporate compliance officer position is ideally suited to a clerical staff person. False Federal Sentencing Guidelines encourage organizations to have fraud prevention and detection programs in place. True Anonymous reporting of compliance violations should be prohibited because it inhibits open communication. False The mission of the Office of the Inspector General for the U.S. Department of Health and Human Services (HHS) is to protect the integrity of HHS programs, and the health and welfare of those programs beneficiaries. True CHAPTER 16 Check Your Understanding 16.1 The medical staff has the ultimate responsibility for the quality and financial well-being of the health organization. False Medical staff bylaws are considered a contract and are legally binding in most states. True Joint Commission standards require that the medical staff bylaws address issues of self-governance and accountability to the governing board. True Credentialing is the process of reviewing and validating qualifications of practitioners for granting medical staff membership. True If a practitioner is assigned a medical staff category of associate, he or she can chair the medical staff executive committee. False Check Your Understanding 16.2 The process for verifying the credentials of a physician who wishes to join a medical staff is referred to as primary source verification. True A healthcare organization does not have a duty to share information on a practitioner upon legitimate request. False The National Practitioner Data Bank enables a healthcare facility to check on the background of a practitioner to determine if the practitioner has had his or her license to practice suspended for any reason. True An adverse action against a physician is not reportable to the National Practitioner Data Bank. False Due process is required in the hiring and disciplinary process that affects a practitioners medical staff privileges or employment. True CHAPTER 17 Check Your Understanding 17.1 The EEOC enforces laws that protect the employer from poor job applicants. False The Age Discrimination in Employment Act of 1967 protects individuals 40 years and older from being discriminated against in the employment setting. True If an employee discovers he is carrying the gene that causes colon cancer his insurance company can deny him insurance. False A hospital has the right to deny employment to an applicant from another country if the applicant does not speak English. False Employers must handle the conditions of pregnancy and childbirth, or related medical conditions, in the same manner as they handle medical conditions afford an individual who is not pregnant. True Check Your Understanding 17.2 The number of hours a child under the age of 16 is protected by law. True ERISA refers to pension plans while COBRA refers to health insurance. True Employees may not self-select to join a union. False Labor unions exist to protect employers from demanding employees. False Hospital employers must provide healthcare workers with information regarding what to do if the worker is accidently stick with a needle that has been used on a patient. 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