Legal And Ethical Issues For Healthcare Professions 3rd Edition by Elsevier -Test Bank

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Chapter 05: Code and Standards Infractions

Test Bank

 

MULTIPLE CHOICE

 

  1. If an individual does something illegal, whose responsibility is it to enforce sanctions?
a. The person who caught them
b. The person who did the illegal action
c. The employer of the governing entity
d. Their coworkers

 

 

ANS:  C

It is the duty of all healthcare professionals to monitor themselves and uphold the ethical standards of the profession. If an individual does something illegal or unethical it is the responsibility of their employer or governing body to enforce the sanctions that would be appropriate for the violation that occurred.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 70

 

  1. Consequence that is levied against a legal or ethical violation is called:
a. compliance.
b. due process.
c. sanction.
d. disciplinary action.

 

 

ANS:  D

Disciplinary actions are consequences that are levied against an individual who has violated either the laws or the ethical standards for that profession. In the medical field violations can range from the unethical treatment of a patient or individual or negligence of care to a HIPAA violation of privacy, fraud, or other illegal actions.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 70

 

  1. Workplace sanctions depend on ____ to instill.
a. laws
b. whistleblowers
c. professional codes of conduct
d. policies and procedures

 

 

ANS:  C

Although committing an illegal act may bring fines and possible imprisonment, professional and workplace sanctions do not depend on laws, but professional codes of conduct, and may include such corrective actions as termination of employment or loss of license.

 

DIF:    Cognitive Level: Comprehension     REF:   pp. 70-71

 

  1. What are workplace standards?
a. Standards that are expected of employees dependent upon their position
b. Rules of the workplace, no matter your position
c. Laws set forth by local governments
d. Standards set by society

 

 

ANS:  A

Every medical or healthcare employer, whether a hospital, agency, or group practice, should have a set of standards of what is expected of their employees based on their position and expertise. As new employees sign-off on the workplace, they acknowledge the specified consequences that will result from working outside of the parameters of that job description or violating the code of ethics.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 71

 

  1. Disciplinary action varies from all of the following except:
a. state to state.
b. facility to facility.
c. one area of expertise to another.
d. state and federal regulations.

 

 

ANS:  D

Reasons for disciplinary action vary from state to state, facility to facility, and one area of expertise to another. State and federal regulations focus on violations in the areas of fraud, substance abuse, illegal acts, operating without a license, acting outside the scope of practice, and malpractice.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 71

 

  1. What is an example of disciplinary action for a minor infraction?
a. Termination
b. Suspension
c. Large fine
d. Corrective action plan

 

 

ANS:  D

The consequences of a minor infraction may just include a corrective action plan (CAP) by an employer or a temporary loss of license or small fine/penalty.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 71

 

  1. What is an example of a disciplinary action for a serious infraction?
a. Permanent loss of license
b. Small fine
c. Suspension
d. Large fine

 

 

ANS:  A

In the case of a more serious infraction, the person may incur permanent loss of license and heavy fines and penalties. If a physician, for example, is found to be guilty of substance abuse, the physician may have a loss of license imposed by Medicare and or the state licensing board and lose their livelihood.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 71

 

  1. A compliance plan is used to:
a. let the employee know the rules of his or her employer.
b. inform the employee of potential measures to be taken when company policies are violated.
c. inform the employee of the results of not reporting one of their coworkers for any wrongdoing.
d. explain to the employee why he or she should not share a patient’s personal information.

 

 

ANS:  B

All employers should have a written policy or new-hire handbook that details expectations and standards for all employees, including, but not be limited to, dress code, code of ethics, and job description. Taking that one step further, it should also detail the measures to be taken in the event of any violation of the company policies, which would be part of the company’s compliance plan.

 

DIF:    Cognitive Level: Comprehension     REF:   pp. 72-73

 

  1. Protected health information is:
a. information about any individual that is protected by law.
b. the patient’s name.
c. the patient’s address.
d. any information a patient does not want you to know.

 

 

ANS:  A

PHI is information about any individual that is protected by law from being shared or discussed outside proper channels for treatment. This extremely private information includes such crucial data as a person’s Social Security number and date of birth.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 72

 

  1. A patient’s right to confidentiality is covered under:
a. AMA.
b. AHIMA.
c. OCR.
d. HIPAA.

 

 

ANS:  D

The Health Insurance Portability and Accountability Act (HIPAA) protects the patient’s right for confidentiality and privacy.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 72

 

  1. What organization regulates HIPAA rules?
a. AMA
b. OIG
c. OCR
d. AHIMA

 

 

ANS:  C

The Office for Civil Rights (OCR) is charged with regulating all established HIPAA rules and regulations.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 72

 

  1. What is necessary for an employee to be terminated for violating a policy that is clearly described in the company’s policies and procedures as “immediate dismissal”?
a. A verbal warning before termination
b. A corrective action plan
c. A written warning before termination
d. Documentation of the offense in the employee’s file

 

 

ANS:  D

If it is not clearly documented in the employee’s file, the employee may be able to challenge his or her termination.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 73

 

  1. Due process is:
a. giving the employee the chance to explain himself.
b. interviewing others who saw the offense.
c. following policies and procedures through every step before termination, and documenting that such steps were taken.
d. firing an employee after speaking to him or her for the third time, but not documenting it.

 

 

ANS:  C

Most employers have a series of steps that must be taken before an employee can be fired. The employer must document each step in the employee’s file to show that due process was followed and that the policy of the institution was obeyed.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 73

 

  1. If a company treats two employees differently for the same infraction, this is considered:
a. noncompliance.
b. discrimination.
c. harassment.
d. illegal.

 

 

ANS:  B

It is considered discrimination if a supervisor or employer treats any one individual differently than another. A compliance officer can ensure this does not happen in the workplace.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 74

 

  1. The Office of the Inspector General investigates:
a. the American Medical Association.
b. the Occupational Safety and Health Administration.
c. the Department of Labor.
d. the Department of Health and Human Services.

 

 

ANS:  D

The Office of Inspector General is an independent agency that functions under the Department of Justice to investigate and protect the integrity of the Department of Health and Human Resources (HHS) and their recipients, as well as welfare programs. There are more than 70 OIG offices throughout the United States.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 74

 

  1. A physician bills an insurance company for services not rendered. This is considered:
a. noncompliance.
b. a violation of the Stark laws.
c. a violation of the Medical Practice Acts.
d. fraud.

 

 

ANS:  D

Fraud is the intentional act to misrepresent facts or mislead in order to gain financially. In this case, the physician would gain financially, so it would be considered fraud.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 74

 

  1. If it is not documented:
a. it did not happen.
b. it can be documented later.
c. it may have happened.
d. it can be billed out.

 

 

ANS:  A

If it is not documented, it did not happen and you cannot bill for it. Many providers are lacking in documentation skills, and, as a result, the work performed is not billed.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 74

 

  1. Down-coding can be considered:
a. a violation of the Stark laws.
b. a violation of the Medical Practice Acts.
c. fraud.
d. noncompliance.

 

 

ANS:  C

Many providers down-code their services to avoid any fraud, but indeed this too is considered to be fraud, although, unlike falsely billing or coding to increase reimbursement, there are no cases of known prosecution for down-coding.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 74

 

  1. If a coder consistently put the wrong code on a claim, this is considered:
a. a fraudulent claim.
b. an infraction.
c. acceptable.
d. a simple mistake.

 

 

ANS:  B

This mistake is not deliberate fraud, but it is of course an infraction—a breaking of the principles and requirements of the insurance carrier for billing and coding.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 76

 

  1. If due diligence is shown in a billing error on behalf of the provider, and any refunds are paid to the insurance company, generally:
a. the provider is issued a fine, but not prosecuted.
b. the provider is fined and prosecuted.
c. the provider is prosecuted, but not fined.
d. no further action is taken.

 

 

ANS:  D

Generally, if the compliance officer shows due diligence to correct a problem found, and voluntarily submits documentation and pays back any monies they received because of it, the carrier sees that the provider is attempting to maintain the integrity of their billing and coding and no further action is taken.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 76

 

  1. If an insurance carrier finds an error, they look for:
a. the intent of the error.
b. reasons to sue the physician.
c. who is responsible for the error within the physician’s office.
d. all of the above.

 

 

ANS:  A

Overall, the main focus of these cases is the intention of the provider. Was this act deliberate or intentionally misleading (and thus fraudulent)? Or did the provider and billing staff just make a mistake—that is, commit an infraction? If a case is found to be intentional, the fraudulent acts will lead to prosecution, and, as we have noted, the fines and penalties can be substantial.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 76

 

  1. If a physician receives rewards from a drug manufacturer to prescribe their drugs, this is considered:
a. abuse of privilege.
b. kickbacks.
c. a violation of the Stark laws.
d. all of the above.

 

 

ANS:  D

Kickbacks create in a physician a bias towards promoting certain specialists, treatments, drugs, and other services or products because promoting them brings personal financial gain for that physician. It is also an abuse of privilege and a violation of the Stark Laws.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 76

 

  1. The Medical Practice Act that governs healthcare professionals is regulated:
a. locally.
b. state by state.
c. federally.
d. by all of the above.

 

 

ANS:  B

Each state has its own Medical Practice Act, which provides laws that govern healthcare professionals’ scope of practice and licensing requirements.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 77

 

  1. Physicians are governed not only by state laws but also by:
a. the American Medical Association.
b. the Association of American Physicians.
c. the American Medical Group Association.
d. all of the above.

 

 

ANS:  A

The AMA sets standards for medical education and advancing medical science and has the power to govern physicians, as well as having the power to revoke physician licenses.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 77

 

  1. If a healthcare professional oversteps his or her scope of practice, which can occur?
a. Loss of license
b. License suspension
c. Censure
d. All of the above.

 

 

ANS:  D

Depending on the case and applicable laws, sanctions can include the following, among others: loss of license, suspension of license, loss of membership to the organization, censure, licensing limitations and restrictions, required treatment, and requirements for further education.

 

DIF:    Cognitive Level: Comprehension     REF:   pp. 77-78

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