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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.
Chapter 2 3
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
Chapter 2 4
Key Terms (cont’d)
Informed consent Liability Licensure Litigation Malpractice Medical practice acts Registration Release of information
Settlement Statute of limitations Subpoena Summons
Chapter 2 5
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
Chapter 2 6
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
Chapter 2 7
Medical Assistant’s Ethical Responsibility
AAMA Code of Ethics and Creed Based on AMA code Medical assistant acts as agent of physician
Chapter 2 8
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
Chapter 2 9
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
Chapter 2 10
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
Chapter 2 11
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
Chapter 2 12
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
Chapter 2 13
Medical Law (cont’d) Certified Specialization American Board of Specialties “Board Certified”
Additional academic in-hospital training as a resident
Comprehensive certification examination
Chapter 2 14
Medical Law (cont’d)
Narcotics Registration Enables physicians to write drug
prescriptions DEA permit
Renewed annually
Chapter 2 15
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
Chapter 2 16
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
Chapter 2 17
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
Chapter 2 18
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
Chapter 2 19
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
Chapter 2 20
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
Chapter 2 21
Medical Liability Legal responsibility for actions or
nonactions and their consequences Responsible for patients Responsible for
Safety of employees Safety of premises
Defensive medicine
Chapter 2 22
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
Chapter 2 23
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
Chapter 2 24
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
Chapter 2 25
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
Chapter 2 26
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
Chapter 2 27
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
Chapter 2 28
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
Chapter 2 29
Good Samaritan Act Protects physician from liability for
civil damages resulting from providing emergency care Minor variations by state
Chapter 2 30
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
Chapter 2 31
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
Chapter 2 32
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
Chapter 2 33
Confidentiality (cont’d)
Exceptions Physicians must file statutory reports for
Births Deaths Abuse Wounds resulting from violence Occupational illnesses Communicable diseases Food poisoning
Chapter 2 34
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
Chapter 2 35
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
Chapter 2 36
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
Chapter 2 37
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
Chapter 2 38
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.