Chapter 3 Legal Issues

Health Information Primary role in the delivery of care Serves as legal record of patient care Subject to stringent oversight HIPAA Laws, regulations, rules, requirements, standards Types of laws

Governmental Entities Branches of government Separation of powers CMS IHS VA FDA

Nongovernmental Entities JCAHO AOA HFAP Deeming authority Other accrediting bodies

Role Application Health record content Completeness “Not documented, not done” Record retention policies

Court System Judicial branch of government Jurisdiction, trials, and appeals Administrative bodies Legal procedures

Principles of Liability Fear of liability for injury Relationship with patients Breach of contract Intentional torts Nonintentional torts

Medical Records and the Law Records a particular episode of a patient’s care Serves as legal record in liability suits and in criminal actions Determines if standard of care was met Used as evidence in credentialing Other uses

HIPAA - Simplification Increased use of electronic patient information for administrative simplification Decrease in costs DHHS Privacy and Security Rules Enforcement responsibilities

HIPAA – Fraud and Abuse New criminal and civil enforcement tools Healthcare Fraud and Abuse Control Program Medicare Integrity Program Beneficiary Incentro Program

Privacy and Confidentiality Individual identifiers under HIPAA De-identified health information Notice of privacy practices to each patient is required

Access to Health care Data Increased demand for health care data Authorizing release of information Core elements of a valid Release of Information Form Minimum necessary standard Checkpoint: Who owns the information? Who can grant authority to release the

HIPAA – Fraud and Abuse Medicaid Fraud and Abuse National Initiative Healthcare Fraud and Abuse Data Collection Program

Identity Theft Unlawful use of another’s identity Frequency is on the rise Possible consequences Preventive measures

Informed Consent Increased demand for information Implied informed consent Expressed informed consent Advance directives Durable power of attorney for health care Living will

Judicial Processes Subpoena Subpoena duces tecum Court order Liability for breach of confidentiality Penalties for failing to obey subpoena or court order

Fraud and Abuse Fraud Abuse Waste Upcoding Unbundling

Fraud and Abuse Laws Must be knowledgeable to minimize exposure to liability Whistle-blowers Major laws addressing fraud and abuse HIPAA

Combating Fraud and Abuse Office of Inspector General of DHHS Postal Inspection Service Federal Bureau of Investigation (FBI) Defense Critical Investigative Services (DCIS)

Compliance Programs Voluntary, not mandated Corporate compliance programs Corporate integrity agreement (CIA) Automated coding software