1. Chapter 3
Legal Issues

2. 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

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

4. Nongovernmental Entities
JCAHO
AOA
HFAP
Deeming authority
Other accrediting bodies

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

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

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

8. 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

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

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

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

12. 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

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

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

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

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

17. Fraud and Abuse
Fraud
Abuse
Waste
Upcoding
Unbundling

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

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

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