1. MEDICAL ETHICS, LAW, AND COMPLIANCE
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MEDICAL ETHICS, LAW, AND COMPLIANCE

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.
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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
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4. Key Terms (cont’d) Informed consent Liability Licensure Litigation
Malpractice
Medical practice acts
Registration
Release of information
Settlement
Statute of limitations
Subpoena
Summons
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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
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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
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7. Medical Assistant’s Ethical Responsibility
AAMA Code of Ethics and Creed
Based on AMA code
Medical assistant acts as agent of physician
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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
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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
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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
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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
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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
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13. Medical Law (cont’d) Certified Specialization
American Board of Specialties
“Board Certified”
Additional academic in-hospital training as a resident
Comprehensive certification examination
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14. Medical Law (cont’d) Narcotics Registration DEA permit
Enables physicians to write drug prescriptions
DEA permit
Renewed annually
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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
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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
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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
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18. Consent Implied consent Express consent Not stated outright
Routine treatment only
Express consent
Oral or written
Persons incapable of giving consent may be treated in an emergency
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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29. Good Samaritan Act
Protects physician from liability for civil damages resulting from providing emergency care
Minor variations by state
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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
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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
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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
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33. Confidentiality (cont’d)
Exceptions
Physicians must file statutory reports for
Births
Deaths
Abuse
Wounds resulting from violence
Occupational illnesses
Communicable diseases
Food poisoning
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34. Electronic Transmission of Information
Fax
Confirm receipt of fax
Do not use for confidential information
Health Insurance Portability and Accountability Act (HIPAA)
Regulates how electronic patient information is stored and shared
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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
Risk areas
Coding and billing
Reasonable and necessary services
Documentation
Improper inducements, kickbacks, self-referrals
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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
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37. Medical Assistant’s Role 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
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38. Safeguards Against Litigation
Maintain confidentiality
Promote effective communication between medical assistant and physician, patient, employees
Keep complete and accurate records
Be safety conscious
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39. Quiz Matching Implied consent Fraud
Malpractice
Assault
Bioethics
Improper care or treatment of a patient.
Ethics of treatment, technology, and procedures.
Intentional commission of dishonest act.
Permission that is not stated outright.
Clear threat of injury.
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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.
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