Healthcare Delivery Exam 3

Healthcare Law, Healthcare Tech, and Financing (Slide )

What is “law” in the slides?

a body of rules for the conduct of individuals and organizations

What are some important aspects of law?

1) Often interpreted differently and may change over time

2) Created so there is at least a minimal standard of action required by individuals/orgs

3) Created by federal, local and state governments4) Enforced through government mechanisms of penalties or sanctions.

What is common law?

When the judiciary system makes decisions on a case based off of previous legal decisions about past cases

What is the minimal standard for action?

Federal law, but state laws may be stricter

What are statutes?

Laws created by legislation

T or F: Both common and statutes are interpreted by administrative agencies by developing rules and regulations that interpret the law

True

What is Civil Law?

Focuses on the wrongful acts agaisnt individuals/orgs based on contractual violations

What is a tort

“A wrong”. A wrongful act, considered under the category of civil law, but may not have a preexisting contractthat causes harm or loss to another person, allowing the injured party to seek legal remedy.

T or F: To prove a civil infraction, you need just as much evidence as a criminal case

False, criminal cases need more

What is criminal law?

Concerned with actions that are illegal based on court decisionsWhat

What is important to remember about criminal law?

1) In order to convict someone of a criminal activity, it has to be proven without reasonable doubt of guilt

What are some examples of criminal law infractions?

Medicaid or Medicare fraud

What is the American Heritage Dictionary’s definition of medical malpractice?

improper or negligent treatment of a patient by a provider, which results in injury, damage, or loss

T or F: Medical malpractice has resulted in over 200,000 deaths per year

False 80-100k

T or F: Patients have sued providers bc they feel they were not given the proper level of care compared to the standard in the industry

True

What is the general requirement for a patient to sue a provider based on standard of care?

The patient must show that the provider acted negligently in rendering care, and that such negligence resulted in an injury

What are the four specific requirements to sue a provider for negligence?

1) Professional Duty owed to the patient

2) Breach of such duty

3) Injury caused by the breach

4) Resulting damages

T or F: Money damages, if awarded, only provide for the economic loss that occured

False, it also accounts for pain/suffering that ocurred as a result

What is the definition of negligence

Unintentional act or omission of an act that would contribute to the positive health of the patient

What is an intentional tort

Assault/battery or invasion of privacy (surgeon performing surgery on a patient without consent)

T or F: As a result of the number of malpractice suits in the US, malpractice insurance premiums have raised

True

What is defensive medicine

Providers order more tests or lab work than necesary to protect themselves from any potential malpractice suits

T or F: There is no cap on the amount someone can claim in malpractice claims

False, there are statutory caps in place to limit the amount

Why did states feel the need to introduce a statutory cap on malpractice claims?

The less an insurance company has paid out in insurance claims, the less they have to raise insurance rates

T or F: Voluntary hospitals are exempt from malpractice suits

False, they used to be but are no longer

T or F: The fact that employers have to take responsibility for their employees wrongdoing has increased malpractice claims

True

The concept of informed consent being expanded has had what effect on malpractice claims?

Increased them

“Standard of care” has become what kind of standard in the US, and what has it done for malpractice claims?

State or national standard, and has increased claims

What did the supreme court state about malpractice claims and income?

They must be included as taxable income to the person who made the claim

What is the most common violation in the healthcare system?

Healthcare fraud (illegal acts for financial gain)

What is the Medicar Fraud Strike Force?

A task force that uses both federal and local law enforcement agencies to combat healthcare fraud

What has the effect of the Medicare Fraud Task force?

They recoup 4$ for every 1$ spent, and combat all kinds of medical abuse