Module 2 - Legal Fundamentals And Medical Ethics

Morals

Personal principles that guide behavior and judgment. (your religious or cultural views).

ethics

The professional standards expected by the healthcare field and your employer.

Medical Laws

Sets official standards that individuals and clinics must follow to avoid legal penalties.

The 4 Principles of Medical Ethics

• Autonomy: Respecting a patient's right to make their own choices about their body, even if you disagree (patient choosing to stop cancer treatment).

• Beneficence: Acting in the patient's best interest to do good (providing care regardless of ability to pay).

• Nonmaleficence: "Do no harm" is the core commitment to avoid hurting or endangering patients.

• Justice: Fair and equal treatment for everyone regardless of race, religion, background, or orientation.

What are two exceptions where private patient information can be shared?

1. The patient signed an authorization of release form.

2. complying with a court order

What constitutes reportable Provider Misconduct?

Knowing that a provider is practicing medicine under the influence of drugs or alcohol (patient safety is always the top priority).

What constitutes reportable Criminal Conduct by a provider?

Illegal actions such as overprescribing opioids or performing unnecessary surgeries falsely labeled as medically necessary.

What must an MA do when their personal morals conflict with a patient's choices?

Set aside personal beliefs and advocate for the patient. Always keep the patient’s morals and preferences at the forefront, never coercing or persuading them.

What is the main goal of healthcare compliance and oversight?

To ensure the highest quality of care is provided to patients while adhering to all laws, standards, and regulations.

What is a benchmark in a medical practice?

A measurable system used to compare and evaluate a practice's performance against national standards

How do laws differ from regulations?

Laws: Created by Congress/Legislatures through the legislative process and apply to everyone equally.

Regulations: Rules established by specific government agencies to enforce passed legislation.

Can a Medical Assistant give legal advice to a patient?

No. Providing legal advice is strictly outside an MA’s scope of practice.

What two main protections does HIPAA provide?

1. Keeps health insurance active when switching/losing jobs.

2. Protects the confidentiality of patient health information (PHI).

What do Americans with Disabilities Act (ADA) and Americans with Disabilities Act Amendments Act (ADAAA) require healthcare facilities to do?

Provide safe access and reasonable accommodations for individuals with disabilities in public spaces and facilities.

What is the main purpose of the Health Information Technology for Economic and Clinical Health Act (HITECH Act)?

It addresses privacy and security concerns specifically related to electronic health records (EHR) and health technology.

What does the Anti-Kickback Statute (AKBS) prohibit?

Receiving financial benefits or rewards in exchange for referrals or business involving federal healthcare programs.

What rights are granted under the Emergency Medical Treatment and Labor Act (EMTALA)?

Guarantees emergency medical treatment regardless of ability to pay.

What rights are granted under the No Surprises Act (NSA)

Protects patients from unexpected, out-of-network surprise bills.

What dose Occupational Health and Safety Administration (OSHA) protect

Enforces workplace safety standards to protect healthcare employees.

What dose Good Samaritan Laws protect

Protect professionals acting within their scope when providing emergency care outside work.

What is the primary purpose of the Affordable Care Act (ACA)?

To make affordable healthcare coverage available to all taxpayers and expand access to health insurance.

What does the Patient Safety and Quality Improvement Act (PSQIA) establish?

A legal framework for gathering and analyzing patient safety data to improve care quality without violating patient privacy laws.

What protections are provided under the Genetic Information Nondiscrimination Act (GINA)?

Protects individuals and employees from being discriminated against based on their genetic information, particularly regarding health insurance coverage and employment.

What are the 3 classifications of HIPAA Security Rule Safeguards?

1. Administrative (policies & training)

2. Physical (workstation & facility security)

3. Technical (access controls & network security)

What are examples of Physical Safeguards?

Screen savers, screen visors (privacy filters), locked doors, and physical workstation security.

What are examples of Administrative Safeguards?

Password rules, mobile device usage policies, security management processes, and workforce training.

What is a Technical Safeguard?

Technology controls that limit access to ePHI (electronic patient health information), such as user login controls, audit logs, integrity controls, and transmission encryption.

What is the main difference between Healthcare Fraud and Abuse?

Fraud: An intentional act or repeated pattern of submitting false claims for higher payment.

Abuse: Practices that are excessive or unnecessary, but not intentionally fraudulent.

What is Upcoding?

Assigning CPT codes for a higher level, longer, or more complex service than what was actually documented or provided.

What is Unbundling?

Billing multiple separate codes for a procedure when a single comprehensive code exists, resulting in a higher total reimbursement.

Name 4 major federal laws governing Medicare fraud and abuse.

1. False Claims Act (FCA)

2. Anti-Kickback Statute (AKS)

3. Stark Law (Physician Self-Referral)

4. Civil Monetary Penalties Law (CMPL)

What is The Joint Commission?

An independent agency that establishes healthcare standards and surveys facilities to ensure safety and quality compliance.

What is the role of the state Department of Public Health (DPH)?

Provides state oversight, investigates safety complaints in healthcare facilities, and reports findings back to Medicare.

What is Accreditation and why do facilities seek it?

Formal verification by an outside agency that a facility meets established standards of safety and care. It is often required to receive Medicare reimbursement

False Claims Act (FCA)

It is illegal to bill Medicare or Medicaid for services that weren't done, were done wrong, or were billed incorrectly.

Physician Self-Referral Law (Stark Law) 

A doctor cannot refer a Medicare patient to an MRI clinic, lab, or pharmacy if the doctor (or their family) profits from that business.

Civil Monetary Penalties Law (CMPL)

A law that gives the government power to hit clinics with massive cash fines or ban them from treating Medicare patients if they commit fraud or break billing laws.

What is Healthcare Certification?

Official proof from an outside agency that a healthcare facility meets high safety and quality standards (an "approval seal" needed for insurance reimbursement).

What is the difference between Accreditation and Certification?

Accreditation evaluates the entire facility for overall safety and operational standards.

Certification evaluates a specific program, specialty service, or individual for meeting expert quality standards.

Duty of Care

The legal obligation to care for a patient (begins when care is agreed upon).

Standard of Care:

The level of care a competent, skilled healthcare professional is expected to provide.

What are the 4 Ds of Negligence that must be proven in court?

1. Duty: Duty of care was owed.

2. Dereliction: Failure to provide standard care.

3. Direct Cause: Breach directly caused the injury.

4. Damages: Patient suffered actual loss or harm.

Criminal Law

Offenses against society (assault, theft, fraud) resulting in arrest/jail.

Civil Law

Disputes between individuals/entities (malpractice, negligence) resulting in monetary fines/damages.

What is the difference between Assault and Battery in healthcare?

Assault: Threatening physical harm (telling a patient you'll force a shot on them).

Battery: Unconsented physical contact (shoving or physically forcing a procedure)

What is False Imprisonment in a medical setting?

Intentionally detaining or preventing a patient from leaving voluntarily without legal authority (locking a confused patient in an exam room).

What is the difference between Slander and Libel?

Slander: Spoken false statements that damage a person's reputation.

Libel: Written or published false statements ( social media posts) that damage reputation.

What is Malfeasance?

Performing an illegal or completely wrongful act (an MA giving pain meds without a doctor's order).

What is Misfeasance?

Performing a legal act improperly or incorrectly (accidentally giving the wrong dose of a prescribed med).

What is Nonfeasance?

Failing to act when under a legal duty to do so (ignoring a patient's adverse drug reaction and sending them home).

Res Ipsa Loquitur

"The thing speaks for itself"—the error is obvious ( surgical sponge left inside a patient).

Respondeat Superior:

"Let the master answer" employers are legally responsible for employees' actions within their job scope.

What is the difference between a Subpoena and a Subpoena Duces Tecum?

Subpoena: A court order requiring an individual to appear in court as a witness.

Subpoena Duces Tecum: A court order requiring specific medical records or documents to be brought to court.

What is Patient Abandonment?

A provider stopping patient care without giving sufficient notice or providing an equally qualified replacement.

Tort

Meaning “wrong”; a harmful act committed by one individual to another.

What is the core role of the patient in their own healthcare?

The patient is considered part of their healthcare team and ultimately oversees and makes decisions regarding all aspects of their care.

What are key decision-making rights guaranteed under the Patient Bill of Rights?

The right to agree to or refuse treatment, make decisions about their plan of care, and create advance directives.

What financial and informational rights do patients have regarding their care?

The right to know immediate/long-term financial costs, obtain accurate medical information, review their own records, and know the identity of their care team.

What is "The Patient Care Partnership"?

A document created by the American Hospital Association that explains in easy-to-understand language what patients can expect during a hospital stay.

What does Section 1557 of the Affordable Care Act (ACA) enforce?

It prohibits discrimination in health services or coverage based on race, color, national origin, sex, age, or disability.

Which government agencies enforce non-discrimination rules under Section 1557?

The Office for Civil Rights (OCR) and the Department of Health and Human Services (HHS).

What rights do patients have regarding medical research studies?

Patients have the right to consent to or refuse participation in any research study without affecting their standard care.

What is Informed Consent?

A formal written consent required for invasive procedures, major treatments, or high-risk medications. The patient must understand the risks, benefits, and alternatives before signing.

What is Expressed Consent?

Permission given verbally (out loud) without signing a written form. It is typically used for routine diagnostic procedures, such as getting an X-ray.

What is Implied Consent?

Agreement shown through a patient's actions or passive cooperation without formal verbal or written discussion ( rolling up a sleeve for a blood draw).

What is an incident report used for in a medical practice?

To document accidents (like patient falls or needlestick injuries) with factual information for risk management and adverse outcome tracking.

Who must sign an incident report after an event occurs?

The injured party and the practice administrator.

What key details must be included in an incident report?

Date/time, location, detailed description, witnesses, notified provider, treatment provided, and suggestions for corrective action.

Should an incident report include opinions or personal feelings about who was at fault?

No. Incident reports must contain strictly factual information about what happened and the immediate response.

Which clinical events must be reported to public health agencies?

Certain STIs (syphilis), contagious diseases (TB, flu outbreaks), vaccines given, parasitic infections, and violent injuries (gunshot/stabbing wounds).

Is patient-identifying information always shared in public health reporting?

Usually no. Most reports only submit data points for public health trending, unless contact tracing is required for a contagious disease exposure.

Who holds primary responsibility for filing public safety reports?

The provider holds primary responsibility, but the task is frequently delegated to the Medical Assistant to complete and submit.

What is the main purpose of contact tracing performed by public health agencies?

To identify, contact, and notify individuals who may have been exposed to a highly contagious disease or public health risk.

What is the very first thing an MA should do if they commit a medical error (wrong vaccine dose)?

Immediately report it to the provider or supervisor and complete legal documentation so the patient can be cared for safely.

Why are medical errors generally viewed as system failures rather than individual failures?

Most errors occur because of flawed processes or unsafe systems, which is why healthcare employers use a nonpunitive approach to learn and fix the workflow.

What agency should be notified if a clinic repeatedly ignores workplace safety guidelines (like PPE or biohazard disposal)?

OSHA (Occupational Safety and Health Administration), which investigates workplace hazards and issues fines or mandates corrective actions.

How does transparent reporting protect the medical practice and the public?

It provides legal protection, creates learning opportunities to prevent future mistakes, and prevents exposure to communicable diseases or hazards

What is a conflict of interest in healthcare?

When a provider's business, personal, or financial interests improperly influence their medical judgment and patient care decisions.

What are Advance Directives (Living Wills)?

Legal documents prepared by a competent person specifying their healthcare preferences in the event they become incapacitated or terminally ill.

What specific care provisions are typically outlined in an advance directive?

Desires regarding life-sustaining measures (ventilators, artificial feeding/hydration), organ donation, and CPR preferences.

What is a Do Not Resuscitate (DNR) order?

A physician's order instructing healthcare teams not to attempt CPR or life-saving resuscitation if the patient stops breathing or their heart stops

How can a patient revoke or change an advance directive?

At any time by verbally communicating the decision to their provider, physically destroying the original document, or executing a new one.

What is a POLST or MOLST document?

Physician/Medical Orders for Life-Sustaining Treatment: Portable medical orders for seriously ill or frail patients that transfer across all care settings.

What is a Durable Power of Attorney for Healthcare (Healthcare Proxy)?

A designated, trusted individual legally authorized to make healthcare decisions for a patient if the patient becomes unable to decide for themselves.

What is the Medical Assistant's responsibility regarding advance directives?

To act as a patient advocate by ensuring the care team is aware of the directive and that the patient's wishes are respected.