Medlegal: Chapter 6 & 16

Procedural due process may apply to:

- a physician's medical staff membership at a hospital - disciplinary actions taken against an HIM employee

Challenges to tax exempt corporations operating with a charitable purpose include:

- aggressive billing practices - insufficient charity care provided - inflated billing practices toward the uninsured

Active physicians on a hospital medical staff have an obligation to perform the following duties?

- complete records in a timely manner - take night call - treat patients regardless of ability to pay - serve on medical staff committees

Credentialing refers to the process of reviewing and validating the qualifications of physicians and other licensed practitioners for granting medical staff membership to provide patient services. It serves as a form of protection for at least four areas. Briefly discuss at least two of these areas:

- protect the public from professional incompetence - protect the medical staff from working with incompetent professionals - protect the facility from liability due to providing inadequate care - protect the rights of the medical staff from unfair restrictions on their practice LOOK UP IN THE BOOK

Which of the following characterizes a corporation?

-It is separate from it's owners or incorporators -It can sue or be sued -It can continue to exist despite an owner's death

Fiduciary duty includes:

-duty of responsibility -duty of loyalty

Economic credentialing:

-may be associated with physicians who have an ownership in competing hospitals -may be based on a perceived loss of loyalty by a physician -may be associated with a review of a physician's volume of cases

Name at least 5 common categories of information on a medical staff application and why you think they are important to the application process:

Board certifications: because you need to make sure they are certified and have passed all their boards to be a licensed physician/doctor Medical education: so that facilities know that the employees they are looking at to hire have the proper education and will help the facility grow Peer references: because new employers may want to know their work ethic, if any complaints were drawn up against them, what their history is as an employee, why they quit their previous job ETC.

Which of the following is an artificial being created per state statutory authority?

Corporation

A corporation's governing board members have fiduciary duty to the corporation. Describe the elements that are part of fiduciary duty. Give an example where each might be violated:

Duty of loyalty: board members must put the interests of the corporation ahead of their own personal interests. -Example of violation: conflict of interest, where a board member puts his own personal interest above that of the corporation on which he serves Duty of responsibility: board members must act with due care in exercising their duties. -Example of violation: lack of due diligence, where a board member does not exercise a legally acceptable level of care in overseeing the corporation's performance.

"Piercing the corporate veil" enables the owners of a corporation to be shielded from liability for wrongdoing committed through the corporation.

False

A breach of contract judgment always requires monetary compensation.

False

A healthcare organization does not have a duty to share information on a practitioner upon legitimate request.

False

A healthcare organization may not form as a partnership.

False

A not-for-profit corporation is prohibited from making money.

False

All restraints of trade are per se antitrust violations.

False

An adverse action against a physician is not reportable to the National Practitioner Data Bank.

False

Antitrust claims are only valid if they relate to an entire group of individuals who have been denied privileges at a healthcare organization.

False

Antitrust violations are generally governed by individual state laws.

False

Courts uphold all non-compete agreements in order to protect the livelihood of organizations that an employee or contractor leaves for other opportunities.

False

Economic credentialing is the granting of medical staff privileges based on quality of care indicators.

False

To be valid, a contract must be in writing.

False

Which of the following is not a federal antitrust law?

HIPPA

Which of the following offers both civil and criminal penalties:

Sherman Act

A "hold harmless" clause may provide for compensation by one individual to another.

True

An acceptance of an offer reflects a meeting of the minds regarding the contract terms.

True

Credentialing is the process of reviewing and validating qualifications of practitioners for granting medical staff membership.

True

Due process is required in the hiring and disciplinary process that affects a practitioner's medical staff privileges or employment.

True

Fiduciary duty includes the duty of loyalty and the duty of responsibility.

True

If a practitioner is assigned a medical staff category of "associate" , he or she can chair the medical staff executive committee.

True

Joint commission standards require that the medical staff bylaws address issues of self-governance and accountability to the governing board.

True

Medical staff bylaws are considered a contract and are legally binding in most states.

True

Medical staff credentialing can lead to antitrust concerns.

True

Mistake of fact is a potential defense for nonperformance of a contract.

True

The National Practitioner Data Bank enables a healthcare facility to check on the background of a practitioner to determine if the practitioner has had his or her license to practice suspended for any reason.

True

The Sherman Act in the oldest of the three major federal antitrust statutes.

True

The medical staff has the ultimate responsibility for the quality and financial well-being of the health organization.

True

The number of procedures performed by a provider may be linked to clinical performance and quality issues when determining medical staff privileges.

True

The owners of a corporation are generally shielded from personal liability for the debts of the corporation, although the corporation itself can sue and be sued.

True

The process for verifying the credentials of a physician who wishes to join a medical staff is referred to as primary source verification.

True

There are nine safety zones in healthcare that the federal government will generally not challenge as antitrust violations.

True

A group boycott is a per se antitrust violations.

Trust

General Hospital is a 1000-bed facility. Mercy Hospital is a 100-bed facility. They join to for one corporation, which is named General Hospital. The restructuring that has most likely occurred is a :

acquisition

Which of the following describes a responsibility of corporation's governing board members?

appointing medical staff members

Bylaws:

are the internal rules of an organization

A term used to describe standard contract terms is:

biolerplate

A physician has been found to have breached his contract with a patient through abandonment. As a remedy, the court may order the following:

compensatory damages

Which of the following is NOT a required element for piercing the corporate veil?

corporation is a not-for-profit entity

Which of the following characterizes a joint venture?

created for both a specific purpose and designed to have a limited lifespan

Which of the following statements is NOT true regarding the National Practitioner Data Bank?

discloses information related to the professional competence of physicians, dentists, and other healthcare practitioners based on authorization from practitioner

Ultra vires acts are those that

exceed a corporation's powers

Which of the following actions related to the medical staff might raise antitrust issues:

excluding entire classes of practitioners from medical staff membership

A publicly held corporation:

generally has thousands of shareholders

Which of the following is ultimately responsible for the quality of care in a hospital?

governing board

"Piercing the corporate veil" refers to:

holding corporation owners liable for bad acts

What classification of medical staff membership denies admitting privileges but recognizes the contributions and reputations of its members?

honorary

Medical staff bylaws are legally binding and any changes must be approved by a vote of which of the following?

medical staff

Which of the following governs the operation of a hospital medical staff?

medical staff bylaws

The Joint Commission's requirements for the minimum contents of the medical staff bylaws include all but which of the following:

medical staff infection control committee

Noncompete agreements:

might violate antitrust law

Contracts:

must contain an offer and acceptance

A not-for-profit corporation that is formed for a charitable purpose:

must meed IRS-established criteria to be tax-exempt

Procedural due process includes which of the following elements?

notice and an opportunity to be heard

A not-for-profit corporation may:

pay reasonable salaries to its employees

In the "learned intermediary" defense used by HIT vendors, who is the learned intermediary?

physician

Through the establishment of the National Practitioner Data Bank, the federal government became involved in malpractice issues and what other issue?

quality of care

Which of the following is NOT a defense for nonperformance of a contract?

specific performance

When two or more entities at different levels in a distribution chain act together to restrain trade, this is:

vertical restraint of trade