Medical Law, Ethics, and Compliance practice questions

Answer: A) Promptly complete an incident report of objective facts and route it through the office's internal reporting process

A fall on the premises is documented promptly on an incident report that contains only objective facts. The report goes through the office's internal reporting process rather than into the patient's medical record.

• ACorrect. Accidents on the premises are documented promptly on an incident report, following office policy. The report states objective facts such as the time, the location, what was observed and who helped. It is an internal risk-management document, so it is handled through the office's reporting process and kept separate from the patient's chart.
• BIncorrect. The timing and content are right, but incident reports are internal quality and risk-management documents. They are not filed in the patient's medical record.
• CIncorrect. An incident is reported when it happens, whether or not an injury is apparent. Injuries can show up later, and details are most accurate while they are fresh.
• DIncorrect. Incident reports record observable facts. Opinions, guesses and blame do not belong in them.

Answer: A) Keeping promises and commitments

• ACorrect. It builds trust.
• BIncorrect. That's beneficence.
• CIncorrect. That's veracity.
• DIncorrect. That's nonmaleficence.

Answer: C) Implied consent

• AIncorrect. The patient agreed.
• BIncorrect. Nothing was written.
• CCorrect. The patient's action implies consent.
• DIncorrect. Consent was given by action.

Answer: B) For the longer of the periods required by the rules that apply

Record retention periods come from state law and from federal and payer rules. When these differ, the practice must keep records for the longer, more stringent period.

• AIncorrect. States generally set retention periods, but a provider is also bound by any federal or payer rules that apply to it. CMS guidance says to comply with whichever requirement is more stringent.
• BCorrect. CMS guidance says providers must meet the more stringent of the applicable state and federal requirements. For example, 42 CFR 424.516(f) requires certain Medicare documentation to be kept for 7 years from the date of service, even if a state allows a shorter period.
• CIncorrect. Cost or convenience does not allow a practice to drop below a legally required retention period. Destroying records early breaks the longer applicable rule.
• DIncorrect. Retention periods are set by law and regulation, often counted from the date of service. They are not tied to when a bill is paid.

Answer: B) Assault

• AIncorrect. Battery is the contact itself.
• BCorrect. Assault is the threat; battery is the actual touching.
• CIncorrect. This is written defamation.
• DIncorrect. This is failure of reasonable care.

Answer: C) Making hiring, firing or pay decisions based on race, color, religion, sex or national origin

Title VII bans employment discrimination based on race, color, religion, sex or national origin. It applies to employers with 15 or more employees. Overtime, patient privacy and medical leave fall under other laws.

• AIncorrect. Overtime pay for nonexempt workers comes under the Fair Labor Standards Act (FLSA), not Title VII.
• BIncorrect. Privacy of protected health information comes under HIPAA, not Title VII.
• CCorrect. Under 42 U.S.C. 2000e-2, an employer may not refuse to hire, fire, or otherwise discriminate in pay or terms of employment based on race, color, religion, sex or national origin. Title VII covers employers with 15 or more employees.
• DIncorrect. Job-protected medical leave comes under the Family and Medical Leave Act (FMLA), not Title VII.

Answer: C) Report the concern as state law and office policy require, often to Adult Protective Services

Suspected elder neglect should be reported as state law and office policy require, usually to Adult Protective Services, or to 911 if the person is in urgent danger. Staff should not investigate or wait for visible injuries.

• AIncorrect. Neglected older adults often cannot or will not ask for help. Staff should report a reasonable suspicion as state law and office policy require, without waiting for the patient to raise it.
• BIncorrect. Office staff are not supposed to investigate. Questioning the suspected caregiver can put the patient at greater risk, and investigating is the job of agencies such as Adult Protective Services.
• CCorrect. Federal health guidance says to call 911 if an older person is in urgent danger and otherwise to contact Adult Protective Services. State law decides who must report and how, so staff should follow those rules and the office's procedure.
• DIncorrect. Neglect means failing to meet basic needs such as food, hygiene and essential medical care. It can be present without any visible injury, so waiting for injuries delays protection.

Answer: A) Procedures to create and maintain retrievable exact copies of ePHI

The HIPAA Security Rule's data backup plan means procedures to create and maintain retrievable exact copies of ePHI, so data can be recovered after events such as fire, vandalism, system failure or natural disaster.

• ACorrect. 45 CFR 164.308(a)(7)(ii)(A) describes the data backup plan as procedures to create and maintain retrievable exact copies of electronic protected health information.
• BIncorrect. That describes the disaster recovery plan, a separate specification. Recovery relies on backups, but the backup plan itself is about creating and keeping exact copies.
• CIncorrect. Giving patients copies of their records falls under the Privacy Rule's individual right of access, not the Security Rule's contingency plan.
• DIncorrect. That describes the applications and data criticality analysis, which supports the other contingency plan components. It does not create copies of ePHI.

Answer: B) Duty, dereliction, direct cause and damages

• AIncorrect. Those aren't the elements.
• BCorrect. All four must be proven.
• CIncorrect. Those aren't the elements.
• DIncorrect. Those aren't the elements.

Answer: B) Fill out the prescription and place it with the chart for the provider to review and sign

An assistant may prepare a prescription or refill request, but only the prescribing practitioner may sign or authorize it. Signing, stamping, or approving it for the provider is outside the assistant's scope.

• AIncorrect. Only the prescribing practitioner may sign a prescription. Adding initials does not make it legal for someone else to sign the provider's name; it is still a forged signature.
• BCorrect. Under federal rules, a secretary or agent may prepare a prescription for the practitioner's signature. The practitioner then signs it and remains responsible for it.
• CIncorrect. A stamp put on by the assistant is not the practitioner signing the prescription. The prescriber has to review and sign it personally.
• DIncorrect. Approving a refill is a clinical decision for the prescriber. An assistant who authorizes it on their own acts outside their scope and misrepresents the provider.