Administrative medical assisting 5th by lindh chapter07

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Chapter 7

Legal Considerations

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• Failure to perform an act, official duty, legal requirement

– In a civil case, a plaintiff brings charges against a defendant

– Common forms of civil law are administrative,

contract, and tort law

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Administrative Law

• IRS

• Medicare/Medicaid

• Title VII of the Civil Rights Act of 1964

– Protects employees from discrimination

– Harassment

• Equal Pay Act (EPA) of 1963

• Federal Age Discrimination in

Employment Act of 1967

Administrative Law

• Americans with Disabilities Act (ADA) of

1990

– Title I prohibits discrimination in employment

– Titles II–IV mandate access to public services by individuals with disabilities

• Family and Medical Leave Act (FMLA)

of 1993

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Administrative Law

• Health Insurance Portability and

Accountability Act (HIPAA) of 1996

– Requires national standards for electronic health care transactions

– Assists in making health insurance more

affordable and accessible when people change or lose their jobs

– Identified in Titles I–VII

Administrative Law

• Occupational Safety and Health Act (OSHA) of 1967

• Controlled Substances Act of 1970

– Five schedules (I, II, III, IV, V) according to potential for abuse and dependence

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Administrative Law

• Uniform Anatomical Gift Act of 1968

• Regulation Z of the Consumer

Protection Act of 1967 (Truth in Lending Act)

• Medical Practice Acts

– Majority of provider–patient contracts

• Contract to be valid and binding, parties who enter into it must be competent

• MAs considered agents of their

employers

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Contract Law

• Termination of contracts

– Patient discharges provider

– Provider formally withdraws from patient care – Treatment no longer needed by patient

• Derelict: breach of duty of care

• Direct cause: legally recognizable injury occurs as a result of the breach of duty of care

• Damage: wrongful activity must have caused injury or harm that occurred

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Tort Law

• Standard of Care and Scope of Practice

– Medical Assistant’s role in negligence

• Practice within scope of one’s instruction and education

• Each state is likely different

• Torts are intentional or negligent

• Intentional torts deliberate acts violating another’s rights

• Negligent torts not deliberate; result of omission or commission of an act

• Res ipsa loquitur and respondeat superior

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Informed Consent

• Nature of any procedure and how it is performed

• Possible risks as well as expected

outcomes of any procedure

• Any other methods of treatment and those risks

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Risk Management

• Practicing good risk management

makes MA and provider less vulnerable

to litigation

• Avoid incidents that may lead to

litigation

Risk Management

• Professional liability coverage

– Cover costs of litigation that may occur

– Health care employees need their own

professional liability coverage

– MAs can purchase from American Association of Medical Assistants (AAMA)

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Civil Litigation Process

– For courts to have access to some records, a

court order required in many states

– HIPAA law requires clinics to identify what

information they will release regarding patients

Civil Litigation Process

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Civil Litigation Process

• Trial

– Held before a judge

– Held before judge and a jury

– If plaintiff’s case successful, judge or jury may

award specific amount of money or damages

– If defendant’s case successful, case is dismissed

Statutes of Limitations

• Begin at time negligent act was

committed

• When act discovered

• When care of patient and provider–

patient relationship ended

• Time limit for individuals to initiate legal action

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Public Duties

• Reportable diseases/injuries

– “Nationally Notifiable Infectious Diseases” listed on CDC’s Web site ( http://www.cdc.gov )

– Electronic or telephone reporting

– Local or state health departments provide lists of diseases and injuries

Public Duties

• Abuse

– Child abuse

– Elder abuse

– Intimate partner violence (IPV)

• Good Samaritan laws

– Encourage health care professionals to provide medical care within scope of training without fear

of being sued for negligence

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• Advanced directives provided to

patients’ providers, family members,

any agent identified