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Chapter 5

Legal and Regulatory Issues

Statutory Law Laws passed by legislative bodies
Case Law (Common Law) Based on court decisions that establish a precedent
Precedent Standard/common law
Civil Law Deals with all areas of the law that are not classified as criminal.( dogs barking)
Criminal Law Public law that defines crimes and their prosecution. Property damage
Subpoena Order of the court that requires a witness to appear at a particular time and place to testify.
Subpoena Duces Tecum ordered by a judge to bring a patient's medical record to court hearing
Deposition Testimony under oath taken outside of court
Interrogatory a list of questions that must be answered in writing.
Qui Tam private citzens to file a lawsuit in the name of the government
Record Retention Storage of documentation for an established period of time
Fraud An intentional deception or misrepresentation that someone makes
Abuse Involves actions that are inconsistent with accepted
Privileged Communication Any information communicated by patient to a healthcare provider
Protected Health Information (PHI) Information that is identifiable to an individual such as name
Privacy Right of individuals to keep their information from being disclosed to others
Confidentiality Involves restricting patient information access to those with proper authorization and maintaining the security of patient information
Security Safekeeping of patient information
overpayments receives in excess of amounts due and payable under Medicare and Medicaid statues and regulations.
authorization official permission or approval prior to disclosing the individuals information
Medicare Conditions of Participation the retention of patient records in their original or legally reproduced form for a period of at least 5 years (CA 7-10 )
Department of Health and Human Services Office to the Inspector General prepares the case for referral to the Department of Justice for criminal and or civil prosecution. A person guilty of Medicare fraud faces criminal
HIPAA - Health Insurance Portability and Accounting Act 1996 improves the portability and continuity of health insurance
HIPAA title I Health Care Access Portability and Renewability
HIPAA title II Preventing Health Care Fraud and Abuse
medically necessary providing the reasons why treatment is medically necessarey
ARRA protects whistle blowers
What special handling is required to release medical information for a patient who is HIV- positive the patient should sign an additional authorization statement for release of information
Created by: 643565250