Regulatory Compliance & Legal Framework Flashcards

When a cosmetic surgeon's employee discovers a potential HIPAA breach involving unauthorized access to patient records, the covered entity's breach notification obligation under the HIPAA Breach Notification Rule requires notifying affected individuals within:

Answer: No more than 60 days of discovery of the breach

The HIPAA Breach Notification Rule requires covered entities to notify affected individuals without unreasonable delay and no later than 60 calendar days following discovery of a breach.

A cosmetic surgery practice's use of a patient's before-and-after photos on its website for marketing purposes without the patient's written authorization violates:

Answer: HIPAA's prohibition on using PHI for marketing without authorization

Before-and-after photos constitute PHI, and using them for marketing purposes without the patient's specific written authorization violates HIPAA's Privacy Rule restrictions on PHI use.

A cosmetic surgeon facing a state medical board investigation for unprofessional conduct has the constitutional right to:

Answer: Due process, including notice of charges and an opportunity to be heard

Professional license holders have a protected property interest in their license, entitling them to procedural due process—notice of charges and a meaningful opportunity to respond—before deprivation.

The practice of 'upcoding' in cosmetic surgery billing—billing for a more complex service than was actually performed—constitutes:

Answer: Healthcare fraud under the False Claims Act and potentially the federal healthcare fraud statute

Intentional upcoding constitutes healthcare fraud, potentially violating the False Claims Act and the federal healthcare fraud statute (18 U.S.C. § 1347), which can result in civil and criminal penalties.

Which of the following scenarios most clearly constitutes an illegal 'kickback' under the federal Anti-Kickback Statute?

Answer: A medical spa paying a cosmetic surgeon a per-referral fee for sending patients for laser treatments

Paying a physician a per-referral fee for directing patients to a healthcare business constitutes remuneration intended to induce referrals, which is prohibited by the Anti-Kickback Statute.

A cosmetic surgeon operating an accredited office-based surgical facility is required by most state regulations and accreditation standards to have immediately available:

Answer: Emergency resuscitation equipment, including a defibrillator and reversal agents, and a transfer agreement with a nearby hospital

Accreditation standards and most state office surgery regulations require that facilities have emergency resuscitation equipment and a written transfer agreement with a nearby hospital to manage life-threatening complications.

Under the Federal Trade Commission Act, a cosmetic surgery practice's claim that a procedure produces 'permanent results' when long-term efficacy has not been established would be considered:

Answer: An unfair or deceptive trade practice subject to FTC enforcement

The FTC prohibits unfair or deceptive acts in advertising; claiming permanent results without adequate substantiation is a deceptive practice subject to FTC enforcement action.