CCM Ethical Principles and Conduct 2 — Questions and Answers
Question 1: A case manager discovers that a client's employer-sponsored insurance plan is denying a medically necessary treatment. What is the case manager's primary ethical obligation?
- Accept the insurer's decision without question
- Advocate for the client's right to medically necessary care (Correct answer)
- Advise the client to pay out-of-pocket to avoid conflict
- Refer the client to another provider without follow-up
Correct answer: Advocate for the client's right to medically necessary care
Advocacy is a core ethical duty of case managers, requiring them to actively support clients' access to medically necessary care.
Question 2: Which ethical principle is BEST reflected when a case manager ensures a client fully understands the risks and benefits of a proposed treatment before agreeing to it?
- Nonmaleficence
- Justice
- Autonomy (Correct answer)
- Fidelity
Correct answer: Autonomy
Respecting autonomy requires that clients receive complete information to make voluntary, informed decisions about their care.
Question 3: A case manager learns that a colleague is falsifying documentation to obtain insurance approvals. What should the case manager do FIRST?
- Ignore it to preserve workplace relationships
- Confront the colleague privately and then report if not resolved
- Immediately report to the appropriate supervisory or regulatory authority (Correct answer)
- Help the colleague correct the documentation quietly
Correct answer: Immediately report to the appropriate supervisory or regulatory authority
Falsifying documentation is fraud; the case manager's ethical and legal duty requires prompt reporting to appropriate authorities.
Question 4: When a case manager works for both a health plan and provides services to its members, which ethical issue is MOST likely to arise?
- Scope of practice violation
- Dual relationship conflict
- Conflict of interest (Correct answer)
- Breach of confidentiality
Correct answer: Conflict of interest
Serving both the payer and the client creates a conflict of interest, as the case manager's loyalties may be divided.
Question 5: A terminally ill client requests information about hospice care but family members ask the case manager to withhold this information. The case manager should:
- Respect the family's wishes to protect the client emotionally
- Provide the client with the requested information, honoring their autonomy (Correct answer)
- Defer to the attending physician to make the decision
- Document the family's request and take no further action
Correct answer: Provide the client with the requested information, honoring their autonomy
A competent client's right to information about their own care supersedes family preferences under the autonomy principle.
Question 6: Which of the following BEST describes the ethical concept of veracity in case management practice?
- Distributing healthcare resources fairly among all clients
- Keeping all client information strictly confidential
- Being truthful and honest in all communications with clients and stakeholders (Correct answer)
- Avoiding harm through careful clinical decision-making
Correct answer: Being truthful and honest in all communications with clients and stakeholders
Veracity refers to the obligation to be truthful and transparent in all professional communications.
Question 7: A case manager is asked by a supervisor to recommend a specific home health agency that the organization has a financial relationship with. This situation BEST represents:
- An appropriate referral based on quality outcomes
- A potential conflict of interest requiring disclosure (Correct answer)
- A breach of confidentiality
- A scope of practice issue
Correct answer: A potential conflict of interest requiring disclosure
Financial relationships between an organization and a referral source create a conflict of interest that must be disclosed to clients.
CCM Ethical Principles and Conduct 2
A case manager discovers that a client's employer-sponsored insurance plan is denying a medically necessary treatment.
What is the case manager's primary ethical obligation?