Ethical and Legal Standards Flashcards

A case manager working for a managed care organization identifies that the most clinically appropriate post-acute facility for a client is out-of-network. The organization has a strict policy to use only in-network providers to control costs. This situation places the case manager in direct conflict between which two ethical obligations?

Answer: Client advocacy and fiduciary duty to the employer

The primary conflict is between the duty to act as an advocate for the client's best interests (beneficence) and the fiduciary responsibility to manage resources and adhere to the policies of their employer. The CCMC Code of Professional Conduct prioritizes the case manager's role as a client advocate.

A case manager receives a phone call from a client's adult son, who is requesting specific details about his father's recent diagnosis and treatment plan. The client's record does not list the son on the release of information form. According to the Health Insurance Portability and Accountability Act (HIPAA), what is the case manager's MOST appropriate response?

Answer: Inform the son that a signed authorization from the client is required before sharing information.

Under HIPAA's Privacy Rule, a covered entity cannot disclose Protected Health Information (PHI) to a family member unless the patient has provided written authorization, is present and does not object, or in specific emergency situations where it is in the patient's best interest. Without a signed release, the case manager must protect the client's privacy and deny the request.

Which of the following is a key requirement for healthcare facilities under the Patient Self-Determination Act (PSDA) of 1990?

Answer: Informing adult patients of their right to make healthcare decisions, including the right to formulate an advance directive.

The Patient Self-Determination Act (PSDA) mandates that healthcare institutions receiving Medicare or Medicaid funds must inform adult patients upon admission about their rights under state law to make decisions concerning their medical care. This includes the right to accept or refuse medical treatment and the right to formulate advance directives, such as living wills or durable powers of attorney for healthcare.

A client offers a case manager a valuable gift certificate to a fine dining restaurant as a thank you for excellent service. According to the CCMC Code of Professional Conduct, what is the most appropriate action for the case manager to take?

Answer: Politely decline the gift, explaining that professional ethics prevent accepting gifts to avoid potential conflicts of interest.

The CCMC Code of Professional Conduct requires case managers to maintain objectivity and avoid dual relationships or conflicts of interest. Accepting gifts, especially those of significant value, can compromise professional judgment and create the appearance of a conflict. The most ethical response is to politely decline and explain the professional boundary.

A case manager is discussing a new, complex treatment option with a client that has significant potential benefits but also serious risks. The ethical principle of veracity is BEST demonstrated by:

Answer: providing a full, honest, and balanced explanation of both the potential benefits and the serious risks.

Veracity is the principle of truth-telling. It obligates the case manager to be honest and provide complete and accurate information to the client. This is critical for ensuring the client can make a fully informed decision about their care, respecting their autonomy.

To avoid the legal and ethical issue of client abandonment when closing a case, which of the following is the MOST critical action for a case manager?

Answer: Ensuring the client has a safe discharge plan and knowledge of how to access future resources.

Client abandonment occurs when a professional unilaterally terminates the relationship without adequate notice or a plan for continuity of care for a client still in need. The most critical step to avoid this is to ensure a safe transition. This includes confirming the client has met their goals, has a clear plan for ongoing needs, and knows how to access necessary resources in the future.