CHL Law and Ethics 3 — Questions and Answers
Question 1: A healthcare organization wants to share de-identified patient data with a research university. Under HIPAA, de-identification requires:
- Patient authorization in all cases
- Removal of the 18 specific identifiers listed in the Safe Harbor method or expert statistical determination (Correct answer)
- IRB approval only
- A signed business associate agreement with the university
Correct answer: Removal of the 18 specific identifiers listed in the Safe Harbor method or expert statistical determination
HIPAA's Safe Harbor de-identification method requires removal of 18 specific types of identifiers; alternatively, a qualified expert may certify that re-identification risk is very small.
Question 2: Which document legally designates another person to make healthcare decisions on behalf of a patient who becomes incapacitated?
- Living will
- POLST form
- Durable power of attorney for healthcare (Correct answer)
- Do-not-resuscitate order
Correct answer: Durable power of attorney for healthcare
A durable power of attorney for healthcare (healthcare proxy) legally authorizes a designated agent to make medical decisions if the patient loses decision-making capacity.
Question 3: An ethics committee is consulted when a family demands aggressive life-sustaining treatment that the care team believes is futile. The ethics committee's primary role is to:
- Issue legally binding treatment orders
- Facilitate communication, clarify values, and provide recommendations to resolve the conflict (Correct answer)
- Replace the attending physician's judgment
- Report the family to legal authorities
Correct answer: Facilitate communication, clarify values, and provide recommendations to resolve the conflict
Ethics committees serve as consultative bodies that help mediate disputes, clarify ethical issues, and facilitate shared decision-making — they do not issue binding orders.
Question 4: Under Title VII of the Civil Rights Act, a healthcare employer is prohibited from discriminating based on all of the following EXCEPT:
- Religion
- National origin
- Clinical competence (Correct answer)
- Sex
Correct answer: Clinical competence
Title VII prohibits discrimination based on race, color, religion, sex, and national origin; clinical competence is a legitimate, non-discriminatory basis for employment decisions.
Question 5: A healthcare leader is structuring a management services agreement with a physician group. To avoid Anti-Kickback Statute liability, the compensation must be:
- Based on the volume of referrals the physicians generate
- Set at fair market value and not tied to referral volume (Correct answer)
- Approved by the state medical board
- Fixed at no more than $50,000 annually
Correct answer: Set at fair market value and not tied to referral volume
The Personal Services safe harbor under the Anti-Kickback Statute requires compensation to reflect fair market value and be unrelated to the volume or value of referrals.
Question 6: A nurse manager notices a colleague charting medications as administered that were never given. The ethical principle most relevant to the manager's obligation to act is:
- Justice
- Veracity (truthfulness) (Correct answer)
- Fidelity
- Paternalism
Correct answer: Veracity (truthfulness)
Veracity obligates healthcare professionals to be truthful; falsifying records violates this principle and endangers patients, requiring the manager to report the behavior.
Question 7: A hospital system is subject to a Corporate Integrity Agreement (CIA) with the OIG. This typically occurs after:
- A Joint Commission accreditation survey
- Settlement of a federal healthcare fraud or abuse case (Correct answer)
- Completion of a Medicare cost report
- Voluntary self-disclosure with no prior violations
Correct answer: Settlement of a federal healthcare fraud or abuse case
CIAs are imposed by the OIG as part of civil settlement agreements in fraud and abuse cases, requiring the organization to implement enhanced compliance measures for a defined period.
CHL Law and Ethics 3
A healthcare organization wants to share de-identified patient data with a research university.
Under HIPAA, de-identification requires: