CHL Law and Ethics 4 — Questions and Answers
Question 1: Which standard of decision-making should a surrogate use when a patient's specific wishes are unknown and no advance directive exists?
- Substituted judgment based on what the patient would have wanted
- Best interest standard based on what a reasonable person would want (Correct answer)
- Surrogate's own values and preferences
- The attending physician's clinical judgment alone
Correct answer: Best interest standard based on what a reasonable person would want
When a patient's specific wishes are unknown, the best interest standard guides surrogates to choose what a reasonable person in the patient's situation would want.
Question 2: The Consolidated Omnibus Budget Reconciliation Act (COBRA) requires employers to:
- Provide free health insurance to all employees
- Offer continuation of group health coverage to employees who lose their jobs or have reduced hours (Correct answer)
- Cover pre-existing conditions without waiting periods
- Match employee contributions to health savings accounts
Correct answer: Offer continuation of group health coverage to employees who lose their jobs or have reduced hours
COBRA gives workers and their families who lose group health benefits the right to choose continuation coverage for limited periods under certain qualifying events.
Question 3: A healthcare organization discovers it has been overbilling Medicare due to a software coding error. Under the 60-day rule, the organization must:
- Report and return the overpayment within 60 days of identification (Correct answer)
- Wait until the annual cost report to reconcile the overpayment
- Notify the OIG within 30 days and repay within 90 days
- Only repay if the amount exceeds $10,000
Correct answer: Report and return the overpayment within 60 days of identification
The 60-day overpayment rule requires Medicare and Medicaid providers to report and return identified overpayments within 60 days or face False Claims Act liability.
Question 4: In ethical decision-making frameworks, the 'four-box' method developed by Jonsen, Siegler, and Winslade organizes clinical ethics cases around all of the following EXCEPT:
- Medical indications
- Patient preferences
- Quality of life
- Financial reimbursement (Correct answer)
Correct answer: Financial reimbursement
The four-box method analyzes cases through medical indications, patient preferences, quality of life, and contextual features — financial reimbursement is not one of the four boxes.
Question 5: Which type of law is created by federal and state legislatures and forms the basis for most healthcare regulations?
- Common law
- Statutory law (Correct answer)
- Administrative law
- Constitutional law
Correct answer: Statutory law
Statutory law is enacted by legislative bodies (Congress or state legislatures) and includes major healthcare laws such as HIPAA, EMTALA, and the ACA.
Question 6: A physician employed by a hospital refers patients for imaging at the hospital's outpatient center. Under Stark Law, this arrangement is permissible under which exception?
- Personal services exception
- In-office ancillary services exception
- Bona fide employment exception (Correct answer)
- Recruitment exception
Correct answer: Bona fide employment exception
The bona fide employment exception under Stark Law permits a hospital to employ physicians and have them refer to hospital-owned services when the compensation arrangement meets specific requirements.
Question 7: A patient's chart reveals a history of substance abuse. A curious colleague who is not involved in the patient's care requests access to the record. Under HIPAA, the healthcare leader should:
- Grant access since the colleague is a licensed provider
- Deny access because the colleague lacks a treatment need for that patient's information (Correct answer)
- Allow access with the patient's verbal permission
- Allow access only if the colleague signs a confidentiality agreement
Correct answer: Deny access because the colleague lacks a treatment need for that patient's information
HIPAA's minimum necessary standard limits access to PHI to those with a legitimate need to know for treatment, payment, or operations — a curious colleague without a care role does not qualify.
CHL Law and Ethics 4
Which standard of decision-making should a surrogate use when a patient's specific wishes are unknown and no advance directive exists?