Professional Ethics & Regulatory Compliance Flashcards

An orthotist discovers that a colleague has been billing Medicare for custom orthoses but delivering prefabricated devices. The orthotist's primary ethical obligation is to:

Answer: Report the suspected fraud to appropriate authorities

Suspected Medicare fraud must be reported to authorities such as the OIG or CMS, as failure to report known fraud may constitute complicity.

Under HIPAA, which of the following constitutes a permissible disclosure of protected health information (PHI) without patient authorization?

Answer: Providing PHI to a treating physician for continuity of care

HIPAA permits disclosure of PHI to other treating healthcare providers involved in the patient's care without written authorization.

Which ABC Code of Ethics principle obligates a certified orthotist to refer a patient when the condition is beyond the practitioner's competence?

Answer: Non-maleficence

Non-maleficence ('do no harm') requires practitioners to avoid harm by recognizing the limits of their competence and referring appropriately.

A certified orthotic fitter has a financial interest in a durable medical equipment company. When recommending devices, the fitter must:

Answer: Disclose the conflict of interest to the patient and referring provider

Conflicts of interest must be transparently disclosed to patients and referring providers so they can make informed decisions.

Under the Stark Law, a physician who refers Medicare patients to an orthotic practice in which the physician has a financial relationship is:

Answer: Generally prohibited unless a specific exception applies

The Stark Law generally prohibits physician self-referrals to entities with which they have financial relationships unless a statutory exception applies.

A patient requests to see their own orthotic records. Under HIPAA, the practice must provide access:

Answer: Within 30 days of the request in most circumstances

HIPAA requires covered entities to provide patients access to their records within 30 days, with one possible 30-day extension.

Which organization is primarily responsible for enforcing Medicare supplier standards and accreditation requirements for orthotic providers?

Answer: The Centers for Medicare & Medicaid Services (CMS)

CMS establishes and enforces Medicare supplier standards, including DMEPOS supplier accreditation requirements for orthotic providers.