COF Professional Ethics & Regulatory Compliance 2 — Questions and Answers
Question 1: 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:
- Ignore it to maintain collegial relationships
- Report the suspected fraud to appropriate authorities (Correct answer)
- Confront the colleague privately and take no further action
- Continue working without involvement in billing matters
Correct 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.
Question 2: Under HIPAA, which of the following constitutes a permissible disclosure of protected health information (PHI) without patient authorization?
- Sharing PHI with a pharmaceutical sales representative
- Disclosing PHI to a patient's employer upon employer request
- Providing PHI to a treating physician for continuity of care (Correct answer)
- Posting a patient's progress on a professional social media page
Correct 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.
Question 3: Which ABC Code of Ethics principle obligates a certified orthotist to refer a patient when the condition is beyond the practitioner's competence?
- Non-maleficence (Correct answer)
- Fidelity
- Justice
- Veracity
Correct answer: Non-maleficence
Non-maleficence ('do no harm') requires practitioners to avoid harm by recognizing the limits of their competence and referring appropriately.
Question 4: A certified orthotic fitter has a financial interest in a durable medical equipment company. When recommending devices, the fitter must:
- Never recommend any device from that company
- Disclose the conflict of interest to the patient and referring provider (Correct answer)
- Only recommend devices if they are the least expensive option
- Obtain written permission from the ABC before any recommendation
Correct 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.
Question 5: Under the Stark Law, a physician who refers Medicare patients to an orthotic practice in which the physician has a financial relationship is:
- Permitted if the devices are medically necessary
- Generally prohibited unless a specific exception applies (Correct answer)
- Allowed as long as the patient provides written consent
- Legal if the practice is accredited by an approved organization
Correct 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.
Question 6: A patient requests to see their own orthotic records. Under HIPAA, the practice must provide access:
- Only if the patient's physician approves the request
- Within 30 days of the request in most circumstances (Correct answer)
- Only in electronic format if records are maintained electronically
- After verifying the patient's insurance covers record retrieval
Correct 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.
Question 7: Which organization is primarily responsible for enforcing Medicare supplier standards and accreditation requirements for orthotic providers?
- The American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC)
- The Centers for Medicare & Medicaid Services (CMS) (Correct answer)
- The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- The Food and Drug Administration (FDA)
Correct answer: The Centers for Medicare & Medicaid Services (CMS)
CMS establishes and enforces Medicare supplier standards, including DMEPOS supplier accreditation requirements for orthotic providers.
COF Professional Ethics & Regulatory Compliance 2
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: