COF Professional Ethics & Regulatory Compliance 3 — Questions and Answers
Question 1: A certified orthotic fitter learns that a patient's insurance will not cover the most clinically appropriate device. The fitter should:
- Prescribe the covered device without informing the patient of the better option
- Inform the patient of all options including the non-covered device and associated costs (Correct answer)
- Bill for the superior device and document it as the covered device
- Automatically upgrade the patient without charge to avoid ethical conflict
Correct answer: Inform the patient of all options including the non-covered device and associated costs
Patients must be fully informed of all clinically appropriate options, including out-of-pocket costs, to exercise informed consent.
Question 2: The Anti-Kickback Statute (AKS) prohibits orthotists from:
- Charging Medicare more than the fee schedule amount
- Accepting or paying remuneration to induce referrals of federal healthcare program patients (Correct answer)
- Billing for services that were not personally performed
- Using modifiers to obtain higher reimbursement rates
Correct answer: Accepting or paying remuneration to induce referrals of federal healthcare program patients
The AKS prohibits any exchange of value intended to induce or reward referrals of items or services covered by federal healthcare programs.
Question 3: When a patient lacks decision-making capacity, informed consent for an orthotic intervention should be obtained from:
- The patient's primary insurance carrier
- A legally authorized representative such as a healthcare proxy or guardian (Correct answer)
- The referring physician on the patient's behalf
- The facility administrator where the patient resides
Correct answer: A legally authorized representative such as a healthcare proxy or guardian
When patients cannot make their own decisions, a legally authorized representative must provide informed consent on their behalf.
Question 4: An orthotic fitter notices that a custom-fitted AFO for a diabetic patient has caused a pressure wound. Ethically, the fitter's first obligation is to:
- Document the wound and notify the patient's physician immediately (Correct answer)
- Modify the device to redistribute pressure before contacting the physician
- Advise the patient to discontinue use and call back in one week
- File an adverse event report with the FDA before contacting anyone
Correct answer: Document the wound and notify the patient's physician immediately
Immediate documentation and physician notification are required when a device causes harm, especially in high-risk patients such as diabetics.
Question 5: The ABC Standards of Practice require that patient treatment records be retained for a minimum of how many years for adult patients?
- 3 years
- 5 years (Correct answer)
- 7 years
- 10 years
Correct answer: 5 years
ABC Standards of Practice require adult patient records to be maintained for a minimum of five years from the date of last service.
Question 6: A pharmaceutical company offers to sponsor an orthotic fitter's continuing education in exchange for product endorsements. The fitter should:
- Accept if the CE content is clinically relevant and unbiased
- Decline because such arrangements always violate ABC ethics rules
- Disclose the sponsorship arrangement and evaluate for conflicts of interest (Correct answer)
- Accept only if the endorsement is limited to written testimonials
Correct answer: Disclose the sponsorship arrangement and evaluate for conflicts of interest
Industry-sponsored CE is permissible when conflicts of interest are disclosed and the educational content remains objective and unbiased.
Question 7: Which federal law protects employees who report suspected healthcare fraud from employer retaliation?
- The Americans with Disabilities Act (ADA)
- The False Claims Act (FCA) whistleblower provisions (Correct answer)
- The Health Insurance Portability and Accountability Act (HIPAA)
- The Occupational Safety and Health Act (OSHA)
Correct answer: The False Claims Act (FCA) whistleblower provisions
The False Claims Act includes qui tam provisions that protect whistleblowers who report fraud against federal healthcare programs from employer retaliation.
COF Professional Ethics & Regulatory Compliance 3
A certified orthotic fitter learns that a patient's insurance will not cover the most clinically appropriate device.
The fitter should: