COT Medical Ethics, Legal and Regulatory Issues 2 — Questions and Answers
Question 1: A certified ophthalmic technician discovers that a colleague has been falsifying patient visual acuity measurements to expedite appointments. What is the technician's primary ethical obligation?
- Report the falsification to the supervising ophthalmologist or appropriate authority (Correct answer)
- Confront the colleague privately and ask them to stop
- Document the incidents in a personal log but take no immediate action
- Ignore the situation since it does not directly affect patient care
Correct answer: Report the falsification to the supervising ophthalmologist or appropriate authority
COT ethical standards require reporting conduct that endangers patients or compromises care integrity. Falsifying clinical measurements directly impacts diagnostic accuracy and patient safety, obligating the technician to escalate the matter to supervisory or administrative authority rather than handling it informally or ignoring it.
Question 2: Under HIPAA, which of the following disclosures of patient information does NOT require prior written patient authorization?
- Sharing records with a patient's employer at the employer's request
- Disclosing information to a specialist for treatment coordination (Correct answer)
- Providing records to a marketing company for a promotional campaign
- Releasing records to the patient's attorney for a civil lawsuit
Correct answer: Disclosing information to a specialist for treatment coordination
HIPAA's Treatment, Payment, and Healthcare Operations (TPO) provisions permit disclosure of protected health information for treatment purposes—such as coordinating care with a specialist—without separate written authorization. Disclosures to employers, marketing companies, or attorneys for litigation generally require explicit patient authorization.
Question 3: A patient who is a competent adult refuses a medically recommended laser procedure after being fully informed of the risks of refusal. How should the ophthalmic team respond?
- Proceed with the procedure because it is medically necessary
- Contact the patient's family to obtain surrogate consent
- Respect the refusal and document the informed refusal in the medical record (Correct answer)
- Discharge the patient from the practice immediately
Correct answer: Respect the refusal and document the informed refusal in the medical record
Informed refusal is the corollary to informed consent. A competent adult has the legal and ethical right to decline treatment after being fully informed of the consequences. The appropriate response is to honor that decision, ensure the patient understands the risks of refusal, and document the interaction thoroughly in the medical record.
Question 4: Which federal law specifically prohibits ophthalmic practices from referring patients to outside facilities in which the referring physician has a financial interest, unless a specific exception applies?
- HIPAA
- The Stark Law (Physician Self-Referral Law) (Correct answer)
- The False Claims Act
- OSHA Bloodborne Pathogen Standard
Correct answer: The Stark Law (Physician Self-Referral Law)
The Stark Law (42 U.S.C. § 1395nn) prohibits physicians from referring Medicare and Medicaid patients to entities providing designated health services in which the physician or an immediate family member has a financial relationship, unless a statutory exception applies. HIPAA addresses privacy, the False Claims Act addresses billing fraud, and OSHA governs workplace safety.
Question 5: An ophthalmic technician is asked by office management to bill Medicare for a comprehensive eye exam when only a brief problem-focused visit was performed. The technician should:
- Submit the billing as directed since management has final authority
- Upcode the claim only if the patient has a secondary insurance to cover the difference
- Refuse and report the request through the practice's compliance channel or to authorities (Correct answer)
- Bill the comprehensive exam code but reduce the charge to make it seem reasonable
Correct answer: Refuse and report the request through the practice's compliance channel or to authorities
Submitting a claim for a more complex service than was actually provided is upcoding, which constitutes healthcare fraud under the False Claims Act. Technicians and all healthcare staff have an ethical and legal obligation to refuse participation in fraudulent billing and to report it through internal compliance mechanisms or, if necessary, to the Office of Inspector General (OIG).
Question 6: A minor patient presents alone for a follow-up visit after emergency treatment for a penetrating eye injury. The technician needs to perform tonometry. Which situation would allow treatment to proceed without parental consent?
- The minor verbally assents to the procedure
- The minor is deemed a 'mature minor' or an emancipated minor under state law (Correct answer)
- The procedure is non-invasive, so consent is not required for minors
- The office manager verbally approves proceeding with the visit
Correct answer: The minor is deemed a 'mature minor' or an emancipated minor under state law
In most jurisdictions, minors cannot provide their own legally binding consent to medical procedures unless they qualify as emancipated (e.g., married, military, living independently) or as a 'mature minor' recognized by state statute. Neither verbal assent, non-invasiveness of the procedure, nor administrative approval substitutes for parental/guardian consent or legal minor exception status.
