(Law) Flashcards

Which of the following best describes 'abandonment' in the context of physical therapy practice?

Answer: Unilaterally terminating the therapeutic relationship without adequate notice or referral while the patient still needs care

Abandonment occurs when a PT unilaterally ends treatment without proper notice, transition planning, or referral when ongoing care is still medically necessary.

Under Medicare Part B, physical therapy services are covered only when they are:

Answer: Medically necessary, skilled, and provided or supervised by a licensed PT

Medicare Part B covers outpatient PT services that are medically necessary and require the skills of a licensed physical therapist.

A PT bills Medicare for 60-minute sessions but consistently provides 45-minute sessions. This practice constitutes:

Answer: Upcoding, a form of healthcare fraud

Billing for more time or services than actually provided is upcoding, which constitutes healthcare fraud under the False Claims Act.

The False Claims Act allows private citizens to file suit on behalf of the government against entities committing fraud. This provision is known as:

Answer: Qui tam

The qui tam provision of the False Claims Act allows 'relators' (whistleblowers) to file fraud suits on the government's behalf and share in any recovery.

Which standard is used to evaluate whether a PT's conduct met the expected level of professional care in a negligence lawsuit?

Answer: The standard of care — what a reasonably competent PT would do under similar circumstances

The standard of care in negligence cases is measured against what a reasonably competent PT with similar training would have done in the same situation.

A PT documents a fall that injured a patient during therapy but does not alter the medical record. Later, the PT adds a note attempting to minimize the incident. This subsequent alteration could be considered:

Answer: Fraudulent alteration of medical records, which can be used as evidence of liability

Altering medical records after an adverse event to minimize apparent liability constitutes fraud and can result in criminal charges and licensure revocation.

Which federal act prohibits healthcare providers from referring patients to entities with which they have a financial relationship, unless a specific exception applies?

Answer: Stark Law (Physician Self-Referral Law)

The Stark Law prohibits physician self-referrals for designated health services (including PT) to entities in which the physician has a financial interest, absent an exception.