Read the hypothetical case study below 

"Check the EMR access log. You'll see that Dr. Payne—whose wife is finally divorcing him (what took her so long?)—accessed his wife's mental health records last week." "A homeless man came into the ER with a blood clot in his leg and after the vascular surgeon on call learned that the man was homeless, he refused to come and treat the patient." "Last week, I saw Mystic Hospital transfer some non-English-speaking ER patients to Mythic Hospital prior to being stabilized even though the medical chart says otherwise." "I watched a 60 Minutes segment about how little oversight there is of SMD labs, and I know that the CMO in particular uses almost nothing but SMD devices here at Mystic. Are we sure these are safe for patients??" "Our patient restraints badly need to be replaced—we're using them on every floor and there just aren't enough! I swear I've been putting these on our patients since I first started working here 15 years ago!" "My mom received a free sample of some new blood pressure medication from Okay Pharma 6 months ago—not sure how they knew she had high blood pressure, but she can't really afford her current prescription, so that was a real blessing. She's out of it now though and Dr. Ego in cardiology isn't returning any calls—can't he just have Okay send her some more?"

 

After reading this case study answer the following questions below:

1. What are the legal and/or compliance issues raised by the hypothetical? 

 

2. What law, regulation, or governance requirement/policy MAY have been violated? Consider among the following and explain why a potential violation may have occurred. 

• Federal False Claims Act
• Physician Self-Referral "Stark" Law
• Federal Anti-Kickback Statute
• Federal Tax-Exempt Law
• Emergency Medical Treatment and Labor Act (EMTALA)
• Health Insurance Portability and Accountability Act (HIPAA)
• Antitrust Law
• Organizational bylaws
• Scope of practice laws, licensure, certification
• Employment law, corporate liability

3. Which issues merit highest priority? Why?

 

4. Which issues would you recommend for further investigation? Why?

 

5. What, if any, further steps would you suggest (e.g., referral to inside/outside counsel, involvement of additional departments or individuals, revision of policies/procedures, termination of employment or contractual relationships, self-reporting to the government, internal audit, etc.)?

 

6. To the extent you believe there to be a legal or compliance-related issue, please recommend alternatives to the problematic program, policy, programmatic element/component, departmental or corporate structure, and/or relationship that you believe would not violate any laws. These alternative proposals do not require detail; however, and particularly where the offending program/policy is designed to increase access, improve quality, or reduce costs, the CEO and board will want to know that these ultimate goals can still be achieved if you are recommending elimination or modification of existing activities.

Answer rating: 100% (QA)

1 The hypothetical case study raises several potential legal and compliance issues 1 Privacy Violation Dr Payne accessing his wifes mental health records without proper authorization raises concerns a... View the full answer