Criminal Aspects of Health Care

Criminal law

· Criminal law (also known as penal law) is the body of statutory and common law that deals with crime and the legal punishment of criminal offenses.

· What is the purpose of criminal law?

Purpose of Criminal Law

· Maintain Public Order & Safety

· Protect Individuals

· Use Punishment as a Deterrent

· Provide for Criminal Rehabilitation

· What are the definitions of a crime, misdemeanor & felony?

Definitions

· Crime – social harm defined & made punishable by law.

· Misdemeanor – offense punishable by less than 1 year in jail and/or a fine.

· Felony – imprisonment in a state or federal prison for more than a year.

· What is an arraignment?

Arraignment

· Formal reading of the accusatory instrument

· a generic term that describes a variety of documents, each of which accuses a defendant of an offense

· includes the setting of bail

· What is the purpose of a conference with the defendant and prosecutor?

Conference

· Meeting for purposes of deliberation

· Plea bargaining time

· Commences with the goal of an agreed-upon disposition

· If no disposition can be reached, a case may be assigned to a trial court.

· Describe the process of conducting a criminal trial.

Criminal Trial – I

· Jury selection

· Opening statements

· Presentation of witnesses & evidence

· Standard of proof must be beyond a reasonable doubt.

· Summations

Criminal Trial – II

· Instructions to the jury by the judge

· Jury deliberations

· Verdict

· must be unanimous

· Opportunity for appeal

· What does the False Claims Act of 1986 prohibit?

False Claims Act of 1986

· Knowingly presenting a false claim for payment.

· making a false record to get a false claim paid.

· conspiring to defraud the government.

· making a false record to avoid an obligation to pay or transmit property to the government.

Ethics in Patient Referral Act

· Prohibits physicians who have ownership interest or compensation arrangements with a clinical laboratory from referring Medicare patients to that laboratory.

· Requires Medicare providers to report the names & provider numbers of all physicians or their immediate relatives with ownership interests in a provider entity.

Health Care Fraud: HIPAA

· Provides criminal & civil enforcement tools & funding to fight health care fraud.

· HIPAA requires U.S. AG & Secretary of DHHS acting through OIG to establish coordinated national Health Care Fraud & Abuse Control Program.

· Program provides coordinated national framework for federal, state, & local law enforcement agencies; private sector; & public to fight health care fraud.

Kickbacks

· Laboratory

· Architectural Contract

Health Care Fraud: Text Cases

· Defrauding Medicare and Medicaid

· False Medicaid Claims

· Pharmacist Submits False Drug Claims

· Inflating Insurance Claims

· Falsification of Records

Falsification of Records

· Falsification of medical & business records is grounds for criminal prosecution.

· Anyone who suffers damage as a result of falsification of records may claim civil liability.

· The provider could lose Medicare & Medicaid funding.

Misuse and Theft of Drugs

· Internet Pharmacy

· Failure to review patient prescriptions prior to dispensing.

· Fraudulent billing.

· Transfer of funds to offshore account.

Physicians: Victims of Fraud Prevention

· Familiarize themselves with patient-billing & recordkeeping practices.

· Avoid having one individual in charge of billing & collection procedures.

· Arrange for an annual audit of office procedures & records by an outside auditor.

Patient Abuse

· Patient abuse is the mistreatment or neglect of individuals who are under the care of a health care organization.

· Describe the signs of resident abuse the surveyors look for.

Forms of Abuse

· Physical

· Psychological

· Medical

· Financial

Abuse Cases – I

· Criminal Negligence

· Reckless disregard for the safety of others.

· Willful indifference to an injury that could follow an act.

· Neglect of Residents

· Abuse & Revocation of License

· Abusive Search

· Physical Abuse

CRIMINAL NEGLIGENCE

· Neglect of Residents

· Abuse and Revocation of License

· Abusive Search

· Medication Violations and Resident Abuse

· Assisted Living Facilities

Murder

· Unusual Number of Deaths

· Nurse Sentenced for Diabolical Acts

· Fatal Injection of Pavulon

· Fatal Injection of Lidocaine

Petty Theft

· Cost Millions Annually

· Patient Valuables

· Staff Valuables

· Supplies

· Medical Equipment

Case: Sexual Assault

· An action was filed against a nursing facility after the plaintiff's mother was sexually assaulted by a dementia patient.

· There was testimony that the facility was properly staffed.

· There was testimony that the resident suffered no physical injury & she was not aware of the assault.

· What was the Court’s decision?

Court Decision

· The court found that the facility had not breached its duty of care.

,

Ethical and Legal Issues in Health Care

Classification of Crimes.jpg

Collepals.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS

Why Hire Collepals.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.