Laws and Regulations

Disparate Impact vs. Disparate Treatment

Sun, 14 Mar 2010 09:10:59 GMT

The most important difference between disparate impact and disparate treatment is that motive is irrelevant in disparate impact case, in disparate treatment cases, on the other hand, the intent to discriminate must be proven.

(Handout Chapter 4 The Legat Environment)

8. Describe the differences between the "Per Se" and the "Rule of Reason" analysis.

Mon, 08 Mar 2010 18:00:12 GMT

A Per Se violation is conduct that falls within a category deemed to be Per Se unlawful--that is, conduct so bad that the conduct itself constitutes a Sherman Act violation even if the activities contemplated were not pursued or the conduct did not have an anti-competitive effect.

The Rule of Reason analysis requires inquiry into the reasonableness of the business practices and requires courts to actually balance the merits of the proposed conduct versus any potential anti-competitive effects it may have. If the anti-competitive effect outweighs the benefits, the conduct is deemed to violate the Sherman Act.

EMTALA Requirements

Sun, 28 Feb 2010 23:35:12 GMT

EMTALA requires all but one of the following:

A. A medical screening exam (MSE)

B. An MSE is performed by a qualified medical professional

C. Requires hospitals to provide free care even without an emergency medical condition.

D. An MSE is provided to any who comes to a dedicated ED or is elsewhere on hospital property and requests examination or treatment.

E. MSE must be performed without delaying to obtain patient financial information.

Answer: C. EMTALA does not apply after a qualified medical professional has determined that the Emergent Medical Condition has ended.

Qui Tam or Whistleblower requirements

Sun, 28 Feb 2010 20:03:12 GMT

In order for a person to be eligible to file a qui tam suit, the following conditions must be met:

1. plaintiff must be the first to file

2. there can not be any other proceedings relating to the same facts

3. suit cannot be based on matters already publically disclosed

(Chapter 8 handouts)

Drawbacks of Corporate Compliance Programs

Sun, 28 Feb 2010 18:20:50 GMT

Although formal compliance programs have prime benefits, there are several drawbacks, as shared in the handouts, Chapter 8.

Drawbacks are:

1) Cost--start-up costs and attorney fees can be extensive

2) During program development, past potential fraudulent activities may be discovered.

3) The program will be considered the organization's standard of care moving forward, which further holds the organization accountable for ensuring that the program is followed.

Of course, these drawbacks are relatively minor compared to the benefits, one of which is improving the accuracy of claims.

Source: Chapter 8 Handout, Corporate Compliance Programs in Healthcare

Corporate Compliance

Sun, 28 Feb 2010 14:38:06 GMT

Corporate Compliance Addresses all of the following, except -

1. Reducing Fraud and Abuse

2. Enhancing provider operations

3. Improving quality, enhancing cost.

4. Improving corporate integrity.

Answer C, Slide 4: Corporate Compliance Rationale

The EMT Police Officer

Sat, 27 Feb 2010 17:05:44 GMT

Being a safety-net County Hospital in a major city, access to medical care is primary. In addition, we are a major hospital for live births in the Texas area. That being said, there are many patients that do not make it to the ED but require medical treatment in the main door or throughout our maze of corridors. To alleviate the load on our Rapid Response Teams (which consist of our already stressed ED staff), we are developing a program that will train and educate our Commissioned Police force to allow them to administer medical care equivalent to the Emergency Medical Technician and paramedics. At face value it sounds like a great program but I am concerned about COBRA/EMTALA and other appropriate level of care implication and vulnerabilities. Obviously, our legal department has much to look into. Does anyone have such set up or comments?

Sexual Harassment

Sat, 27 Feb 2010 03:22:58 GMT

In Sexual Harassment cases, courts typically address the following issues EXCEPT:

A. Harassment Severity

B. Did Plaintiff invited or welcomed sexual advances?

C. Did the harassor intended to harm the harassee?

D. Is the employer liable for the harassment?

Answer: "C"

Fraud, Stark, and Anti-kickback

Fri, 26 Feb 2010 09:49:58 GMT

According to Sanders, JD, which one of the following laws addressing payments to induce or reward referrals requires intent to be proven?

1. False claims act

2. Physician self- referral law

3. Anti-kickback

4. Stark

Answer: 3. Anti-kickback requires intent. Week 10 Law presentation by Sanders and DiVacro

Antitrust Safety Zone

Fri, 26 Feb 2010 02:35:05 GMT

Because of competitive market conditions, Tarrimont Hospital and John Q. Public Hospital decide they are going to merge. This could take place in the antitrust safety zone under which of the following conditions?

A. One of the hospitals has fewer than 100 licensed beds, has an ADC of fewer than 60 patients, and is more than 10 years old.
B. One of the hospitals has fewer than 75 licensed beds, has an ADC of fewer than 40 patients, and is more than 5 years old.
C. One of the hospitals has fewer than 100 licensed beds, has an ADC of fewer than 40 patients, and is more than 5 years old.
D. One of the hospitals has fewer than 100 licensed beds, has an ADC of fewer than 40 patients, and is less than 10 years old.

Answer: C (Antitrust Compliance, 15.8)

Reasonable Accommodation under ADA

Fri, 26 Feb 2010 02:25:20 GMT

Which of the following statements is true regarding reasonable accommodation under ADA?
A. The GAO has found that reasonable accommodation has significantly increased costs for organizations.
B. Reasonable accommodation is limited to physical changes to the facility.
C. Reasonableness is determined unilaterally for all employees with disabilities.
D. Reasonable accommodation is determined by what constitutes undue hardship for the organization, along with the operating budget and overall size of the organization.

Answer: D (Fried, B., The Legal Environment, Pages 72-73)

The Messenger Model - Sample Test Question

Wed, 24 Feb 2010 03:56:52 GMT

One way for multiprovider networks to avoid per se price fixing is through employing the "messenger model" in its negotiations with purchasers. Which of the following is permitted under the "messenger model?"

A. The agent can have authority to contract on each participant's behalf at or above some minimum level.

B. The agent can disseminate to network providers the views or intentions of other network providers as to the proposal.

C. The agent can express an opinion on the terms offered.

D. The agent can coordinate the providers' responses to a particular proposal.

Answer: Laws and Regulations readings packet, Chapter 15 ("Antitrust Compliance"), p. 152.

Family and Medical Leave Act

Tue, 23 Feb 2010 18:52:26 GMT

Looking for some clarification:

In the FMLA slide,

about the application of FMLA to -

Employees who have worked at least 12 nonconsecutive months for a total of 1250 hours.

What does all this mean in plain English -

1. That the employment does not need to be 12 consecutive months altogether.

2. That part-time employees are eligible for FMLA.

3. Where did 1250 hours, come from. Somebody, please simplify the math for me. As I see it, does it amount to 31 weeks of employment, and that too in the context of non-consecutive employment.