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. 

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)

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"

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

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

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.

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.

Elements of a False Claim

1- Knowingly presenting to the U.S. government

2- False or fraudulent claim for payment or approval

3- No intent to defraud is required

4--All of above.

Answer :4 is correct.

This is news you can use.  Often there is confusion over whether or not patient identifiers and names can be posted in clinical areas like the ED or OR.  According to Sarah Fontenot  BSN, JD and teacher in the BOG Review Course, safety always trumps privacy appropos of  HIPAA.  She states this is even on the HIPAA information website with examples of the whiteboard as NOT a violation.

 I find much confusion over this in hospitals and without having visible showings of which patient is where in the ED and on other clinical units, you increase the risk of medication errors, wrong tests and treatments in the rapid fire clinical areas. Without a roster like this that is easily visible to staff you are inviting sentinel events.

Take this back to your ED's and they will love you for it!

Shari Welch, MD

We must consider and be aware of the collective agreement process which can be long, arduous and could lead to mistrust if we are not prepared and the bargaining process which could impact productive and caring workplace relationships if we are not educated.

 There is certainly a need for unions in a number of environments, therefore we must also take a proactive approach in understanding the laws, regulations, challenges and opportunities that unions bring to our field.

We must take a proactive approach to this subject.

A few key points:

Under the Fair Labor Standards Act of 1938:

-"The act does not limit either the number of hours in a day or the number of days in a week that an employer may require an employee to work, as long as the employee is at least 16 years old.  Similarly, the act does not limit the number of hours of overtime that may be scheduled.  However, the act requires employers to pay covered employees not less than one and one-half times their regular rates of pay for all hours worked in excess of 40 in a workweek, unless the employees are otherwise exempt."

-"It is a violation of the act to fire or in any other manner discreminate against an employee for filing a complaint or for participating in a legal proceeding under the act."

-"In addition, an employee may file a private suit, generally for the previous two years of back pay (three years in the case of a willful violation) and an equal amount as liquidated damages, plus attorney's fees and court costs."

Family and Medical Leave Act of 1993 (FMLA)

What is the purpose of FMLA?

a.  to provide a means of employees to balance their work and family responsibility by taking unpaid leave for certain reasons.  b.  to promote the stability and economic security of families as well as the nation's interest in preserving the integrity of families.  c.  to ensure appropriate coverage for companies with less than 50 employees.  d.  Both answers a and b.  e.  A, b, and c are all correct

Correct answer: d.  Both answers a and b

"FMLA provides that eligible employees of covered employers have the right to take up to 12 weeks of job-protected leave in any 12-month period for qualifying events without interferance or restraint from their employers." (Department of Labor FMLA)

What are the qualifying events that would make someone eligible for up to 12 weeks of job-protected, unpaid leave during any 12-month period?

a.  Birth and care of the employee's child, or placement for adoption or foster care of a child with the employee  b.  care of an immediate family member (spouse, child, parent) who has a serious health condition  c.  care of an employee's own serious health condition  d.  all of the above

Correct answer:  d.  All of the above

Appreciating the specialized and technical nature of medical peer review, I'm interested in knowing if anyone is familiar with a process that incorporates the patient?  The trend to include and treat the patient as member of the care team, in my opinion, is extremely positive.  Realizing that patient feedback/data may be evaluated as part of the process, I'm wondering if there are hospitals/medical centers that actually provide opportunities for patients to participate in the peer review process, directly.  Have any organizations appointed patients to sit on the peer review committee?  With the increased emphasis on collaboration, coordination, and teamwork, I'd also be interested in hearing about organizations that have "mirrored" a 360 performance evaluation process by including nurses, social workers and others in the peer review process.  With a working concept, that suggests modifying the peer review process to broaden representation and perspective, what are the practical, legal, and regulatory barriers or issues that would need to be addressed?  While most organizations have established interdisciplinary performance improvement programs, one question is whether such an approach (interdisciplinary) would be appropriate for peer review.  Thoughts on any or all of these questions/issues would be appreciated, as would comments about best practices, challenges, etc.

As a method to increase transparency and improve collaboration on contracting initiatives, especially in physician preference items in the operating room, being able to share pricing and price comparisons between vendors with your MD's can prove to be very beneficial.

That being said, many vendors work language into their contracts that prohibits such sharing of data. From a legal perspective, has anyone experienced this and what risk is a hospital actually at if they engage their MD's in this fashion on contract initiatives?

Does anyone have any insight as to what kind of information can be shared between hospitals and the medical colleges that employ the physicians?  I am also interested in any reference materials on the subject matter.

I'm wondering how other organizations are interpreting EMTALA.  Most organizations have taken a very conservative stance on EMTALA given the negative publicility that can come from even being accused of patient dumping.  Yet, over-use of the ED, increased wait times, increased bad debt ,and uncompensated care is forcing organizations to take a different approach with applying EMTALA.

Examples include:

1.  Placing a physician/PA in the triage room to deliver the MSE, and securing payment once an emergency medical condition is determined to not be present.

2.  With-hold discharge instructions/prescriptions until payment has been received

3.  Triage-less ED's

4.  Pre-scheduled ED appointments for non-emergency conditions.

5.  Patient registration kiosks - which brings up a follow-up question as to how EMTALA applies to a patient when they self-register

Slide 42 of the presentation indicates EMTALA applies to all individuals who come to a hospital's dedicated ED or elsewhere on hospital property. 

This is unclear to me because my understanding of EMTALA is that a patient must request emergency care.  So, if a hospital has an outpatient clinic on the property, does EMTALA apply to patient's arriving for a clinic appointment simply because it is on the same campus as the Emergency Department? 

Again, a patient must clearly request emergency care or state that an emergency exists in order to EMTALA to apply.

The question I have is when hiring for various positions many factors are looked at and how do you balance finding the best canidate while trying to make sure you don't dicriminate on any of the many factors?  While you always want the best candidiate how do you ensure your view of each candidate is 20/20 and not biased?

There are three Stark Laws...Stark I, Stark II and now Stark III.  I always look up information, but does anyone know the clear-cut differences among the three laws?  Differences are always so subtle that I can't remember what is what and have difficulty remembering.  (I remember there was a question about Starks I and II on the test.)

Along the same vein...Anti-kickback is similar to Stark. They are considered "separate but integrated". Anyone have an easy explaination differentiating these two laws?