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Texas Jurisprudence Exam Part 6

Medicine40 CardsCreated 4 months ago

This deck covers key concepts and regulations regarding medical practice and healthcare laws in Texas, including licensing, partnerships, anti-kickback laws, and hospital privileges.

Do they need to be licensed or registered by the boards?

Yes, they need registration
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Key Terms

Term
Definition
Do they need to be licensed or registered by the boards?
Yes, they need registration
What is the difference between a partnership and a limited liability partnership?
The limited liability partnership can limit individual liability white partner A is liable for the acts of partner B
Who can incorporate in Texas? Can physicians practice through corporations?
Dentists, PT but NOT MD; MD cannot practice through corporation
Are there any corporations that can employ physicians?
Yes, Certified Nonprofit Healthcare Corporation
Who can grant a title of Certified Nonprofit Healthcare Corporation?
TMB
What are 5 important characteristics of Certified Nonprofit Healthcare Corporations?
Must conduct scientific research, support education, improve capabilities to study and teach, deliver health care to the public, instruct public in me...

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TermDefinition
Do they need to be licensed or registered by the boards?
Yes, they need registration
What is the difference between a partnership and a limited liability partnership?
The limited liability partnership can limit individual liability white partner A is liable for the acts of partner B
Who can incorporate in Texas? Can physicians practice through corporations?
Dentists, PT but NOT MD; MD cannot practice through corporation
Are there any corporations that can employ physicians?
Yes, Certified Nonprofit Healthcare Corporation
Who can grant a title of Certified Nonprofit Healthcare Corporation?
TMB
What are 5 important characteristics of Certified Nonprofit Healthcare Corporations?
Must conduct scientific research, support education, improve capabilities to study and teach, deliver health care to the public, instruct public in medical science, public health
Can hospitals provide 'physician guarantees'? How do the finances work?
Physicians can contract with hospitals but are not employees; guarantees paid for availability, billing, etc
Are there federal anti-kickback laws?
Yes
What does the health care insurance portability and accountability act do to federal anti-kickback provisions?
Applies to all federal health care insurances = all insurances
Do the anti-kickback laws apply only to Medicare and Medicaid?
No
Does federal anti-kickback law apply only to patient referrals?
No
Does this law apply only to giving money as a kickback? Who is punished, giver or taker?
No, any money or monetary value; both are punished
What kind of crime is a violation of anti-kickback law, and what is the penalty for physicians and hospitals?
Felony; up to $250,000 for individuals and $500,000 for institutions
What are safe harbors in anti-kickback law? Give examples.
Acts NOT in violation of anti-kickback regulation; e.g., space and equipment rental, sale of practice, discounts, etc
Are STARK laws federal?
Yes
What is a STARK law? Can you refer to family?
Anti-self-referral law; no
What is the difference between STARK 1 and STARK 2?
Stark 1 applies to laboratories, Stark 2 to PT, OT services, etc
What is the CIVIL FALSE CLAIMS act? Is it state or federal? How long has it been around? What does it prohibit?
Submitting false claims to government for payment; federal law since War Between the States
Does Texas prohibit remuneration in exchange for referral volume?
Yes, prohibition on the solicitation of patients
What kind of crime is it to tamper with Texas Medical Board documents?
Class A Misdemeanor
Barratry—what is it? Is it illegal?
Contacting prospective patients in attempts to solicit them; it is illegal
Who can be part of a medical peer review committee?
Physicians, health care workers, anybody in the hospital
Does physician competency include membership in societies, participation in education, participation in group plans?
No
Who makes rules (by laws) for hospitals?
The governing body
Can a hospital reject an orthopedist because he is a DO and not an MD?
No
Can a hospital deny you privileges because you don't accept HMOs? Participate in other hospitals?
No
Who makes the final decision in a hospital to grant or deny privileges to a physician?
Governing body
Does the hospital have to get a report from the NPDB about physicians prior to granting privileges?
Yes, initially and every 2 years; if they don't, they are liable
How many days does the board have to give data to a hospital requesting it?
15 days
How often must a physician update his core credentials? How many days does he have to provide corrections?
Yearly; corrections within 30 days
Prior to the 'first release' of his information, how many days does a physician have to review it?
15 business days
If a physician's privileges will be suspended, does he/she have the right to due process?
Yes
How many days prior to hearing of due process must the hospital give the physician notification?
30 days
Do hospitals have to accept NPs and PAs?
No
If accepting NPs and PAs, what are the hospital's responsibilities?
Due process, fairness, appeal
Is the peer review file confidential?
Yes, EXCEPT for possible civil rights violation and possible anti-trust violation
When must a hospital's medical peer review report actions taken against physicians to the TMB? to the HCQIA? to the NPDB?
If action affects privileges for longer than 30 days or if physician surrenders privileges or if it affects membership; never, the TMB reports to NPDB
How much time does the committee have to report to the TMB?
15 days
Is it good enough to get the signature for informed consent?
No, actual informed consent must be achieved
Which procedures need 'full disclosure' of LIST A and LIST B?
Only List A