Legal Aspects Of Health Care Administration 11th Edition by George D. Pozgar Test Bank

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Legal Aspects Of Health Care Administration 11th Edition by George D. Pozgar Test Bank

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WITH ANSWERS
Legal Aspects Of Health Care Administration 11th Edition by George D. Pozgar Test Bank

Chapter 2Introduction to the Legal System

 

  1. A general rule of conduct enforced by government
  2. legal document
  3. policy
  4. departmental regulation
  5. law

 

P 15, d

 

  1. Laws governing relationships between people
  2. public law
  3. federal acts
  4. private law
  5. administrative law

 

P 15, c

 

  1. Body of law dealing with relationships between private parties and government
  2. bill of rights
  3. public law
  4. private law
  5. constitutional law

 

P 15, b

 

  1. Body of law consisting of principles derived from judicial decisions
  2. common law
  3. statutory law
  4. natural law
  5. public law

 

P 16, a

 

  1. Common law in the United States had its origins in
  2. Greece
  3. Ireland
  4. England
  5. France

 

P 16, c

 

  1. Common law principle in which courts apply previous decisions to subsequent cases involving similar facts and questions
  2. respondeat superior
  3. res gestae
  4. stare decisis
  5. res judicata

 

P 18, c

 

  1. The state that civil law of is rooted in the French and Spanish legal systems
  2. New York
  3. Virginia
  4. Maryland
  5. Louisiana

 

P 17, d

 

  1. The highest in the hierarchy of decisional law is
  2. the U.S. Constitution
  3. the U.S. Supreme Court decisions
  4. common law decisions
  5. a state constitution

 

P 19, a

 

  1. The federal agency responsible for administering Medicare and Medicaid programs
  2. Public Health Service
  3. Family Support Administration
  4. Office of Human Development
  5. Centers for Medicare and Medicaid Services

 

P 25, d

 

  1. The federal department responsible for overseeing the nations social insurance program
  2. Public Health Service
  3. Office of Human Development
  4. Health and Human Services
  5. Family Service League

 

P 25, c

 

  1. The federal Food and Drug Administration is an agency within the
  2. Social Security Administration
  3. Public Health Service
  4. Department of Justice
  5. CMS

 

P 28, b

 

  1. The federal agency that issues public warnings when hazardous products have been identified
  2. Department of Justice
  3. Health Care Financing Administration
  4. Family Support Administration
  5. Food and Drug Administration

 

P 28, d

 

  1. Extensive body of law issued by state or federal agencies to direct the enacted laws of the federal or state government.
  2. administrative law
  3. labor law
  4. common law
  5. criminal law

 

P 20, a

 

  1. A procedure used by the President when he prevents a bill from becoming law by avoiding any action while Congress is in session
  2. constitutional neglect
  3. pocket veto
  4. separation of powers
  5. administrative prerogative

 

P 25, b

 

  1. A major function of the executive branch of government
  2. enforce and administer the law
  3. enact laws
  4. resolve disputes
  5. adjudicate the law

 

P 21, a

 

  1. One of the main duties of the legislative branch of government is to
  2. enact laws
  3. legislate values
  4. prejudice the law
  5. require religious activities

 

P 21, a

 

  1. Function of the judicial branch of government
  2. amend the law
  3. enforce the law
  4. adjudicate the law
  5. repeal the law

 

P 23, c

 

  1. The highest federal court is the
  2. U.S. Court of Appeals
  3. U.S. Supreme Court
  4. U.S. Customs Court
  5. U.S. District Court

 

P 24, b

 

  1. A state trial court is sometimes referred to as the
  2. U.S. Court of Claims
  3. Supreme Court
  4. U.S. Court of Appeals
  5. District Court

 

P 24, d

 

  1. A court of limited jurisdiction
  2. U.S Supreme Court Supreme Court
  3. U.S. Court of Appeals
  4. U.S. Court of Military Appeals
  5. U.S. TaxCourt

 

P 24, d

 

  1. The only court created by the U.S. Constitution
  2. U.S. Supreme Court
  3. United States Court of Military Appeals
  4. U.S. District Court
  5. U.S. Court of Appeals

 

P 24, a

 

  1. Trial court of the federal court system
  2. U.S. Court of Appeals
  3. U.S. District Court
  4. U.S. Supreme Court
  5. U.S. Court of Claims

 

P 24, b

 

  1. Torts and contracts are examples of
  2. state statutes
  3. negligence
  4. public law
  5. private law

 

P 16, d

 

  1. The U.S. Supreme Court consists of
  2. seven associate justices and one chief justice
  3. eight associate justices and one chief justice
  4. seven associate justices and one rotating chief justice
  5. ten associate justices and one chief justice

 

P 24, b

 

  1. Action that claims that one party has breached an agreement by failing to fulfill an obligation
  2. contract
  3. writ of certiorari
  4. tort
  5. fraud

 

P 16, a

 

  1. Laws that are established by legislative bodies
  2. civil
  3. statutory
  4. private
  5. contract

 

P 19, b

 

  1. In common law, the term referring to that which has been acted on or decided by the courts
  2. adjudication
  3. stare decisis
  4. res judicata
  5. writ of certiorari

 

P 18, c

 

  1. Federally sponsored health insurance program for persons over 65 years of age and certain disabled persons
  2. Medicaid
  3. welfare
  4. Medicare
  5. commercial insurance

 

P 25, c

 

  1. Government program administered by the states to provide medical services to the medically needy
  2. Medicaid
  3. Medicare
  4. welfare
  5. medigap

 

P 26, a

 

  1. The federal act that addresses the privacy of health information
  2. administrative
  3. statutory
  4. Medicare Part A
  5. HIPAA

P 27, d

Chapter 3Tort Law

 

  1. A civil wrong committed by one person against the person or property of another s a
  2. crime
  3. tort
  4. intentional conduct
  5. misdemeanor
  6. trespass

 

P 32, b

 

  1. Example/s of intentional tort(s)
  2. battery, negligence
  3. invasion of privacy, malpractice
  4. battery, slander
  5. negligence
  6. negligence, false imprisonment

 

P- 32, c

 

  1. The commission or omission of an act, as judged against the actions of a hypothetical reasonably prudent person is
  2. negligence
  3. retribution
  4. tort
  5. vengeance
  6. self-help

 

P 32, a

 

  1. Medical malpractice is negligence committed by a
  2. registered nurse, grounds-man
  3. pharmacist
  4. physician, pharmacist
  5. dietary aide

 

P 33, c

 

  1. The intentional performance of an illegal or improper act
  2. malfeasance
  3. misfeasance
  4. nonfeasance
  5. malpractice
  6. criminal negligence

 

P 33, a

 

  1. The improper performance of a legal act, resulting in injury to another is
  2. misfeasance
  3. malfeasance
  4. nonfeasance
  5. malpractice
  6. tort-feasor

 

P- 33, a

 

  1. Failure to act when there is a duty to act
  2. misfeasance
  3. nonfeasance
  4. intentional conduct
  5. malfeasance
  6. malpractice

 

P 33, b

 

  1. The reckless disregard for the safety of another is known as
  2. nonfeasance
  3. malpractice
  4. misfeasance
  5. criminal negligence

 

P 33, d

 

  1. Legal obligation that requires a person to conform to a specific standard of care to protect others
  2. causation
  3. breach of duty
  4. duty to use due care
  5. standard of care
  6. proximate cause

 

P 33, c

 

  1. Failure to conform to or departure from a required duty of care owed to a patient is considered as a
  2. foreseeability
  3. breach of duty
  4. proximate cause
  5. standard of care
  6. last clear chance doctrine

 

P 33, b

 

  1. In the law of negligence, that which describes the conduct expected of an individual in a given situation
  2. duty to use reasonable care
  3. proximate cause
  4. foreseeability
  5. standard of care

 

P 33, 38, d

 

  1. Element of negligence that must be present in order to establish negligence
  2. duty to use due care, breach of duty, injury, causation
  3. proximate cause, foreseeablity
  4. breach of duty, causation
  5. duty, injury, foreseeability

 

P 33, a

 

  1. Touching a person without their consent
  2. jostling
  3. battery
  4. false imprisonment
  5. assault
  6. menacing

 

P 43, b

 

  1. The threat coupled with the apparent present ability to do immediate physical harm to another is
  2. battery
  3. extortion
  4. false imprisonment
  5. menacing
  6. assault

 

P 43, e

 

  1. A person who is physically restrained from leaving a health care facility for not paying a bill is a victim of
  2. kidnapping
  3. lawful confinement
  4. false imprisonment
  5. malfeasance

 

P 44, c

 

  1. Wrongfully accusing someone of committing a crime
  2. malicious prosecution
  3. slander per se
  4. false imprisonment
  5. libel
  6. false light privacy invasion

 

P 47, b

 

  1. A complete defense to a defamation action is
  2. truth
  3. consent
  4. retraction
  5. libel
  6. false accusations

 

P 47, a

 

  1. The written form of defamation is
  2. slander
  3. false accusations
  4. libel
  5. intentional misconduct

 

P 47, c

 

  1. The spoken form of defamation is
  2. libel
  3. slander
  4. newspaper article
  5. tort-feasor

 

P 47, b

 

  1. The legal wrong that is a violation of a persons right to his or her own space
  2. slander
  3. libel
  4. false imprisonment
  5. infliction of mental distress
  6. invasion of privacy

 

P 52, e

 

  1. The tort of willful and intentional misrepresentation that could cause harm or loss to a person or property
  2. slander
  3. invasion of privacy
  4. defamation
  5. criminal conduct
  6. fraud

 

P 51, e

 

  1. Liability of a manufacturer, seller, or supplier to a buyer or other third party for injuries sustained because of a defect in a product is called
  2. crime
  3. tort per se
  4. intentional tort
  5. products liability

 

P 53, d

 

  1. Liability without fault is another name for
  2. censored liability
  3. negligence
  4. strict liability
  5. products liability
  6. tort

 

P 53, c

 

  1. Another word for a civil wrongdoer is a
  2. tort-feasor
  3. witness
  4. judge
  5. plaintiff

 

P 32, a

 

  1. Defense against recovery in a products liability case is
  2. negligence
  3. a priori
  4. assumption of a risk
  5. malpractice

 

P 56, c

 

  1. A pharmacist misreads a prescription and fills it with the wrong medication. The cashier accepts payment for the drug and the consumer leaves. The consumer, who had been filling the same prescription for the past two years, ingests the drug and suffers injuries. Who is responsible for the consumers injuries?
  2. drug manufacturer
  3. pharmacist
  4. prescribing physician
  5. cashier

 

P 32, 33 (malpractice by the pharmacist), b

 

  1. The party likely to pay for the damages suffered by the consumer is the
  2. drug manufacturer
  3. prescribing physician
  4. pharmacy
  5. cashier

 

P 33 (see elements of negligence, the pharmacy will be liable, as the pharmacists is an employee of the pharmacy), c

 

  1. A defense in a case where the patient uses a product in a manner in which it was not intended to be used.
  2. strict liability
  3. intervening cause
  4. disclaimers
  5. contributory negligence

 

P -56, d

 

  1. Mrs. Smith was tied to her hospital bed and not fed for two days for failing to pay her telephone bill prior to discharge. She has an action for
  2. false imprisonment
  3. defamation
  4. battery
  5. larceny
  6. a and c above

 

P 43, 44, e

 

  1. In this sample case, Dr. Miller, an obstetrician, was enjoying a 25th anniversary celebration and had a few drinks. He arrived at the hospital and was seen staggering toward the delivery room. Ms. Marshall suggested that the on-call obstetrician be called to perform the delivery. Dr. Miller insisted that he was quite capable of delivering the baby and the on call obstetrician was never called. During surgery, Dr. Miller accidentally nicked the patients right thigh with a scalpel. Liability for the injury extends to
  2. the on-call obstetrician
  3. Dr. Miller and the hospital
  4. the hospital
  5. the on-call physician and the hospital

 

P 33 (see elements of negligence), b

 

Chapter 23Managed Care

 

  1. The process of structuring or restructuring the health care system in terms of financing, purchasing, delivering, measuring, and documenting a broad range of health care services and products is generally referred to as
  2. group practice
  3. managed care
  4. preferred provider organization
  5. vertically integrated delivery system

 

P 513, b

 

  1. Organized health care systems that are responsible for both the financing and the delivery of a broad range of comprehensive health services to an enrolled population is a
  2. experience rated HMO
  3. point-of-service plan
  4. health maintenance organization
  5. group practice plan

 

P 514, c

 

  1. An organizations through which employer health benefit plans and health insurance carriers contract to purchase health care services for covered beneficiaries from a selected group of participating providers is a
  2. preferred provider
  3. exclusive provider organization
  4. specialty HMO
  5. group practice without walls

 

P 514, a

 

  1. Organizations limit their beneficiaries to using only participating providers for any health care services
  2. medical foundation
  3. exclusive provider organization
  4. group practice without walls
  5. exclusive provider organization

 

P 414, d

 

  1. An association that is a legal entity composed of physicians organized for the purpose of negotiating contracts to provide physician services
  2. independent practice association
  3. medical foundation
  4. independent practice
  5. group practice

 

P 514, c

 

  1. A group practice a physician organization formed for the purpose of sharing some administrative and management costs (such as group practices) while continuing to practice at their own location rather than at a centralized location

 

  1. group practice with walls
  2. group practice without walls
  3. horizontal consolidation
  4. point-of-service-plan

 

P 515, b

 

  1. An organization that is a legal entity consisting of a joint venture of physicians and a hospital, formed to facilitate managed care contracting, to improve cost management and services, and to create new health care resources in the community is referred to as a
  2. exclusive provider organization
  3. hospital owned corporation
  4. physician owned corporation
  5. physician-hospital organization

 

P 515, d

 

  1. An organization, or group of affiliated organizations, that provides physician and hospital services to patients is referred to as
  2.  vertically integrated delivery system
  3. horizontal consolidation
  4. group practice
  5. specialty practice

 

P 515, a

 

  1. A process whereby a third-party payer evaluates the medical necessity of a course of treatment
  2. nursing review
  3. management review
  4. utilization review
  5. quality review

 

P 516, c

 

  1. The system where the payer determines whether to pay for treatment before the treatment is initiated is referred to as a
  2. retrospective review system
  3. prospective review system
  4. quality review system
  5. admission review system

 

P 516, b

 

  1. A review that is performed during the course of treatment is referred to as
  2. retrospective review
  3. initial review
  4. prospective review
  5. concurrent review

 

P 516, d

 

  1. A review that is performed after the treatment has been completed is referred to as
  2. constructive review
  3. retrospective review
  4. prospective review
  5. contemporary review

 

P 516, b

 

  1. An increasingly important aspect of utilization management that involves identifying at an early stage those patients who could be treated more cost effectively in an alternative setting or at a lower level of care without negatively affecting the quality of care is referred to as
  2. prospective review
  3. lab review
  4. case review
  5. financial audit

 

P 516, 517, c

 

  1. Whenever a managed care organization possesses significant market share
  2. antitrust implications can arise
  3. greed can falter
  4. malpractice is likely to occur
  5. corporate liability is likely to occur

 

P 522, a

 

  1. Health maintenance organizations
  2. act as the insurer of health care services
  3. charge insurers a fixed premium for each employee who subscribes
  4. act as both as the insurer and provider of health care services
  5. provider of health care services

 

P 514, c

 

  1. Managed care is the process of structuring or restructuring the health care system in terms of
  2. financing a narrow range of health care services and products
  3. delivering, measuring, and documenting a broad range of health care services and products
  4. measuring and documenting a limited range of health care services and products
  5. purchasing a extremely restricted range of health care services and products

 

P 513, b

 

  1. The federal act that was designed to ensure that employee welfare and benefit plans conform to a uniform body of benefits law was the
  2. Medicare Benefit Act
  3. Social Security Act
  4. Employee Retirement Expense Act
  5. Employee Retirement Income Security Act

 

P 517, d

 

  1. The Employee Retirement Income Security Act requires
  2. plans to provide participants with plan information and information about plan features and funding
  3. a description of fiduciary responsibilities for those who do not manage and control plan assets
  4. plans to establish a grievance but not an appeals process for participants to get benefits from

their plans

  1. plans to provide participants the right to sue for benefits and but not for breaches of fiduciary duty

 

P 517, a

 

  1. A managed contract should be developed between the employer and the selected fiduciary and the contract should ensure that
  2. the fiduciary is not responsible for monitoring its discretionary authority.
  3. fiduciary is committed to supplying the employer with data on the various aspects of its performance.
  4. the proper indemnities are negotiated on behalf of the employer and its employees
  5. a hold-harmless clause is provided for employees for payment for services rendered and financial disclosures are made as appropriate.

 

P 518, c

 

  1. The purpose of the Health Care Quality Improvement Act is to
  2. provide those persons giving information to professional review bodies no immunity from damages that may arise as a result of adverse decisions that affect a physicians medical staff privileges.
  3. provide those assisting in review activities limited immunity from damages that may arise as a result of adverse decisions that affect a physicians medical staff privileges.
  4. provide those persons giving information to professional review bodies limited immunity from damages that may arise as a result of adverse decisions that affect a physicians medical staff privileges.
  5. provide those persons giving information to professional review bodies and those assisting in review activities limited immunity from damages that may arise as a result of adverse decisions that affect a physicians medical staff privileges.

 

P 518, d

 

  1. The Ethics in Patient Referral Act of 1989
  2. allows physicians who have ownership interest or compensation arrangements with a clinical laboratory from referring Medicare patients to that laboratory
  3. requires all Medicare providers to report the names and provider numbers of all physicians or their immediate relatives with ownership interests in the provider entity
  4. does not provide for the imposition of penalties for those who fail to comply with the disclosure requirements
  5. requires all Medicare providers to report the names and provider numbers of all physicians with ownership interests in the provider entity

 

P 519, b

 

  1. Health Maintenance Organizations can
  2. not refuse benefit coverage to patients if they determine retrospectively that a patients condition did not require emergency department care
  3. refuse benefit coverage to patients if they determine retrospectively that a patients condition did not require emergency department care even though federal law prohibits hospital emergency departments from turning away patients seeking emergency care.
  4. refuse benefit coverage to patients if they determine retrospectively that a patients condition did not require emergency department care
  5. refuse benefit coverage to patients if they determine retrospectively that a patients condition did not require emergency department care, thus placing the burden on the provider to seek reimbursement from the patient if the insurer does decide to cover the charges

 

P 518, 519, b

 

  1. Those who are enrolled in Point-of-Service (POS) plans
  2. use specialty care physicians as gatekeepers to coordinate and control their medical care
  3. are entitled to choose a provider outside the plan with no copayment imposed
  4. use primary care physicians as gatekeepers to coordinate and control their medical care
  5. can choose a provider outside the plan, with the added benefit of lower copayments

 

P 514, c

 

  1. A Group Practice without Walls
  2. is a physician organization formed for the purpose of sharing some administrative and management costs while continuing to practice at their own locations
  3. utilize specialty care physicians as gatekeepers to coordinate and control their medical care
  4. is a physician organization formed for the purpose of sharing some administrative and management costs while continuing to practice at centralized locations
  5. is a medical foundation that employs or contracts with physicians to provide care to the foundations patients.

 

P 515, a

 

  1. A Management Service Organization (MSO)
  2. is an entity that provides administrative assistance but does not offer management services to physicians
  3. an organization that requires physicians to perform their own services, such as, practice management, marketing, managed care contracting, accounting, billing, and personnel management
  4. cannot be hospital affiliated , hospital-physician joint venture, physician owned, or investor owned
  5. can be hospital affiliated, hospital-physician joint venture, physician owned, or investor owned

 

P 515, d

 

  1. A Vertically Integrated Delivery System
  2. is any organization or group of affiliated organizations that provides limited physician services to patients
  3. has a goal of offering physician integration with specialists in order to provide a full range of services to patients
  4. in its best form provides services ranging from primary outpatient care to tertiary inpatient care
  5. if organized well provides a minimal range of services, such as home health care, long-term care, rehabilitation, and mental health care

 

P 515, c

 

  1. In a Horizontal Consolidation
  2. recognizing a congressional intent to preserve competition by preventing undue market concentration, the courts have focused primarily on the possibility that consolidation will substantially lessen competition
  3. a wide variety of businesses are involved
  4. there is a single qualitative or quantitative factor from which it can be determined whether such a group merger is permissible
  5. similar or identical businesses are not involved at the same level of the market

 

P 515, a

 

  1. The majority of state HMO laws require that the provision of basic health services include
  2. physician, outpatient and emergency care, and no inpatient hospital care
  3. physician care and outpatient care
  4. inpatient, and outpatient care
  5. physician, emergency, inpatient, and outpatient care

 

P d

 

  1. If an HMO employs physicians, such as in a Staff-Model HMO, the HMO can be held liable for the negligence of its employees under
  2. the captain of the ship doctrine
  3. borrowed servant doctrine
  4. the doctrine of respondeat superior.
  5. res ipsa loquitur doctrine

 

P 517, c

 

  1. Price fixing is considered a per se violation of the antitrust laws. Price fixing occurs when two or more competitors come together to decide on a price that will be charged for services or goods. The per se rule here applies to
  2. price fixing and group boycotts
  3. horizontal market allocation and price fixing
  4. group boycotts.
  5. tying

 

P 521, b

 

Chapter 24Tort Reform and Risk Reduction

 

  1. The type of medicine practiced by physicians designed to limit their exposure to malpractice suits is often referred to in the legal community as

 

  1. positive medicine
  2. defensive medicine
  3. over-treatment
  4. under-treatment

 

P 525, b

 

  1. A common law principle that prohibits a court or jury from taking into account (when setting an award) the fact that part, or even all, of the plaintiffs damages have been covered by other sources of payment such as health insurance
  2. contingency fee
  3. respondeat superior
  4. collateral source rule
  5. joint and several liability

 

P 526, c

 

  1. A method of payment for services rendered by an attorney predicated on the favorable outcome of a case
  2. contingency fee
  3. collateral source rule
  4. joint and several liability
  5. malpractice cap

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