Case Study

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University of North Georgia, Dahlonega *

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HLTH-230

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Medicine

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Jan 9, 2024

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docx

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Uploaded by UltraAlligatorMaster995

A member of the hospital’s medical staff has been accused of improperly billing Medicare for treatments done in his office that were not medically necessary. A subpoena for copies of patient records was received but the subpoena does not include a patient authorization for release of the records. In addition, the subpoena requests all “peer review committee” records pertaining to this physician. Respond to the following questions in detail (at least 5 sentences per question): 1) What must you check before releasing the patient records? Before releasing patient records, you must check the identity of the patient, check what information can be released about the patient, and make sure the record is complete. You should have evidence that an authority witness signatures that prove that the person releasing the records and the patient are on the same page. You must check it complies according to your state and federal guidelines to avoid any violations. 2) What legal concept described in this chapter will determine admissibility of the hospital records into evidence? Admissible evidence is evidence that may be presented before the judge or jury. Legally the documents that were submitted are valid evidence to prove the improper billing. Evidence is used to prove a crime and when the medical records were released without patient authorization. This evidence can be proven using documentary evidence which is “ Evidence in written form, not oral, original records, letters, emails, photos, use to prove a fact” (Brodnik, 2017). There could be a letter presented of the patient saying they didn’t sign a patient authorization. 3) The defendant’s lawyer objects to the subpoena, arguing that the patient records are “hearsay.” To resolve this issue, identify at least one element that will likely be required in your testimony (or certification of the records). Hearsay is an out of court statement introduced into a court proceeding to prove the truth of the facts asserted in that statement. Health records are considered hearsay. In order for the hearsay to have an exception is if the record is admitted under business records. Another way to rule out against hearsay evidence is if medical statement is made to a medical provider for the purpose of diagnosis or treatment.

4) Your hospital attorney objects to the subpoena of the peer review committee materials, citing state law that protects peer review records from discovery. What legal concept describes this protection? Peer review is a form of medical documentation protection. “ State laws may define scope of peer review activities and provide privilege protecting records from litigation” (Brodnik,2017). Peer review often contains inadmissible opinions and conclusion, and they also are records that are generally meet in the business records hearsay exception for admissibility. Patient-Physician privilege also is a good tool that protects patient privacy in the context of litigation. 5) In the course of acting on the subpoena, you discover that one of the patient records (which are electronic) has had major sections deleted. Your review of the audit trails determine that a hospital staff member was responsible for the deletions. Under what legal concept could the hospital be subject to liability for the deletions? What should have been done to protect the records? This is a violation of HIPAA. Consequences need to be served to the staff member who altered the patient records. HIPAA violation can be fined up to $10,000 and jailed for up to 5 years. Criminal liability in healthcare includes HIPAA privacy rule which is a civil liability. What needs to be done moving forward in that hospital is making sure only the patient’s medical team has access to the patient records, and the patient record are secured safely to avoid future violations. Reference: Brodnik, M. S., Rinehart-Thompson, L. A., & Reynolds, R. B. (2017). Fundamentals of law for Health Informatics and Information Management . AHIMA Press.

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