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Chapter 01: The U.S. Legal System
Test Bank
MULTIPLE CHOICE
- Which is a situation in which the goal of law is not accurately portrayed?
| a. | A woman takes her husband to court to obtain a divorce. |
| b. | An individual sues his neighbor over a property line. |
| c. | A man slashes his neighbor’s tires over a dispute. |
| d. | A child is taken from her neglectful mother and placed in foster care by the state. |
ANS: C
Taking the law into one’s own hands never fulfills the goal of law. The goal of law is to resolve disputes without violence and to protect individual citizens’ health, safety, and welfare. Taking an individual to court or to the proper regulatory agency resolves matters peacefully.
DIF: Cognitive Level: Comprehension REF: p. 3
- The foundation of the law of the land is:
| a. | state constitutions. |
| b. | municipal laws. |
| c. | district court decisions. |
| d. | the Constitution of the United States. |
ANS: D
The U.S. Constitution grants certain powers to the federal government. Unless a specific power is granted to the U.S. government, that power is left to the jurisdiction of state government.
DIF: Cognitive Level: Knowledge REF: pp. 3-6
- Who has the power to regulate healthcare through their capacity to protect the health, safety, and welfare of their citizens?
| a. | City government |
| b. | County government |
| c. | State government |
| d. | Federal government |
ANS: C
States have the police power to regulate nurses, pharmacists, physicians, chiropractors, physical therapists, and other licensed healthcare providers.
DIF: Cognitive Level: Knowledge REF: p. 6
- Which branch of government developed the source of law that implemented the Medicaid and Medicare amendments to the Social Security Act of 1965?
| a. | Legislative |
| b. | Judicial |
| c. | Executive |
| d. | Municipal |
ANS: A
The legislative branch of government develops statutory law. The executive branch can propose or veto laws, and the judicial branch develops and interprets statutory law.
DIF: Cognitive Level: Knowledge REF: p. 4
- Which is not an agency that can enact rules that become administrative law?
| a. | Occupational Safety and Health Administration |
| b. | American Bar Association |
| c. | Department of Health and Human Services |
| d. | Environmental Protection Agency |
ANS: B
The legislature enables certain agencies to develop rules and regulations, such as the Occupational Safety and Health Administration, the Department of Health and Human Services, and the Environmental Protection Agency. The American Bar Association is a private organization, not a governmental agency.
DIF: Cognitive Level: Comprehension REF: pp. 4-5
- Which statements about the checks and balances system is untrue?
| a. | The legislature can develop statutes and veto the executive branch. |
| b. | The executive branch has veto power and can propose legislation. |
| c. | The judicial branch interprets laws. |
| d. | The legislature proposes laws. |
ANS: A
The legislature can propose laws and develop statutes, but it does not have veto power. The executive branch can veto and propose legislation, while the judicial branch interprets laws and their application to individual cases.
DIF: Cognitive Level: Comprehension REF: p. 6
- Which state does not have roots in English common law?
| a. | Texas |
| b. | California |
| c. | Louisiana |
| d. | Maine |
ANS: C
All states except Louisiana have adopted a common law system. Louisiana adopted a civil code system based on Napoleonic code, because France originally colonized the state.
DIF: Cognitive Level: Comprehension REF: pp. 6-7
- All the cases below would be considered a civil case except:
| a. | divorce. |
| b. | breach of contract. |
| c. | dispute over real estate sale. |
| d. | terrorist threats. |
ANS: D
Civil law includes areas of the law such as contract issues, intentional torts, negligence, malpractice, and privacy issues. A terrorist threat would be considered a criminal offense.
DIF: Cognitive Level: Comprehension REF: pp. 7-8
- Which is primarily a criminal case?
| a. | A physician refuses to repay student loans. |
| b. | A physician performs a pelvic exam without a glove. |
| c. | An office assistant releases medical information without patient consent. |
| d. | An office assistant accesses medical information by computer about a patient who is not under a physician’s care at the time. |
ANS: B
The physician has probably committed battery, a criminal offense, on the patient by not using a glove for the pelvic examination. Issues related to contracts, such as student loans, are civil matters. Privacy issues also fall under administrative law, which is part of the civil category.
DIF: Cognitive Level: Application REF: pp. 7-8
- An example of in personam jurisdiction is:
| a. | a dispute between neighbors over a fence line. |
| b. | theft of a computer from a private home. |
| c. | vandalism to a car parked in a school lot. |
| d. | all of the above. |
ANS: D
In personam jurisdiction means that the court has jurisdiction over the person involved in the case. If the action giving rise to the case occurred in a certain geographical area, then the trial court in that area has jurisdiction over the case and the people involved in the case.
DIF: Cognitive Level: Application REF: p. 10
- When a court has jurisdiction over property or a thing itself, rather than over the people involved, the type of jurisdiction is called:
| a. | in rem jurisdiction. |
| b. | in personam jurisdiction. |
| c. | ad litem jurisdiction. |
| d. | appellate jurisdiction. |
ANS: A
The court determines right to the property in an in rem jurisdiction case, which is usually binding against the whole world, not just the parties involved.
DIF: Cognitive Level: Knowledge REF: p. 10
- Which cases could be sent from the district court to the appellate court?
| a. | A woman suing for the right to have an abortion in her last trimester of pregnancy |
| b. | A man suing a physician for negligence |
| c. | A parent suing on behalf of a child injured in a car accident |
| d. | All of the above |
ANS: D
The right to terminate a pregnancy is determined by the state statute. An appellate case must be sent to the appellate court from the district court. All of these cases have the potential to be sent from the district court to the appellate court.
DIF: Cognitive Level: Application REF: pp. 11-12
- The individual who brings a case to court is the:
| a. | defendant. |
| b. | prosecuting attorney. |
| c. | plaintiff. |
| d. | defending attorney. |
ANS: C
The person bringing suit is the plaintiff, and the defendant is the person being sued. Attorneys are not named as the person bringing suit. The names in the case reveal who is suing whom.
DIF: Cognitive Level: Knowledge REF: p. 10
- If a physician is being sued by a patient for the acts of a medical assistant, which of the following applies?
| a. | Stare decisis |
| b. | Respondeat superior |
| c. | Res ipsa loquitur |
| d. | Quid pro quo |
ANS: B
Respondeat superior is a Latin term that means, “Let the master answer.” If the medical assistant is sued for actions that harmed a patient, her superior is also likely to be sued, because the supervisor—specifically the physician—should have had control over the medical assistant’s actions.
DIF: Cognitive Level: Comprehension REF: pp. 5, 10, 85
- A defendant is asked, “What did you see just before you stopped your car to help the victims of the car wreck?” What situation likely is involved?
| a. | Sovereign immunity |
| b. | Malpractice |
| c. | Good Samaritan |
| d. | Negligence |
ANS: C
Good Samaritan laws protect healthcare providers or citizens who care for a person involved in an emergency or disaster without reimbursement.
DIF: Cognitive Level: Application REF: pp. 8, 89
- When the U.S. Supreme Court decides a case, it is binding to:
| a. | only the parties involved. |
| b. | only the city involved and its residents. |
| c. | only the state involved and its residents. |
| d. | all state and federal courts. |
ANS: D
Cases heard by the U.S. Supreme Court are binding on all state and federal courts.
DIF: Cognitive Level: Knowledge REF: p. 12
- If a man enters surgery to have his left leg amputated and leaves surgery with his right leg amputated, which Latin term of law applies?
| a. | Respondeat superior |
| b. | Res ipsa loquitur |
| c. | Stare decisis |
| d. | Quid pro quo |
ANS: B
Res ipsa loquitur means, “The thing speaks for itself.” The presumption that the surgeon removed the wrong leg means that the plaintiff does not have to prove that negligence occurred to recover from the defendant.
DIF: Cognitive Level: Application REF: p. 10
- If a judge decides a case on the basis of findings of a previous court in a similar case, which Latin term applies?
| a. | Respondeat superior |
| b. | Res ipsa loquitur |
| c. | Stare decisis |
| d. | Quid pro quo |
ANS: C
Stare decisis means “to stand by things decided.” Courts often follow decisions made by courts of higher or equal jurisdiction.
DIF: Cognitive Level: Knowledge REF: p. 5
- The Supreme Court hears cases from courts with what jurisdiction?
| a. | Higher jurisdiction than the Supreme Court |
| b. | Lower jurisdiction than the Supreme Court |
| c. | Equal jurisdiction to the Supreme Court |
| d. | No jurisdiction |
ANS: B
The Supreme Court only hears cases from courts with lower jurisdiction. No court has higher jurisdiction than the U.S. Supreme Court.
DIF: Cognitive Level: Knowledge REF: pp. 11-12
- Which is true about a malpractice case?
| a. | There must be proof of a breach of duty. |
| b. | No damages can be present. |
| c. | The cause of the damages does not have to be specific. |
| d. | The person who caused the damages does not have the duty to care for the patient. |
ANS: A
Four elements are required in a negligence action: duty, breach of duty, causation, and damages.
DIF: Cognitive Level: Comprehension REF: p. 9
- This branch of government proposes legislation and enforces laws.
| a. | Legislative |
| b. | Executive |
| c. | Judicial |
| d. | Municipal |
ANS: B
The President or Governor proposes legislative action to be taken by individual legislators, either vetoes or approves laws agreed to by the legislature, and enforces the laws.
DIF: Cognitive Level: Knowledge REF: p. 4
- This branch of government establishes agencies to enact administrative law.
| a. | Legislative |
| b. | Executive |
| c. | Judicial |
| d. | Municipal |
ANS: B
The executive branch also proposes and establishes certain agencies to enact rules and regulations that become administrative law. Once the legislature creates a statute, it empowers the appropriate executive agency to implement and establish rules and regulations to meet the intent of the statute.
DIF: Cognitive Level: Knowledge REF: p. 4
- This branch of government interprets statutory law.
| a. | Legislative |
| b. | Executive |
| c. | Judicial |
| d. | Municipal |
ANS: C
The judicial branch is also the source of common law, or case law, which is the law that develops from the decisions made by courts. Previous decisions are considered precedent and binding on all lower courts.
DIF: Cognitive Level: Knowledge REF: p. 5
- OSHA was created by which branch of government?
| a. | Legislative |
| b. | Executive |
| c. | Judicial |
| d. | Municipal |
ANS: B
Once the legislature creates a statute, it empowers the appropriate executive agency to implement and establish rules and regulations to meet the intent of the statute. These rules and regulations codify the interactions between the citizens and the agencies, provide for certain police powers to the agencies to enforce the regulations, and govern the agencies themselves.
DIF: Cognitive Level: Comprehension REF: pp. 4-5
- This develops from decisions previously made by courts, or precedents, and these are binding on all lower courts.
| a. | Criminal law |
| b. | Common law |
| c. | Medical law |
| d. | None of the above |
ANS: B
In Latin this is called stare decisis, which means to stand by things decided or adhere to decided cases. Common law originated from England with the Pilgrims and original settlers of the land. Since that time, each state’s courts have made decisions regarding civil and criminal cases.
DIF: Cognitive Level: Knowledge REF: p. 6
Chapter 05: Code and Standards Infractions
Test Bank
MULTIPLE CHOICE
- If an individual does something illegal, whose responsibility is it to enforce sanctions?
| a. | The person who caught them |
| b. | The person who did the illegal action |
| c. | The employer of the governing entity |
| d. | Their coworkers |
ANS: C
It is the duty of all healthcare professionals to monitor themselves and uphold the ethical standards of the profession. If an individual does something illegal or unethical it is the responsibility of their employer or governing body to enforce the sanctions that would be appropriate for the violation that occurred.
DIF: Cognitive Level: Comprehension REF: p. 70
- Consequence that is levied against a legal or ethical violation is called:
| a. | compliance. |
| b. | due process. |
| c. | sanction. |
| d. | disciplinary action. |
ANS: D
Disciplinary actions are consequences that are levied against an individual who has violated either the laws or the ethical standards for that profession. In the medical field violations can range from the unethical treatment of a patient or individual or negligence of care to a HIPAA violation of privacy, fraud, or other illegal actions.
DIF: Cognitive Level: Knowledge REF: p. 70
- Workplace sanctions depend on ____ to instill.
| a. | laws |
| b. | whistleblowers |
| c. | professional codes of conduct |
| d. | policies and procedures |
ANS: C
Although committing an illegal act may bring fines and possible imprisonment, professional and workplace sanctions do not depend on laws, but professional codes of conduct, and may include such corrective actions as termination of employment or loss of license.
DIF: Cognitive Level: Comprehension REF: pp. 70-71
- What are workplace standards?
| a. | Standards that are expected of employees dependent upon their position |
| b. | Rules of the workplace, no matter your position |
| c. | Laws set forth by local governments |
| d. | Standards set by society |
ANS: A
Every medical or healthcare employer, whether a hospital, agency, or group practice, should have a set of standards of what is expected of their employees based on their position and expertise. As new employees sign-off on the workplace, they acknowledge the specified consequences that will result from working outside of the parameters of that job description or violating the code of ethics.
DIF: Cognitive Level: Knowledge REF: p. 71
- Disciplinary action varies from all of the following except:
| a. | state to state. |
| b. | facility to facility. |
| c. | one area of expertise to another. |
| d. | state and federal regulations. |
ANS: D
Reasons for disciplinary action vary from state to state, facility to facility, and one area of expertise to another. State and federal regulations focus on violations in the areas of fraud, substance abuse, illegal acts, operating without a license, acting outside the scope of practice, and malpractice.
DIF: Cognitive Level: Comprehension REF: p. 71
- What is an example of disciplinary action for a minor infraction?
| a. | Termination |
| b. | Suspension |
| c. | Large fine |
| d. | Corrective action plan |
ANS: D
The consequences of a minor infraction may just include a corrective action plan (CAP) by an employer or a temporary loss of license or small fine/penalty.
DIF: Cognitive Level: Comprehension REF: p. 71
- What is an example of a disciplinary action for a serious infraction?
| a. | Permanent loss of license |
| b. | Small fine |
| c. | Suspension |
| d. | Large fine |
ANS: A
In the case of a more serious infraction, the person may incur permanent loss of license and heavy fines and penalties. If a physician, for example, is found to be guilty of substance abuse, the physician may have a loss of license imposed by Medicare and or the state licensing board and lose their livelihood.
DIF: Cognitive Level: Comprehension REF: p. 71
- A compliance plan is used to:
| a. | let the employee know the rules of his or her employer. |
| b. | inform the employee of potential measures to be taken when company policies are violated. |
| c. | inform the employee of the results of not reporting one of their coworkers for any wrongdoing. |
| d. | explain to the employee why he or she should not share a patient’s personal information. |
ANS: B
All employers should have a written policy or new-hire handbook that details expectations and standards for all employees, including, but not be limited to, dress code, code of ethics, and job description. Taking that one step further, it should also detail the measures to be taken in the event of any violation of the company policies, which would be part of the company’s compliance plan.
DIF: Cognitive Level: Comprehension REF: pp. 72-73
- Protected health information is:
| a. | information about any individual that is protected by law. |
| b. | the patient’s name. |
| c. | the patient’s address. |
| d. | any information a patient does not want you to know. |
ANS: A
PHI is information about any individual that is protected by law from being shared or discussed outside proper channels for treatment. This extremely private information includes such crucial data as a person’s Social Security number and date of birth.
DIF: Cognitive Level: Knowledge REF: p. 72
- A patient’s right to confidentiality is covered under:
| a. | AMA. |
| b. | AHIMA. |
| c. | OCR. |
| d. | HIPAA. |
ANS: D
The Health Insurance Portability and Accountability Act (HIPAA) protects the patient’s right for confidentiality and privacy.
DIF: Cognitive Level: Knowledge REF: p. 72
- What organization regulates HIPAA rules?
| a. | AMA |
| b. | OIG |
| c. | OCR |
| d. | AHIMA |
ANS: C
The Office for Civil Rights (OCR) is charged with regulating all established HIPAA rules and regulations.
DIF: Cognitive Level: Knowledge REF: p. 72
- What is necessary for an employee to be terminated for violating a policy that is clearly described in the company’s policies and procedures as “immediate dismissal”?
| a. | A verbal warning before termination |
| b. | A corrective action plan |
| c. | A written warning before termination |
| d. | Documentation of the offense in the employee’s file |
ANS: D
If it is not clearly documented in the employee’s file, the employee may be able to challenge his or her termination.
DIF: Cognitive Level: Comprehension REF: p. 73
- Due process is:
| a. | giving the employee the chance to explain himself. |
| b. | interviewing others who saw the offense. |
| c. | following policies and procedures through every step before termination, and documenting that such steps were taken. |
| d. | firing an employee after speaking to him or her for the third time, but not documenting it. |
ANS: C
Most employers have a series of steps that must be taken before an employee can be fired. The employer must document each step in the employee’s file to show that due process was followed and that the policy of the institution was obeyed.
DIF: Cognitive Level: Knowledge REF: p. 73
- If a company treats two employees differently for the same infraction, this is considered:
| a. | noncompliance. |
| b. | discrimination. |
| c. | harassment. |
| d. | illegal. |
ANS: B
It is considered discrimination if a supervisor or employer treats any one individual differently than another. A compliance officer can ensure this does not happen in the workplace.
DIF: Cognitive Level: Comprehension REF: p. 74
- The Office of the Inspector General investigates:
| a. | the American Medical Association. |
| b. | the Occupational Safety and Health Administration. |
| c. | the Department of Labor. |
| d. | the Department of Health and Human Services. |
ANS: D
The Office of Inspector General is an independent agency that functions under the Department of Justice to investigate and protect the integrity of the Department of Health and Human Resources (HHS) and their recipients, as well as welfare programs. There are more than 70 OIG offices throughout the United States.
DIF: Cognitive Level: Knowledge REF: p. 74
- A physician bills an insurance company for services not rendered. This is considered:
| a. | noncompliance. |
| b. | a violation of the Stark laws. |
| c. | a violation of the Medical Practice Acts. |
| d. | fraud. |
ANS: D
Fraud is the intentional act to misrepresent facts or mislead in order to gain financially. In this case, the physician would gain financially, so it would be considered fraud.
DIF: Cognitive Level: Comprehension REF: p. 74
- If it is not documented:
| a. | it did not happen. |
| b. | it can be documented later. |
| c. | it may have happened. |
| d. | it can be billed out. |
ANS: A
If it is not documented, it did not happen and you cannot bill for it. Many providers are lacking in documentation skills, and, as a result, the work performed is not billed.
DIF: Cognitive Level: Comprehension REF: p. 74
- Down-coding can be considered:
| a. | a violation of the Stark laws. |
| b. | a violation of the Medical Practice Acts. |
| c. | fraud. |
| d. | noncompliance. |
ANS: C
Many providers down-code their services to avoid any fraud, but indeed this too is considered to be fraud, although, unlike falsely billing or coding to increase reimbursement, there are no cases of known prosecution for down-coding.
DIF: Cognitive Level: Comprehension REF: p. 74
- If a coder consistently put the wrong code on a claim, this is considered:
| a. | a fraudulent claim. |
| b. | an infraction. |
| c. | acceptable. |
| d. | a simple mistake. |
ANS: B
This mistake is not deliberate fraud, but it is of course an infraction—a breaking of the principles and requirements of the insurance carrier for billing and coding.
DIF: Cognitive Level: Comprehension REF: p. 76
- If due diligence is shown in a billing error on behalf of the provider, and any refunds are paid to the insurance company, generally:
| a. | the provider is issued a fine, but not prosecuted. |
| b. | the provider is fined and prosecuted. |
| c. | the provider is prosecuted, but not fined. |
| d. | no further action is taken. |
ANS: D
Generally, if the compliance officer shows due diligence to correct a problem found, and voluntarily submits documentation and pays back any monies they received because of it, the carrier sees that the provider is attempting to maintain the integrity of their billing and coding and no further action is taken.
DIF: Cognitive Level: Comprehension REF: p. 76
- If an insurance carrier finds an error, they look for:
| a. | the intent of the error. |
| b. | reasons to sue the physician. |
| c. | who is responsible for the error within the physician’s office. |
| d. | all of the above. |
ANS: A
Overall, the main focus of these cases is the intention of the provider. Was this act deliberate or intentionally misleading (and thus fraudulent)? Or did the provider and billing staff just make a mistake—that is, commit an infraction? If a case is found to be intentional, the fraudulent acts will lead to prosecution, and, as we have noted, the fines and penalties can be substantial.
DIF: Cognitive Level: Comprehension REF: p. 76
- If a physician receives rewards from a drug manufacturer to prescribe their drugs, this is considered:
| a. | abuse of privilege. |
| b. | kickbacks. |
| c. | a violation of the Stark laws. |
| d. | all of the above. |
ANS: D
Kickbacks create in a physician a bias towards promoting certain specialists, treatments, drugs, and other services or products because promoting them brings personal financial gain for that physician. It is also an abuse of privilege and a violation of the Stark Laws.
DIF: Cognitive Level: Comprehension REF: p. 76
- The Medical Practice Act that governs healthcare professionals is regulated:
| a. | locally. |
| b. | state by state. |
| c. | federally. |
| d. | by all of the above. |
ANS: B
Each state has its own Medical Practice Act, which provides laws that govern healthcare professionals’ scope of practice and licensing requirements.
DIF: Cognitive Level: Comprehension REF: p. 77
- Physicians are governed not only by state laws but also by:
| a. | the American Medical Association. |
| b. | the Association of American Physicians. |
| c. | the American Medical Group Association. |
| d. | all of the above. |
ANS: A
The AMA sets standards for medical education and advancing medical science and has the power to govern physicians, as well as having the power to revoke physician licenses.
DIF: Cognitive Level: Knowledge REF: p. 77
- If a healthcare professional oversteps his or her scope of practice, which can occur?
| a. | Loss of license |
| b. | License suspension |
| c. | Censure |
| d. | All of the above. |
ANS: D
Depending on the case and applicable laws, sanctions can include the following, among others: loss of license, suspension of license, loss of membership to the organization, censure, licensing limitations and restrictions, required treatment, and requirements for further education.
DIF: Cognitive Level: Comprehension REF: pp. 77-78
