| A | B |
|---|
| abuse | (in Federal law)actiothe monthe government has allocatedfor particular uses "to bill when it is not necessary" |
| audit | investigators review selected records for compliance with accepted documentation standards |
| breach of contract | if eith "competent medical care" is not fairly exchanged by "payment of fee"as agreed by contract promise(IMPLIED legal contract) |
| compliance plan | to find compliance problems and correct them before a liability occurs |
| comfidential information | information including all but a few facts in the patient's medical record |
| contract | enforcible agreement in which specific promises are made |
| fraud | act of deception used to take advantage of another person or entity "to bill when the task was not done" |
| HIPPA | Health Insurance Portability and Accountibility Act:legislation for action against medical fraud and abuse in Medicare, Medicaid, and private payers |
| libel | written information given out with the intent to harm the reputation of the patient |
| medical professional liability | responsibility for providing the state-required standard of care to their patients |
| negligence | when health care professionals fail to perform their medical duties properly |
| nonconfidential information | a person's name, dates of service,verification of hospital admission |
| qui tam | "whistle blower" The accusor(=relator)is protected against employer retaliation & may be entitled to 15-25% of fine paid by accused |
| respondent superior | law in which employer is responsible for an employee's actions(physicians can be charged for fraudulent behavior of any staffmember) |
| slander | oral information given out with the intent to harm the reputation of the patient. |
| supoena | an order of the court directing a party to appear and testify |
| supoena tecum duces | directs the person and his medical record to appear in court |
| OBRA | Emergency Release of Information Without Consent"Omnibus Budget Reconsiliation Act" |
| 4 ways for release of information to be transmitted | faxing, telephone, mail,electronic transmission |
| HIPPA | governs fraud and abuse enforced by office of inspector general(OIG) |
| E &O insurance | Error and Ommission insurance (for coders) |
