Law, Liability, & Ethics For Medical Office Professionals

Sixth Edition

Chapter 4

Criminal Acts and Intentional Torts

Objectives

Summarize the various felonies described in the text

Identify behavior that is classified as criminal

Recognize some of the indicators of an abused child or elderly person

Explain what types of abuse mandates reporting

Distinguish between criminal and civil causes of action

Describe the various types of fraud

Criminal Acts

A misdemeanor is an offense classified lower than a felony

Generally punishable by a fine or imprisonment other than in a penitentiary

A felony is defined as a crime of grave or more serious nature than those designated as misdemeanors

Punishable by death or imprisonment for a term exceeding one year

Robbery

An individual is guilty of robbery if, while carrying out theft, the victim is physically injured or has been threatened and put in fear of bodily injury

Murder

An act done with intent to kill the victim

Attempted Murder

To prove that a defendant is guilty of an attempt, three things must be proven beyond a reasonable doubt:

That the defendant had specific intent to commit that particular crime

That the defendant took an overt act toward committing that crime, which was part of carrying out the crime

That the defendant’s act did not result in a complete crime

Euthanasia

Act or practice of painlessly putting to death persons suffering from incurable and distressing disease as an act of mercy

Manslaughter

Unlawful killing of another without malice

It is necessary to prove that there is wanton or reckless conduct

Conspiracy (1 of 2)

A conspiracy between two or more persons formed for purpose of committing, by their joint efforts, some unlawful or criminal act, or some act that is lawful in itself but becomes unlawful when done by the concerted action of the conspirators

Conspiracy (2 of 2)

To prove a defendant guilty of the crime of conspiracy, three things must be proven beyond a reasonable doubt:

That the defendant joined in an agreement or plan with one or more other persons

That the purpose of the agreement was to do something unlawful

That the defendant joined the conspiracy knowing of the unlawful plan and intending to help carry it out

Larceny Is Stealing

To prove a defendant guilty of larceny, three things must be proven beyond a reasonable doubt:

That the defendant took and carried away the property

That property was owned or possessed by someone other than the defendant

That the defendant took the property with the intent to permanently deprive that person of the property

Abuse

Three types of abuse may involve medical office personnel with criminal investigating agencies:

Child abuse

Elder abuse

Domestic abuse

Reporters

Under state statutes, teachers and health care providers are identified as mandated reporters

Behavioral Indicators of Child Abuse

Overly compliant, passive, keep a low profile, avoid confrontation with parents

Extremely aggressive, demanding, and rageful behaviors caused by the child’s repeated frustrations at not getting basic needs met

Role-reversed “parental” behavior, or extremely dependent behavior

Lags in development (—) child may fall behind norm for their age in toilet training, motor skills, socialization, and language development

Elder Abuse

Elder abuse is divided into five classifications:

Passive neglect

Active neglect

Psychological abuse

Financial abuse

Physical abuse

Domestic Violence

Abuse, physical or mental, that occurs within home

Violence is unjust and unwarranted exercise of force, usually accompanied by vehemence, outrage, or fury

Sexual Assault

The United States Department of Justice defines sexual assault as:

“… any type of sexual contact or behavior that occurs without the explicit consent of the recipient. Falling under the definition of sexual assault are sexual activities as forced sexual intercourse, forcible sodomy, child molestation, incest, fondling, and attempted rape”

Fraud

Fraud is a deliberate deception intended to produce unlawful gain

Examples include:

“Upcoding” procedures

Kickbacks for referrals

Filing false information

Billing for services not provided

“Renting” patients

Informants

An investigation is usually triggered by a tip

Tips come from Medicare carriers, peer review organizations, state licensing boards, whistle-blowing physicians, ex-staff members, and patients

Medical assistants may be considered co-conspirators with the physician in fraud

Health Insurance Portability and Accountability (HIPAA) Act of 1996

Included in the Act is a provision requiring every health plan and provider to maintain “reasonable and appropriate” safeguards to ensure confidentiality of any health information that:

Identifies the individual or relates to individual’s physical or mental health

Is created or received by a health plan, provider, or employer

Embezzlement

Embezzlement occurs in the medical office when the assistant handling payments from patients takes money and uses it for his or her own purpose

In order to prove embezzlement:

There must be a relationship, such as employment between the embezzler and the owner of money

The money must come into the hands of the embezzler because of the relationship

There must be an intent to fraudulently misappropriate the money

Illegal Sales of Drugs

In order to be found guilty of this offense:

The substance in question has to be a controlled substance

The individual being charged has to have a perceptible amount of the substance on his or her person or have distributed some perceptible amount with the intent to distribute it to another person or persons

The individual must have done so knowingly or intentionally

Intentional Torts (1 of 4)

Assault and battery

Invasion of privacy

False imprisonment

False Claims Act

Defamation of character

Intentional infliction of emotional distress

Intentional Torts (2 of 4)

Assault and battery

Any willful attempt or threat to injure another with the apparent ability to do so

Invasion of privacy

Privacy is a constitutional right

Intentional Torts (3 of 4)

False imprisonment

Intentionally confining a person without the legal right to do so

False Claims Act

Department of Justice (DOJ) civil fraud section recovers funds in the health care arena

Intentional Torts (4 of 4)

Defamation of character

Defamation of character occurs when one person communicates to second person about a third in such a manner that the reputation of the person about whom the discussion was held is harmed.

Such a written communication is termed libel

Spoken defamation is slander

Intentional infliction of emotional distress

Tort of outrageous conduct

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