Fundamentals of Medical Practice Investigation
| Main Author: | Lane, Jeffrey D. |
|---|---|
| Format: | eBook |
| Language: | English |
| Published: |
Milton :
Taylor & Francis Group,
2016.
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| Physical Description: |
1 online resource (389 pages) |
| Subjects: | |
| Online Access: |
Connect to Resource |
| Item Description: |
Cover -- Half Title -- Title Page -- Copyright Page -- Dedication -- Table of Contents -- Preface -- Disclaimer -- Acknowledgments -- Author -- Chapter 1: Medicine and the investigation thereof -- Definition -- The standard of care -- Two broad approaches to medicine -- Allopathic medicine -- Osteopathic medicine -- Investigation -- References -- Chapter 2: Professional ethics -- Hippocratic Oath -- Professional ethics -- Profession -- Ethics -- The Four Principles Approach -- Autonomy -- Beneficence and nonmaleficence -- Justice -- Influencers of unethical behavior -- The ethical investigator -- Ethical decision making -- References -- Chapter 3: The regulation of the practice of medicine -- How physicians gain licensure -- How state medical boards regulate physicians after licensing -- Difference between a medical board disciplinary action and malpractice -- Sharing of information -- How state medical boards serve the public -- State medical board physician profiles -- Physician discipline statistics -- The Medical Practice Act -- References -- Chapter 4: The investigative process -- Definition and purpose of an investigation -- Attributes of an effective investigator -- Survey of state medical practice acts -- Initial complaint review -- References -- Chapter 5: Witness interviews and respondent interviews -- Witness interview -- Time, location, and setting of the interview -- Preparation for the interview -- Preparation -- Introduction -- Body -- Conclusion -- Developing pertinent questions -- Asking the question -- Listening and observing -- Documenting the interview -- Interview review -- Respondent/subject interview -- The Miranda warning -- Logical approach -- Emotional approach -- Verbal and nonverbal responses -- Truthful verbal responses -- Untruthful verbal responses -- Nonverbal responses -- References. Chapter 6: The medical record -- The medical chart and its purpose -- Obtaining a medical record -- Reviewing the medical record -- Comparative table -- Time line -- Parts of the medical record -- Ambulance call report or ambulance trip sheet -- Emergency department record -- Face sheet -- Admission note/history and physical -- Radiology note -- Consult note -- Informed consent -- Operative note or procedure note -- Anesthesia note -- Physician order sheet -- Progress note -- Nursing notes -- Medication administration record -- Laboratory and pathology reports -- Discharge summary -- Incident reports -- Autopsy report -- Altering and falsifying the medical record -- Detecting chart tampering -- Strategies to detect altered medical records -- Properly correcting the medical record -- References -- Chapter 7: Evidence and evidence handling -- Purposes of evidence -- Types of evidence -- Rules of evidence -- Exclusionary rule -- Hearsay rule -- Authentication of documentary evidence -- Obtaining evidence -- Voluntary relinquishment -- Subpoena -- Search warrant -- Chain of custody -- References -- Chapter 8: Standard of care investigations -- Definition -- Medical malpractice -- Physician/patient relationship -- Common SOC issues -- Failure to obtain consultation and referral -- Physician/patient communication failure -- Failure to diagnose/misdiagnosis -- Treatment errors -- Prescribing of drugs -- Investigation -- Interview of complainant -- Interview of witnesses -- Obtaining records -- Reviewing the records -- Interview of the respondent -- Peer review -- References -- Chapter 9: Controlled substance prescribing investigations -- Definitions -- Opioids/narcotics -- Effects on the brain and body -- Potential consequences of opioid use and abuse -- Stimulants -- Effects on the brain and body -- Potential consequences of stimulant use and abuse. Central nervous system (CNS) depressants -- Effects on the brain and body -- Potential consequences of CNS depressant use and abuse -- Tolerance versus dependence versus addiction -- Tolerance -- Dependence -- Physical dependence -- Psychological dependence -- Addiction -- Regulation -- 21 CFR 1306.04 Purpose of issue of prescription -- 21 CFR 1306.05 Manner of issuance of prescriptions -- Scope of the problem -- Prescription drug monitoring programs -- Investigation -- Covert approach -- Overt approach -- Interview of complainant and witnesses -- Collecting pharmacy data -- Organizing the pharmacy data -- Reviewing the pharmacy data -- Obtaining patient records -- Reviewing the patient records -- Interviewing the physician -- Internet prescribing -- References -- Chapter 10: Professional sexual misconduct investigations -- Definition -- Boundaries -- Boundary blurring -- Dual relationships -- Sexual impropriety -- Boundary transgressions -- Sexual violations -- Investigation -- Interview of complainant -- Interview of victim/patient -- Assessing the victim/patient's credibility -- Interview of witnesses -- Documentary evidence -- Interview of the respondent/physician -- Assessing the physician's credibility -- Potential outcomes -- References -- Chapter 11: Mental and physical impairment investigations -- Definitions -- Illness versus impairment -- Substance abuse/addiction -- Definitions -- Substance -- Substance use disorder (according to DSM-IV) -- Addictive illness -- Psychiatric disorders -- Disruptive behavior -- Inappropriate behaviors -- Inappropriate words or actions -- Inappropriate responses to patient needs or staff requests -- Physical and medical disability and the aging physician -- Physician health programs -- Investigation -- Self report -- Report from family, co-worker, pharmacist, et al -- Physician interview. Report of adverse action by hospital or practice -- References -- Chapter 12: Investigating healthcare fraud -- Scope of the problem -- Definitions -- General definition of fraud -- Definition of healthcare fraud -- Federal statutes relating to healthcare fraud -- Health Insurance Portability and Accountability Act of 1996 -- Types of fraud schemes -- Billing for services not rendered -- Up-coding of services -- Up-coding of medical equipment and devices -- Substitute providers/misrepresenting the provider of service -- Unnecessary or excessive tests or services -- Unnecessary surgeries and procedures -- Unbundling -- Misrepresenting noncovered treatments as medically necessary -- Kickbacks -- Investigation -- Complainant interview -- Witness interviews -- Benefit program data -- Patient interviews -- Obtain patient charts -- Review patient charts -- Interview of suspect provider -- References -- Chapter 13: Other investigative concerns -- Criminal convictions -- Hospital adverse actions -- Disciplinary actions taken by another jurisdiction -- Settlements and judgments of malpractice suits -- Fraud when applying for licensure -- References -- Chapter 14: Investigating the unlicensed practice of medicine and complementary and alternative medicine -- Elements of the offense -- Complementary and alternative medicine -- Prevalence of the use of CAM -- Ethical issues -- Autonomy -- Beneficence and maleficence -- Justice -- Legal status of CAM -- Ethnic and cultural practices -- Investigation -- Overt investigation -- Interview of complainant/source of information -- Interview of other witnesses -- Interview of patients -- Obtaining evidence -- Covert investigation -- Interview of suspect practitioner -- Telemedicine -- Licensure -- Establishment of a physician-patient relationship -- Evaluation and treatment of the patient -- Informed consent. Continuity of care -- Referrals for emergency services -- Medical records -- Privacy and security of patient records and exchange of information -- Disclosures and functionality on online services making available telemedicine technologies -- Prescribing -- What services can be provided by telemedicine? -- Benefits of telemedicine -- References -- Chapter 15: The report of investigation -- Purpose of the ROI -- Characteristics of an effective ROI -- The 4 Cs of effective report writing -- Correct -- Concise -- Clear -- Guidelines for clarity -- Complete -- Who -- What -- When -- Where -- How -- Why -- Report writing process -- Introduction -- Body -- Conclusion -- References -- Chapter 16: The trial and hearing process and the investigator as a witness -- The concept of due process of law -- Burden of proof -- Reasonable doubt -- Preponderance of the evidence -- Trial and hearing process -- Opening statements -- Presentation of evidence by the petitioner -- Presentation of evidence by the defense -- Rebuttal -- Closing statements -- The investigator as a witness -- Credibility -- Characteristics of a good investigator witness -- Testifying on direct examination -- Testifying on cross-examination -- References -- Chapter 17: Managing your caseload -- References -- Appendix 1: HIPAA privacy authorization form -- Appendix 2: Ambulance call report -- Appendix 3: Emergency department notes -- Appendix 4: Face sheet -- Appendix 5: Admission note-history and physical -- Appendix 6: Radiology note -- Appendix 7: Consult note -- Appendix 8: Informed consent for invasive, diagnostic, medical, and surgical procedures -- Appendix 9: Operative note -- Appendix 10: Anesthesia note -- Appendix 11: Physician orders -- Appendix 12: Progress note -- Appendix 13: Nursing notes -- Appendix 14: Medication administration record -- Appendix 15: Lab report. Appendix 16: Discharge summary. Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2021. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries. |
|---|---|
| Physical Description: |
1 online resource (389 pages) |
| ISBN: |
9781315350929 |