JP Exam
T - ANS-The health and safety of patients shall be the first consideration of the practitioner. The
principal objective to the practitioner is to render service to humanity
T - ANS-iv. TERMS—staggered 6 year terms (staggered = not all appointed at the same time),
Governor appoints successor
Board Rule §375.3 "General" provides that: - ANS-Board Rule §375.3 "General" provides that:
"(a) The health and safety of patients shall be the first consideration of the
Podiatric Physician. The principal objective to the podiatric profession is to
render service to humanity. A Podiatric Physician shall continually strive to
improve his medical knowledge and skill for the benefit of his patients and
colleagues. The Podiatric Physician shall administer to patients in a
professional manner and to the best of his ability. Secrets and personal
information entrusted to him shall be held inviolate unless disclosure is
necessary to protect the welfare of the individual or the community. A
Podiatric Physician shall be temperate in all things in recognition that his
knowledge and skill are essential to public health, welfare, and human life. (b)
A licensed podiatric physician shall conduct his practice on the highest plane
of honesty, integrity, and fair dealing and shall
Soliciting Patients; Offense. - ANS-§102.001. Soliciting Patients; Offense. (a) A person commits
an offense if the person
knowingly offers to pay or agrees to accept, directly or indirectly, overtly or covertly any
remuneration in cash or in kind to or from another for securing or soliciting a patient or
patronage for or from a person licensed, certified, or registered by a state health care
regulatory agency. (b) Except as provided by Subsection (c), an offense under this section
is a Class A misdemeanor. (c) An offense under this section is a felony of the third degree
if it is shown on the trial of the offense that the person: (1) has previously been convicted
of an offense under this section; or (2) was employed by a federal, state, or local
government at the time of the offense.
- ANS-i. "Podiatric Medical Practice Act, Texas Occupations Code, Chapter 202" (Statute)
ii. "Title 22—Part 18 Texas Administrative Code" (Rules)
i. Scope of Practice:
6. "Podiatry"—the treatment of or offer to treat any disease, disorder, physical injury, deformity
or ailment of the human foot by any system or method. The term includes "podiatric medicine"
7. Practice of Podiatry is limited to the treatment of the "Foot/Ankle" - ANS-of July 30th, 2010,
the Texas Supreme Court has made a final decision on the podiatry scope of practice.
,2. Scope of practice had then been a matter for final determination to be decided by the Texas
Legislature.
3. The 82nd Legislative Session began in January 2011
With regards to ALL credentialing/privileging issues, that is a matter for LOCAL CONTROL
between podiatrist & facility = Texas Health & Safety Code Subchapter E
ii. The Board is NOT authorized to order any hospital to grant privileges - ANS-i.
iii. TSBPME DOES make recommendations
iv. WETHER OR NOT PRIVILEGES ARE GRANTED IS A MATTER FOR LOCAL CONTROL
1. Notify board of Practice & Trade names, OK to use Ankle, must get approval, notify them of
changes in practice address or phone # w/in 10 days of changes - ANS-Chapter 373—Rules
Governing Advertising & Practice Identification
1. Advertising/Identification violations = $500/day - ANS-2. Properly Identify yourself:
a. Doctor of Podiatric Medicine
b. DPM
c. Podiatrist
d. Podiatric Physician
i. Records Retention: - ANS-1. CME = 4 years
2. Ads = 2 years
3. MR = 5 years
g. WHAT IS HEALTHCARE FRAUD (HCF)?—more detailed below...
i. Altered or fabricated medical bills & other documents;
ii. Excessive or unnecessary treatments;
iii. Billing schemes, such as:
1. Charging for a service more expensive that the one provided;
2. Charging for services that where NOT provided; or
3. Duplicate charges
iv. False or exaggerated medical disability; &
v. Collecting on multiple polices for the same illness or injury - ANS-iv. Every bill/claim is
considered fraud if you practice w/o a license = General Criminal Penalty
i. HCF is expected to continue to rise as people live longer=increase demand for Medicare
ii. CMS reports total health care costs of $2.4 trillion = 14% of the GDP, (by 2016 = $4.14/19.6
GDP) - ANS-ii. ALL health care programs are subject to FRAUD, however Medicare & Medicaid
programs are the most visible
iii. 3% - 10% of total health care expenditures come from fraud (public & private combined)
i. EMERGING TRENDS
1. PUBLIC:
a. US Health & Human Services—Office of Inspector General (USHHS-OIG)
, b. FDA
c. DEA
d. Defense Criminal Investigative Service
e. Office of Personnel Management
f. IRS—CID
2. PRIVATE:
a. National Health Care Anti-Fraud Association
b. National Insurance Crime Bureau (NICB) - ANS-j. FBI = primary investigative agency in the
fight against HCF, they have jurisdiction over BOTH the federal and private insurance groups
Fraud Eg - ANS-i. Billing for Services not Rendered, ex:
1. No medical service of any kind was rendered
2. The service was not rendered as described in the claim for payment
3. The service was previously billed & the claim had been paid
ii. Upcoding of Service = Billing a procedure code that yields a higher payment, ex:
1. Follow-up visit billed as initial or comprehensive visit
2. Group therapy billed as individual session
3. Unilateral procedure billed as bilateral
4. 30 minute session billed as a 50+ minute session
Section 1877 of the Social Security Act (42 U.S.C. 1395nn) is also known as the "Physician
Self-Referral" law and commonly referred to as the "Stark Law". - ANS-Section 1877 of the
Social Security Act (42 U.S.C. 1395nn) is also known as the "Physician
Self-Referral" law and commonly referred to as the "Stark Law".
12
"Federal Stark Law / False Claims Act / Anti-Kickback Statute / Physician Self-Referral Law"
complaints should be filed directly to the United States Department of Health & Human Services
DATA MINING TECHNIQUES: - ANS-l. i. FBI + DOJ + IRS—CID = 2005 = Electronic Bank
Records Initiative (EBRI) for financial institutions = Made investigations more efficient
ii. Upcoding of Service = Billing a procedure code that yields a higher payment, ex: - ANS-viii.
Kickbacks = offers, solicits, pays, or accepts money, or something of value, in exchange for
referral of a patient for health care services that maybe paid by Medicare or Medicaid, ex: a lab
owner gives $50 to a doctor for each Medicare patient sent for testing = violation of the
Anti-Kickback Statue
1. Follow-up visit billed as initial or comprehensive visit
2. Group therapy billed as individual session
3. Unilateral procedure billed as bilateral
4. 30 minute session billed as a 50+ minute session
T - ANS-The health and safety of patients shall be the first consideration of the practitioner. The
principal objective to the practitioner is to render service to humanity
T - ANS-iv. TERMS—staggered 6 year terms (staggered = not all appointed at the same time),
Governor appoints successor
Board Rule §375.3 "General" provides that: - ANS-Board Rule §375.3 "General" provides that:
"(a) The health and safety of patients shall be the first consideration of the
Podiatric Physician. The principal objective to the podiatric profession is to
render service to humanity. A Podiatric Physician shall continually strive to
improve his medical knowledge and skill for the benefit of his patients and
colleagues. The Podiatric Physician shall administer to patients in a
professional manner and to the best of his ability. Secrets and personal
information entrusted to him shall be held inviolate unless disclosure is
necessary to protect the welfare of the individual or the community. A
Podiatric Physician shall be temperate in all things in recognition that his
knowledge and skill are essential to public health, welfare, and human life. (b)
A licensed podiatric physician shall conduct his practice on the highest plane
of honesty, integrity, and fair dealing and shall
Soliciting Patients; Offense. - ANS-§102.001. Soliciting Patients; Offense. (a) A person commits
an offense if the person
knowingly offers to pay or agrees to accept, directly or indirectly, overtly or covertly any
remuneration in cash or in kind to or from another for securing or soliciting a patient or
patronage for or from a person licensed, certified, or registered by a state health care
regulatory agency. (b) Except as provided by Subsection (c), an offense under this section
is a Class A misdemeanor. (c) An offense under this section is a felony of the third degree
if it is shown on the trial of the offense that the person: (1) has previously been convicted
of an offense under this section; or (2) was employed by a federal, state, or local
government at the time of the offense.
- ANS-i. "Podiatric Medical Practice Act, Texas Occupations Code, Chapter 202" (Statute)
ii. "Title 22—Part 18 Texas Administrative Code" (Rules)
i. Scope of Practice:
6. "Podiatry"—the treatment of or offer to treat any disease, disorder, physical injury, deformity
or ailment of the human foot by any system or method. The term includes "podiatric medicine"
7. Practice of Podiatry is limited to the treatment of the "Foot/Ankle" - ANS-of July 30th, 2010,
the Texas Supreme Court has made a final decision on the podiatry scope of practice.
,2. Scope of practice had then been a matter for final determination to be decided by the Texas
Legislature.
3. The 82nd Legislative Session began in January 2011
With regards to ALL credentialing/privileging issues, that is a matter for LOCAL CONTROL
between podiatrist & facility = Texas Health & Safety Code Subchapter E
ii. The Board is NOT authorized to order any hospital to grant privileges - ANS-i.
iii. TSBPME DOES make recommendations
iv. WETHER OR NOT PRIVILEGES ARE GRANTED IS A MATTER FOR LOCAL CONTROL
1. Notify board of Practice & Trade names, OK to use Ankle, must get approval, notify them of
changes in practice address or phone # w/in 10 days of changes - ANS-Chapter 373—Rules
Governing Advertising & Practice Identification
1. Advertising/Identification violations = $500/day - ANS-2. Properly Identify yourself:
a. Doctor of Podiatric Medicine
b. DPM
c. Podiatrist
d. Podiatric Physician
i. Records Retention: - ANS-1. CME = 4 years
2. Ads = 2 years
3. MR = 5 years
g. WHAT IS HEALTHCARE FRAUD (HCF)?—more detailed below...
i. Altered or fabricated medical bills & other documents;
ii. Excessive or unnecessary treatments;
iii. Billing schemes, such as:
1. Charging for a service more expensive that the one provided;
2. Charging for services that where NOT provided; or
3. Duplicate charges
iv. False or exaggerated medical disability; &
v. Collecting on multiple polices for the same illness or injury - ANS-iv. Every bill/claim is
considered fraud if you practice w/o a license = General Criminal Penalty
i. HCF is expected to continue to rise as people live longer=increase demand for Medicare
ii. CMS reports total health care costs of $2.4 trillion = 14% of the GDP, (by 2016 = $4.14/19.6
GDP) - ANS-ii. ALL health care programs are subject to FRAUD, however Medicare & Medicaid
programs are the most visible
iii. 3% - 10% of total health care expenditures come from fraud (public & private combined)
i. EMERGING TRENDS
1. PUBLIC:
a. US Health & Human Services—Office of Inspector General (USHHS-OIG)
, b. FDA
c. DEA
d. Defense Criminal Investigative Service
e. Office of Personnel Management
f. IRS—CID
2. PRIVATE:
a. National Health Care Anti-Fraud Association
b. National Insurance Crime Bureau (NICB) - ANS-j. FBI = primary investigative agency in the
fight against HCF, they have jurisdiction over BOTH the federal and private insurance groups
Fraud Eg - ANS-i. Billing for Services not Rendered, ex:
1. No medical service of any kind was rendered
2. The service was not rendered as described in the claim for payment
3. The service was previously billed & the claim had been paid
ii. Upcoding of Service = Billing a procedure code that yields a higher payment, ex:
1. Follow-up visit billed as initial or comprehensive visit
2. Group therapy billed as individual session
3. Unilateral procedure billed as bilateral
4. 30 minute session billed as a 50+ minute session
Section 1877 of the Social Security Act (42 U.S.C. 1395nn) is also known as the "Physician
Self-Referral" law and commonly referred to as the "Stark Law". - ANS-Section 1877 of the
Social Security Act (42 U.S.C. 1395nn) is also known as the "Physician
Self-Referral" law and commonly referred to as the "Stark Law".
12
"Federal Stark Law / False Claims Act / Anti-Kickback Statute / Physician Self-Referral Law"
complaints should be filed directly to the United States Department of Health & Human Services
DATA MINING TECHNIQUES: - ANS-l. i. FBI + DOJ + IRS—CID = 2005 = Electronic Bank
Records Initiative (EBRI) for financial institutions = Made investigations more efficient
ii. Upcoding of Service = Billing a procedure code that yields a higher payment, ex: - ANS-viii.
Kickbacks = offers, solicits, pays, or accepts money, or something of value, in exchange for
referral of a patient for health care services that maybe paid by Medicare or Medicaid, ex: a lab
owner gives $50 to a doctor for each Medicare patient sent for testing = violation of the
Anti-Kickback Statue
1. Follow-up visit billed as initial or comprehensive visit
2. Group therapy billed as individual session
3. Unilateral procedure billed as bilateral
4. 30 minute session billed as a 50+ minute session
