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| Section | Objectives |
|---|---|
| Topic 1: Claims and Litigation Management | - Litigation support and documentation handling - Claims investigation and management processes |
| Topic 2: Healthcare Risk Management Foundations | - Principles of healthcare risk management - Risk identification and assessment methods - Risk mitigation strategies |
| Topic 3: Legal, Regulatory, and Ethical Issues | - Ethical considerations in healthcare risk management - Healthcare law and regulatory compliance - Consent, confidentiality, and documentation standards |
| Topic 4: Healthcare Risk Management Program Administration | - Performance measurement and improvement - Program development and governance |
| Topic 5: Clinical and Patient Safety | - Patient safety principles and frameworks - Clinical risk reduction strategies - Adverse event analysis and reporting |
| Topic 6: Risk Financing and Insurance | - Captive insurance and self-insurance models - Insurance structures in healthcare - Risk financing mechanisms |
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質問 # 85
An interrogatory requests insurance policy information. A risk manager should
正解：B
解説：
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, insurance policy information is generally discoverable in litigation. Most jurisdictions require disclosure of applicable liability coverage, including policy limits, pursuant to civil procedure rules governing discovery. Therefore, when an interrogatory properly requests insurance policy information, the organization should provide the specifically requested information in coordination with defense counsel.
Providing more information than requested, such as automatically including excess limits if not asked, may exceed the scope of the interrogatory and should be guided by legal counsel. A certificate of insurance is not a substitute for responding to formal discovery requests, as it may not contain all required details regarding coverage, limits, and applicable policy periods.
Objecting to the interrogatory without valid legal grounds is generally inappropriate, as insurance coverage information is typically relevant to potential satisfaction of judgment.
Claims and litigation objectives emphasize cooperation with counsel, compliance with discovery rules, and accurate disclosure of coverage information. Therefore, the appropriate response is to provide the specifically requested insurance policy information in accordance with legal guidance.
質問 # 86
Which of the following is a program of the Food and Drug Administration FDA post market surveillance system for medical devices that requires healthcare facilities to report patient deaths or injuries related to a medical device?
正解：B
解説：
Under Health Care Risk Management standards recognized by ASHRM and the American Hospital Association Certification Center, the Safe Medical Devices Act SMDA is part of the FDA's post market surveillance system for medical devices. The SMDA requires healthcare facilities to report to the FDA and, in some cases, to the manufacturer when a medical device has or may have caused or contributed to a patient death or serious injury. This mandatory reporting system enhances device safety monitoring and supports regulatory oversight after products enter the market.
EMTALA governs emergency medical screening and stabilization obligations, not device reporting. The Occupational Safety and Health Act focuses on workplace safety for employees rather than patient device- related injuries. Patient Safety Organizations operate under the Patient Safety and Quality Improvement Act and facilitate voluntary reporting of patient safety events, but they do not replace FDA-mandated device reporting requirements.
Legal and regulatory objectives in healthcare risk management emphasize compliance with federal reporting statutes, timely submission of required reports, and maintenance of documentation to mitigate regulatory exposure. Therefore, the Safe Medical Devices Act is the correct answer regarding mandatory FDA post market surveillance reporting for device-related deaths or injuries.
質問 # 87
The set of values, norms, guiding beliefs, and understandings that is shared by members of a healthcare organization and is taught to new members is
正解：B
解説：
Within Health Care Risk Management frameworks identified by ASHRM and the American Hospital Association Certification Center, organizational culture refers to the collective values, shared norms, guiding beliefs, and behavioral expectations that shape how members of a healthcare organization function. It influences decision-making, communication patterns, leadership styles, and responses to risk and safety concerns. Culture is transmitted formally through policies and training, and informally through leadership behavior, peer interactions, and organizational traditions.
Organizational culture plays a critical role in patient safety, compliance, and ethical conduct. A strong culture of safety encourages reporting of adverse events, supports transparency, and promotes continuous improvement. Conversely, a punitive or hierarchical culture may suppress reporting and increase liability exposure.
Corporate vision describes the aspirational future state of the organization. A strategic mission outlines the organization's purpose and objectives. Managerial ethics refers to principles guiding leadership conduct.
While these elements contribute to the broader organizational framework, they do not encompass the shared and socially transmitted system of norms and beliefs that define culture.
Therefore, the correct term describing shared and taught values and norms within a healthcare organization is organizational culture.
質問 # 88
What is responsible for many HIPAA privacy violations in practice?
正解：B
解説：
A frequent HIPAA Privacy Rule violation isimpermissible access or disclosureof protected health information-commonly including employee "snooping" (accessing records of family, friends, coworkers, or celebrities without a work-related need) and other unauthorized disclosures. Risk management objectives focus on preventing these events through role-based access, audit logs with active monitoring, sanctions policies consistently enforced, workforce training, and a culture that treats privacy as patient safety. Even when disclosures are not malicious, "minimum necessary" failures, misdirected faxes/emails, and unsecured devices can create reportable breaches. Effective prevention is layered: technical controls (access restrictions), administrative controls (policies, training), and detection/response (auditing, rapid mitigation). Privacy violations are high-risk because they harm patients, trigger regulatory action, and damage trust and reputation.
質問 # 89
What group reports information (historically HIPDB content; now within NPDB) related to fraud/abuse oversight?
正解：D
解説：
The Healthcare Integrity and Protection Data Bank (HIPDB) was created to combat healthcare fraud and abuse; it isno longer operational as a separate bank, and its content was merged into the NPDB. Reporting and querying are governed by HRSA rules defining authorized entities, including certain peer review and oversight organizations in specific reporting frameworks. Risk management objectives include ensuring organizations understand which actions must be reported, ensure due process, and comply with data handling rules. Proper reporting supports system integrity by preventing practitioners or entities with serious adverse actions from moving undetected across organizations. For hospitals and health plans, this strengthens credentialing and contracting decisions, reducing organizational exposure to negligent credentialing and improper network participation risks.
質問 # 90
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