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NEW QUESTION # 29
An HMO advertises it is "the best" and its physicians can manage any illness/injury. A patient relies on this and is injured. The patient might sue the HMO for:
Answer: A
Explanation:
Marketing claims can create liability exposure when they reasonably induce reliance and the patient suffers harm. Depending on jurisdiction and facts, plaintiffs may allegeapparent agency(belief that physicians acted as the HMO's agents),vicarious liability, negligent credentialing, or negligent misrepresentation/consumer protection claims if statements are misleading. Risk management objectives include reviewing public claims for accuracy, ensuring marketing does not overpromise clinical capability, and aligning network adequacy and credentialing with representations. Clear disclosures about independent contractors may help but do not always defeat apparent agency claims. Controls include legal review of advertising, credentialing rigor, quality oversight, and complaint surveillance to detect mismatches between marketing and actual service capability.
NEW QUESTION # 30
Which type of information was associated with the former HIPDB (now within NPDB) but not the original NPDB focus?
Answer: C
Explanation:
The HIPDB was established to help combathealthcare fraud and abuse, while the NPDB historically focused on practitioner competence and professional conduct (including items like malpractice payments and certain adverse actions). HRSA explains that HIPDB is no longer separate and that its information is now collected and disclosed through the NPDB following the 2013 merger. For risk managers, the objective is to ensure credentialing, contracting, and compliance teams understand the expanded scope and proper use:
querying supports safer hiring/privileging decisions and reduces negligent credentialing risk, while reporting supports system integrity. Organizations must also ensure due process and correct categorization of reportable events to avoid wrongful reporting exposure.
NEW QUESTION # 31
Which of the following is the BEST reason for the selection of defense counsel?
Answer: B
Explanation:
According to Health Care Risk Management standards outlined by ASHRM and the American Hospital Association Certification Center, the selection of defense counsel should be based primarily on demonstrated expertise in the relevant area of law. Medical malpractice litigation involves complex clinical issues, evolving standards of care, expert witness coordination, and familiarity with healthcare regulations. Counsel with specialized experience in healthcare liability defense is better equipped to manage case strategy, assess exposure, and navigate jurisdiction-specific procedural rules.
Proximity to the facility may offer logistical convenience but does not ensure competency in complex medical litigation. Percentage of defense verdicts can be misleading, as case mix, settlement strategy, and jurisdictional tendencies influence outcomes. A high defense verdict rate does not necessarily reflect effective risk management or cost control. Fee schedule is an important financial consideration; however, cost alone should not override qualifications and experience.
Claims and litigation objectives emphasize effective case management, accurate evaluation of liability exposure, and protection of organizational reputation. Selecting counsel based on specialized expertise supports stronger legal defense, strategic settlement evaluation, and improved coordination with clinical experts. Therefore, area of expertise is the best reason for selecting defense counsel.
NEW QUESTION # 32
An intervention between parties to promote reconciliation, settlement, or compromise is
Answer: C
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, mediation is a form of alternative dispute resolution designed to facilitate voluntary settlement between parties. In mediation, a neutral third party assists disputing parties in communicating, clarifying issues, and exploring mutually acceptable resolutions. The mediator does not impose a binding decision but guides negotiation toward compromise and reconciliation.
Arbitration differs in that the neutral arbitrator typically renders a decision that may be binding, depending on the agreement between parties. Jury trials and bench trials involve formal court proceedings where a judge or jury determines liability and damages based on legal standards and evidence. These processes are adversarial and result in judicial determinations rather than negotiated compromise.
Claims and litigation objectives emphasize cost containment, early resolution, and reduction of adversarial conflict when appropriate. Mediation can reduce defense expenses, shorten case duration, and preserve professional relationships. It also provides greater confidentiality and flexibility than courtroom litigation.
Therefore, the intervention specifically intended to promote reconciliation, settlement, or compromise between parties is mediation.
NEW QUESTION # 33
An employer is not required to offer a reasonable accommodation to a job applicant with a qualified disability unless
Answer: B
Explanation:
Under Health Care Risk Management principles aligned with ASHRM and the American Hospital Association Certification Center, compliance with the Americans with Disabilities Act ADA requires employers to provide reasonable accommodations to qualified individuals with disabilities. However, the obligation to provide accommodation is generally triggered when the applicant or employee makes the employer aware of the need for accommodation.
The interactive process required by the ADA begins once the applicant requests an accommodation or discloses a need related to a disability. Employers are not required to speculate about potential disabilities or initiate accommodations without notice. While documentation may be requested to verify the disability in certain circumstances, proof is not the triggering requirement. Instead, the request itself initiates the employer' s duty to engage in good faith discussion to determine reasonable accommodation.
Withholding accommodation that creates an unsafe condition may raise separate workplace safety concerns, but that is not the threshold requirement under the ADA. Similarly, an employer's recognition alone does not automatically impose an obligation absent a request or clear disclosure.
Legal and regulatory objectives emphasize proper documentation, consistent application of ADA standards, and engagement in the interactive process once accommodation is requested. Therefore, the employer's duty arises when the applicant requests the accommodation.
NEW QUESTION # 34
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