Federal Regulations Affecting the Medical Professional

1. Federal Regulations Affecting the Medical Professional Chapter 8

2. Equal Employment Opportunity and Employment Discrimination • Government regulations regarding employment Includes laws that affect recruitment, placement, pay plans, benefits, penalties, and termination • People must be judged primarily by job performance

3. Employment-at-Will Concept • Employment takes place at will of either employer or employee • Employment may be terminated at will at any time for no reason • Employee may quit at any time • Exception for a specific employment contract in which employment cannot be terminated during contract period

4. Title VII of the Civil Rights Act of 1964 • Prohibits discrimination, or unfair treatment based on race, color, religion, sex, or national origin • Several exceptions: certain religious-affiliated colleges, public officials and their staff • Forbids discrimination in all aspects of patient care in institutions that receive federal financial assistance • Makes sexual harassment a form of unlawful sex discrimination

5. Pregnancy Discrimination Act of 1978 • Employers must treat pregnant women as they would any other employee, providing pregnancy does not hinder job performance • Employer cannot force woman to quit her job because she is pregnant • Insured equal treatment in areas of disability, sick leave, and health insurance

6. Civil Rights Act of 1991 • Permits court to award both compensatory damages (for loss of income or emotional pain and suffering) and punitive damages (to punish the defendant and deter others from committing this action)

7. Age Discrimination Act of 1978 • Protects persons 40 and older against discrimination • Applies to employers with 20 or more employees • Mandatory retirement prohibited except for certain exempt executives

8. Rehabilitation Act of 1973 • Prohibits discrimination based on disability in institution that receives federal financial assistance

9. Americans with Disabilities Act(ADA) of 1990 • Prohibits employers who have more than 15 employees from discriminating against individual with disability • Employer must make reasonable accommodations • Exception if undue hardship for employer to make accommodations • AIDS patients protected under this statute

10. Employee Health and Safety • Regulated by both federal and state laws • State law may be stricter than federal but cannot be more lenient

11. Occupational Safety and Health Act (OSHA) of 1970 • Employer required by law to provide safe and healthy work environment • Must protect worker against hazards • Occupational Exposure to Bloodborne Pathogens Standards • Standards refer to urine, stool, sputum, nasal secretions, vomitus, and sweat if there is visible evidence of blood

12. Health Maintenance Organization (HMO) Act of 1973 • Requires company with 25 or more employees to provide HMO alternative to regular group insurance if HMO is available in area • Under HMO, patient has limited choice of doctors • Patient may have to get a second opinion and permission from HMO for major procedures

13. Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 • Company with 25 or more employees must provide extended health care insurance to terminated employees for as long as 18 months • Usually at employee’s expense

14. Drug-Free Workplace Act of 1988 • Employers contracting to provide goods or service to the federal government must certify that they maintain a drug-free workplace • Employer must inform employee of intent to maintain drug-free workplace and of any penalties employee would incur for violation of policy

15. Fair Labor Standards Act (FLSA) of 1938 • Main statute regulating employee benefits • Establishes minimum wage, requires pay for overtime, sets maximum hours employees can work • Covers nonmanagement employees in for-profit and not-for-profit institutions • Affects full-time hourly employees

16. Unemployment Compensation • Employers pay taxes into state compensation plan • Covers employees unable to work through no fault of their own • Provides temporary weekly payments for unemployed workers • If fired for good cause, employee is not entitled to benefits

17. Equal Pay Act of 1963 • Amendment to Fair Labor Standards Act (FLSA) • Illegal for employer to discriminate on basis of gender if performing same job

18. Federal Insurance Contribution Act (FICA) of 1935 • Employers required to contribute to Social Security plans for employees • Severe fine if payment not made on time • Requires detailed recordkeeping

19. Worker’s Compensation Act • Protects workers and families from financial problems resulting from employment-related injury, disease, or death • Employers pay into a fund to help cover costs when employee has work-related injury or disease • Goal to get employee back to work as soon as possible

20. Employee Retirement Income Security Act (ERISA) of 1974 • Regulates employee benefits and pension plans • Guarantees vesting (certain point in time when employee has right to receive benefits from retirement plan)

21. Family and Medical Act (FMLA) of 1994 • Allows mother and father to take leave of absence of up to 12 weeks in 12-month period when a baby is born • Job or equivalent position must be available when employee returns to work • Almost always, leave is without pay • Also allows leave for own or family member’s medical or family-related situation

22. Fair Credit Reporting Act of 1971 • Establishes guidelines for use of individual’s credit information • If denied credit, consumer must be notified and agency must disclose credit information to consumer, who may correct and update information

23. Equal Credit Opportunity Act of 1975 • Prohibits businesses from granting credit based on race or sex • Women and minorities must be issued credit if they qualify for it

24. Truth in Lending Act(Regulation Z) of 1969 • Requires full written disclosure about interest rates or finance charges concerning payment of any fee that will be collected in more than four installments

25. Fair Debt Collection Practices Act of 1978 • Prohibits unfair collection practices by creditors(institutions or persons who are owed money) • Credit collection phone calls can be made only between 8 A.M. and 9 P.M., Monday through Friday • Prohibits telephone harassment and threats

26. Collection calls are made between 8 A.M. and 9 P.M. Figure 8-1

27. Using a Collection Agency • Professional collection agencies available when all other attempts to collect unpaid bills fail • Agencies charge flat fee per account or percentage of amount collected • Once patient is told account is going to collection agency, it must by law go • Once account is turned over, no further collection attempts can be made by physician office or hospital

28. Bankruptcy • When unable to pay debts, may file for bankruptcy • Provides some protection to debtors • Establishes fair method for distribution of debtor’s assets to all creditors • Assets placed in special fund by court-appointed trustee, then distributed according to predetermined method

29. Federal Wage Garnishment Law of 1970 • Garnishment: court order requires employer to pay a portion of employee’s paycheck directly to one of employee’s creditors until debt is resolved • Restricts amount of paycheck that can be used to pay off a debt

30. Claims Against Estates • When patient dies, bills should be sent to the estate of the deceased • Generally, specific time limit allowed when filing a claim against an estate

31. The Statute of Limitations • Defines how long medical practice has to file suit to collect on past-due account • Important to attempt any debt collection as soon as possible

32. Antitrust Laws • Seek to preserve the private competitive market system by prohibiting activities that are anticompetitive • Primary antitrust laws that affect medical industry are the Sherman Antitrust Act, the Clayton Act, and the Federal Trade Commission (FTC) Act

33. Sherman Antitrust Act • Seeks to eliminate restraints of trade and prevent formation of monopolies • If person or practice is “injured” economically due to violation of this act, plaintiff can receive three times, or treble, damages in a civil lawsuit

34. Clayton Act • Forbids price discrimination and prohibits acquisitions and mergers where these practices may substantially lessen competition or create monopoly

35. Federal Trade Commission (FTC) Act • Prohibits unfair methods of competition and deceptive practices affecting commerce such as false advertising • FTC may issue cease and desist order requiring violators to immediately stop the unlawful behavior and not attempt any further violation

36. National Labor Relations Act (NLRA) of 1935 • Gives employees right to form and join unions, to bargain collectively, and to strike for better benefits and working conditions • Purpose of law is to protect employees • Establishes rights for both employees and employers, and defines some prohibitive acts by employers, called unfair labor practices

37. Labor Management Relations Act (LMRA) • Seeks to protect employers and employees by balancing power fairly between unions and management • Lists things that unions cannot do

38. Labor Rights • Election: held under supervision of NLRB • Effective hiring practices: can improve quality of employees by using effective screening process before actual hiring • Legal and illegal interview questions: strict guidelines on types of questions that can be asked during an interview