Q: Specific legal liability for hospital and doctor in respect to Medicare CfC and CoP.

Medicare CfC and CoP are elaborate. Which specific regulations present basis for legal liability in respect to wrong classification of patient, and improper discharge referrals? (Other than EMTALA, AKS, Stark law).

What statutes defines defense responsibility to do due diligence and present evidences that laws were NOT violated?

1 Lawyer Answer
James L. Arrasmith
PREMIUM
James L. Arrasmith pro label Lawyers, want to be a Justia Connect Pro too? Learn more ›
Answered

A: Regarding the specific regulations under Medicare's Conditions for Coverage (CfC) and Conditions of Participation (CoP) that could create a basis for legal liability in the case of wrong patient classification and improper discharge referrals, certain sections are particularly pertinent. For instance, under the CoPs, hospitals are required to have established policies regarding patient admission, classification, and discharge. Violation of these policies, especially if they lead to patient harm, can be a basis for liability.

Additionally, the CoPs require hospitals to maintain an effective discharge planning process that evaluates the patient's need for post-hospital services and the availability of such services. If a hospital fails to properly assess a patient's needs upon discharge or makes an inappropriate referral, this could result in liability, particularly if it leads to adverse patient outcomes.

In terms of defense responsibility, the burden of proof in civil litigation generally lies with the party making the claim. However, in a healthcare compliance context, the principle of 'due diligence' is key. This means that hospitals and physicians need to demonstrate that they have taken reasonable steps to comply with applicable laws and regulations, including Medicare's CfC and CoP.

In California, as in other jurisdictions, demonstrating due diligence typically involves showing that comprehensive policies and procedures are in place and that they are actively followed and enforced. It may also involve showing that appropriate training is provided to staff and that there is ongoing monitoring and auditing for compliance.

It's important for hospitals and doctors to maintain thorough documentation of their compliance efforts. This documentation can be crucial in defending against allegations of non-compliance or negligence. Remember, in legal disputes over healthcare compliance, the specifics of each case will greatly influence the defense strategy and the determination of liability.

Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.

The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.

Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.