Case+9+Relevant+Laws+and+Legal+Considerations

Relevant Laws and Legal Considerations media type="youtube" key="kyIjU3NEl1E" width="448" height="251" Although a counselor should maintain appropriate ethical standards, it is also important to know the laws and statues of the state he or she works in. Besides the ethical concerns in Ethical Case 9: Pitfalls in Managed Care, there are also relevant laws that Martin needs to be aware of.

 One of the biggest legal issues that Martin could be facing is insurance fraud. By providing martial counseling to a couple and billing it to the insurance company under their child, Martin has broken the law. If found out, this could cause Martin to have his licenses suspended in Georgia. The following section of Georgia law pertains to fraud and license revocation:


 *  43-10A-17. Denial or revocation of license; other discipline; subpoenas; judicial review; reinstatement; investigation; immunity; failure to appear; voluntary surrender of license; other applicable law **


 *  (a) The board shall have the authority to refuse to grant a license to an applicant therefor or to revoke the license of a person licensed by the board or to discipline a person licensed by the board, upon a finding by a majority of the entire board that the licensee or applicant has: **


 *  (2) Knowingly made misleading, deceptive, untrue, or fraudulent **
 *  representations in the practice of a specialty or on any document **
 *  connected therewith; or practiced fraud or deceit or intentionally **
 *  made any false statement in obtaining a license to practice the **
 *  specialty; or made a false statement or deceptive registration **
 *  with the board; **

There are also laws in Georgia that deal exclusively with making false insurance claims. Martin could be convicted of a felony and face 2-10 years in prison, and a fine of up to $10,000. The statues are listed below:


 * 33-1-9. Insurance fraud; venue; penalty; exemption **
 * 1) **Any natural person who knowingly or willfully: Makes or aids in the making of any false or fraudulent statement or representation of any material fact or thing: **


 *  (A) In any written statement or certificate; **
 *  (B) In the filing of a claim; **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;"> (C) In the making of an application for a policy of insurance; **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;"> (D) In the receiving of such an application for a policy of insurance; or **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;"> (E) In the receiving of money for such application for a policy of insurance **


 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">for the purpose of procuring or attempting to procure the payment of any false or fraudulent claim or other benefit by an insurer; **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Another potential legal issue in this case concerns Martin giving private health information to the insurance company. Martin must get the proper authorization from the client before releasing this information, otherwise he is breaking the law. This section of Georgia law pertains to this issue:


 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">§ 31-33-2. Furnishing copy of records to patient, provider, or other authorized person **


 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">(d) A provider shall not be required to release records in accordance with this Code section unless and until the requesting person has furnished the provider with a signed written authorization indicating that he or she is authorized to have access to the patient's records by paragraph (2) of subsection (a) of this Code section. Any provider shall be justified in relying upon such written authorization. **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Even though Martin is worried about the information he discloses to insurance companies, he is covered by Georgia law. Even though the state has a "Minimum Necessary Rule" that says an entity must make an effort to limit the amount of information disclosed, this does not apply when disclosing information to health care providers. The law says the following:


 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Generally, a covered entity must make reasonable efforts to limit protected health information to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request. 45 CFR §164.502 (b). However, covered entities are not required to make a minimum necessary determination for disclosures to a health care provider for treatment or for public health disclosures that are required by law. 45 CFR §164.502 (b)(2). **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">This is a HIPAA factsheet that outlines some rules of how health information is disclosed <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">This is a link to Georgia law and statues where the above information was taken from <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">[]