Ethics, professionalism, and regulatory compliance
What this domain tests
This domain tests whether you can maintain honesty, objectivity, and appropriate boundaries in a medico-legal setting while complying with privacy, licensure, and billing rules. The exam expects recognition of conflicts and the courage to refuse improper requests.
Core rules and concepts
- Core duties: honesty, scientific objectivity, patient welfare, confidentiality, informed consent, competence, and disclosure of conflicts. A medico-legal opinion should not be changed to please a payer, attorney, or patient.
- Privacy: HIPAA and state law govern disclosures. Workers compensation and litigation create limited permissions, not unlimited access. Minimum necessary, authorization, and ex parte communication rules still matter. Do not discuss a case publicly or with unauthorized parties.
- Regulatory compliance: maintain licensure and scope of practice; follow mandatory reporting; avoid false or misleading billing; do not pay or accept inducements for referrals; comply with subpoenas and court orders; and keep accurate, contemporaneous records.
- Professional boundaries: avoid dual roles that impair objectivity, such as treating a patient and serving as an IME for the same dispute without disclosure. Contingent fees for testimony are generally improper because they create a financial incentive tied to the outcome.
- Corrections and amendments: errors should be corrected transparently with a dated addendum. Never alter or destroy records to support a position.
Worked example
An attorney asks a physician to change a report from possibly work-related to definitely work-related and offers a bonus if the claim succeeds. The physician should decline the change unless new objective evidence supports it, refuse the contingent payment, document the request, and issue a correction only through a proper addendum if a factual error exists. The original opinion and its basis should remain intact.
Traps that cost marks
Ghostwriting for a party; accepting outcome-based compensation; failing to disclose a conflict; discussing a case without authorization; altering records; billing for unnecessary services; and letting loyalty to the referring attorney override the medical evidence.