CPCO : Chapter 1 Quiz

Which entity below could NOT bill for medically unnecessary services?

Patients (There is tremendous pressure to contain healthcare costs, and government payers necessarily must be on guard against hospitals, physicians, and ancillary providers billing for wasteful or medically unnecessary services.)

What is required for a compliance program to be effective?

Regularly review and update the compliance program. (Simply implementing a compliance program is not enough. It will need to be reviewed and updated on a regular basis)

Which of the following can be a result of an effective compliance program?

Helping create financial success, customer loyalty, community support, and employee satisfaction. (There is no guarantee that a compliance program will keep a provider from facing criminal penalties. However, it will help create a culture of compliance, which will lead to customer loyalty and increased employee satisfaction.)

In what year did the OIG post guidance for hospitals?

1998

What term would be used for actions that, either directly or indirectly, results in unnecessary costs to the Medicare program?

Abuse ("Abuse describes practices that, either directly or indirectly, result in unnecessary costs to the Medicare Program.")

Which government department is comprised thousands of employees who enforce the nation's federal criminal laws and help develop and implement criminal law policies?

Department of Justice (The Department of Justice (DOJ) works closely with the OIG. It is comprised of more than 105,000 employees, including hundreds of lawyers who enforce the nation's federal criminal laws and help to develop and implement criminal law policies. Their role in healthcare fraud and healthcare compliance is to investigate and prosecute healthcare crimes.)

Which federal government departments is the OIG NOT responsible for overseeing?

Drug Enforcement Agency (The OIG is responsible for overseeing the Centers for Medicare & Medicaid Services (CMS), and programs under other HHS agencies, including the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and the U.S. Food and Drug Administration (FDA). DEA is overseen by DOJ.)

Which department is the largest inspector general's office in the federal government?

Office of Inspector General (The OIG is the largest inspector general's officew in the federal government, with more than 1,700 workers dedicated to combating fraud, waste, and abuse.)

Sue works for ABC Family Physicians. The providers at this office ask her to research the department that helps to protect patients from unfair treatment or discrimination? What department or agency would that be?

Office for Civil Rights (Civil rights help to protect individuals from unfair treatment or discrimination because of race, color, national origin, disability, age, sex (gender), or religion.)

How many elements are required to have a successful compliance program?

Seven (The OIG guidance documents utilize the seven elements of the Federal Sentencing Guidelines as the basis of an effective compliance program.)