BFC10040 - Healthcare Fraud, Waste, and Abuse 2.0 (US)

If convicted of violating the Health Care Fraud Statute you can be (select all that apply)

-Fined -Imprisoned

A hospital system enters into numerous contracts with area physicians to encourage the physicians to refer patients to hospitals in the system. Some of the physicians are paid to be Medical Directors at one or more of the hospital system's facilities while others can lease office space in the hospital system's professional office buildings for $10 per year. Which of the following statutes is the hospital most likely to have violated?

-Stark Statute -Anti-Kickback Statute

Examples of waste include: (select all that apply) Conducting excessive office visits for a patient Making sure the patient is comfortable Submitting claims for services not provided Ordering excessive diagnostic tests

-ordering excessive diagnostic tests -conduction excessive office visits for patients

Which of the following are included in the 7 elements of an effective compliance program?

All of the above

When an employee believes they have seen or suspect signs of healthcare fraud or abuse in their organization, what should they do?

Refer to the organization's compliance program

The Qui Tam Whistleblower Provision allows ____________ with actual knowledge of false claims activity (referred to as a whistleblower) to report, provided they are the first to provide original information.

any person

Which of the following examples is a kickback prohibited by the federal Anti-Kickback Law? (Select all that apply)

-An all-expense paid weekend get-away trip to an exclusive resort for a physician and her husband given as a gift by a pharmaceutical company for solely prescribing a certain prescription medication -Receiving payments from a radiology facilities medical director for requiring your patients to only go to that facility

True or False? You may lawfully be fired if you report suspected healthcare fraud or abuse.

False

True or False? Fraud can be defined as intentional deception to obtain money from the Medicare program.

True

Which of the following penalties could the courts impose on violators of the Stark Statute? (Select all that apply)

-Monetary fines -exclusion from medicare reimbursement