Chapter 16 & 17

Fraud is defined as: Select one: A. an intentional act of deception B. an unintentional act of deception C. bribery D. high crimes and misdemeanors

A. an intentional act of deception

HEAT is the President's newest tool against: Select one: A. billing code discrepancies in health care B. fraud and abuse concerning Medicare and Medicaid claims C. hospital energy audits D. for-profit organizations that don't accept Medicare and Medicaid patients E. none of these are correct

B. fraud and abuse concerning Medicare and Medicaid claims

An example of a Stark Law violation is: Select one: A. a hospital offering a physician office space at fair market value B. paying a physician for a referral C. hiring a doctor who is an excluded party as a Medicare Provider D. upcoding a claim to receive higher reimbursement E. all of these are correct.

B. paying a physician for a referral

Safe Harbor regulations were put in place by: Select one: A. The Affordable Care Act B. Office of the Attorney General C. Department of Health and Human Services D. All of these are correct. E. None of these are correct

C. Department of Health and Human Services

The investigative and enforcement authority to deal with fraud and abuse violations was granted to the Department of Health and Human Services (DHHS) through: Select one: A. False Claims Act B. Stark Laws C. Operation Restore Trust D. Anti-Kickback Act

C. Operation Restore Trust

The False Claims Act was enacted by the federal government as a: Select one: A. criminal remedy B. constitutional amendment C. civil remedy D. contract dispute resolution device E. none of these are correct

C. civil remedy

Violations of the Emergency Medical Treatment and Active Labor Act (EMTALA) include all of the following, except: Select one: A. dumping a patient on another hospital because they are very sick B. diverting a patient to another hospital because they are unable to pay for services C. completing a Medical Screening exam and stabilizing the patient D. refusing to treat a patient because their benefits are better at a different hospital E. none of these are correct.

C. completing a Medical Screening exam and stabilizing the patient

Human error is: Select one: A. intentional act B. disregard for human life C. inadvertent slip, lapse, or mistake D. all of these are correct. E. none of these are correct.

C. inadvertent slip, lapse, or mistake

ORT is an acronym that stands for: Select one: A. Outside Restoration Team B. Operation Remedy Torts C. Overview Record Transactions D. Operation Restore Trust E. Open Receivables Total

D. Operation Restore Trust

EMTALA: Select one: A. requires all Medicare and Medicaid hospitals to provide an appropriate screening B. requires only private, for-profit hospitals to provide patients an appropriate screening C. mandates that no patient should be billed for services if they can't pay D. all of these are correct. E. none of these are correct.

D. all of these are correct.

Medical tourism includes: Select one: A. outbound B. inbound C. intrabound D. all of these are correct. E. none of these are correct.

D. all of these are correct.

The qui tam provision offers individuals: Select one: A. protection for coming forward against their organization or employer B. monetary incentives C. shelter from prosecution in many instances D. all of these are correct. E. none of these are correct

D. all of these are correct.

The Anti-Kickback Statutes: Select one: A. only apply civil penalties for willful payment or receipt of money for referring patients B. impose a civil monetary penalty of $10,000 per violation C. are not restricted by the Safe Harbor Laws D. impose criminal liability for the knowing and willful payment of any kind or receipt of payment of any kind for a patient or service referral E. all of these are correct

D. impose criminal liability for the knowing and willful payment of any kind or receipt of payment of any kind for a patient or service referral

Violations of the Criminal Disclosure Provision of the Social Security Act include which of the following penalties? Select one: A. no criminal penalties B. up to 10 years in prison and/or $50,000 in fines C. up to 1 year in prison and/or up to $10,000 in fines D. up to 5 years in prison and/or up to $25,000 in fines E. none of these are correct.

D. up to 5 years in prison and/or up to $25,000 in fines

Seven essential elements of an effective compliance program include: Select one: A. establishing compliance standards of conduct and procedures B. overall compliance program oversight C. due care in delegation of authority D. monitoring and auditing systems E. all of these are correct

E. all of these are correct

Examples of health care fraud and abuse include: Select one: A. claims do not meet medical necessity B. duplicate billing C. upcoding of services D. kickbacks for referrals E. all of these are correct.

E. all of these are correct.

Gursky identified which of the following issues putting rural hospitals at risk for bioterrorism? Select one: A. lack of training on how to identify early signs of potential biological hazards B. lack of reliable communication equipment C. lack of vaccinations D. lack of quarantine facilities or up-to-date facilities E. all of these are correct.

E. all of these are correct.

Human trafficking involves: Select one: A. modern-day slavery B. exploitation of laborers C. exploitation of women and children D. sexual exploitation E. all of these are correct. F. none of these are correct

E. all of these are correct.

Which of the following is an example of stalking? Select one: A. unwanted phone calls, texts, letters, emails, or social media posts B. following or spying on a person C. leaving unwanted items, gifts, or flowers D. spreading rumors about someone E. all of these are correct. F. none of these are correct

E. all of these are correct.

STARK I: Select one: A. expanded STARK II B. was enacted to deal with physician self-referrals C. prohibits billing by a laboratory for services provided pursuant to illegal referrals D. expanded STARK II and prohibits billing by a laboratory for services provided pursuant to illegal referrals E. was enacted to deal with physician self-referrals and prohibits billing by a laboratory for services provided pursuant to illegal referrals

E. was enacted to deal with physician self-referrals and prohibits billing by a laboratory for services provided pursuant to illegal referrals

Compliance internal controls include: Select one: A. presidential overview B. monitoring to assess the quality of the system C. risk assessment D. public policy E. monitoring to assess the quality of the system, and public policy F. monitoring to assess the quality of the system, and risk assessment

F. monitoring to assess the quality of the system, and risk assessment

Regulations under the Anti-Kickback Statute and Stark Law Select one: a. have both been revoked recently b. will probably be amended soon c. are being combined into one law because they are so similar d. are being shifted to state jurisdiction because the federal government does not want to investigate these any more e. none of these is correct

b. will probably be amended soon

Violations of the Emergency Medical Treatment and Active Labor Act (EMTALA) include all of the following except Select one: a. dumping a patient on another hospital because they are very sick b. diverting a patient to another hospital because they are unable to pay for services c. completing a medical screening exam and stabilizing the patient d. refusing to treat a patient because their benefits are better at a different hospital e. all of these are violations of EMTALA.

c. completing a medical screening exam and stabilizing the patient

The WHO has named __________ as number 8 on the top 10 lists of threats to global health in 2019. Select one: a. earth b. wind c. fire d. vaccine hesitancy

d. vaccine hesitancy

Essential elements of an effective compliance program include which of the following? Select one: a. establishing compliance standards of conduct and procedures b. overall compliance program oversight c. due care in delegation of authority d. monitoring and auditing systems e. all of these are correct

e. all of these are correct