Healthcare Compliance, common laws and regulations

5 most important federal fraud and abuse laws:

*False Claims Act (FCA) *Anti - kickback Statute (AKS) *Physician Self-Referral Law (Stark I II III ) *Exclusion Authorities *Civil Monetary Penalties Law (CMPL)

False Claim Act (FCA), what is and does it do?

- Implemented during civil war - Also called the "Lincoln's Law" - Law to fight FWA, imposes liability to anyone that submits false/fraudulent claims to the Federal government - Allows private citizens to bring civil action (whistleblowers or relators) - Empowers government to investigate and bring civil action in fraud case

whistleblowers can be eligible to receive __ to __% of government's total award if DOJ decides to assume the case

15-25% (DOJ assumes case)

whistleblowers can be eligible to receive __ to __% of government's total award if DOJ declines the case

25-30% (DOJ declines case)

What is the Medicare Overpayment look back period?

6 years (other timeframes may apply to other issues, Stark, AKS, harassment)

Fill in the blank: The ___________ ____ Act further required that the HHS Secretary, in consultation with HHS-OIG, establish "core elements" for provider and supplier compliance programs within a particular industry or sector.

Affordable Care Pursuant to 42 C.F.R. §§ 422.503(b)(4)(vi), 423.504(b)(4)(vi), and as incorporated into Chapter 21, Section 30 of the "Medicare Managed Care Manual": "All sponsors are required to adopt and implement an effective compliance program, which must include measures to prevent, detect and correct Part C or D program noncompliance as well as FWA. The compliance program must, at a minimum, include the following core requirements: 1. Written Policies, Procedures and Standards of Conduct; 2. Compliance Officer, Compliance Committee and High Level Oversight; 3. Effective Training and Education; 4. Effective Lines of Communication; 5. Well Publicized Disciplinary Standards; 6. Effective System for Routine Monitoring and Identification of Compliance Risks; and 7. Procedures and System for Prompt Response to Compliance Issues." These seven elements are functionally equivalent to the seven elements of an effective compliance plan identified by HHS-OIG in its publication, Compliance Program for Individual and Small Group Physician Practices.

CIAs require regular monitoring how often?

At least annually

Organizations have the opportunity to reduce their culpability in accordance with the Federal Sentencing Guidelines by A. establishing mandatory audits. B. effectively dealing with any offense after it has occurred. C. developing a code of conduct and educating senior management. D. voluntarily disclosing overpayments.

B. effectively dealing with any offense after it has occurred. (review FSG capability factor https://www.ussc.gov/guidelines/2015-guidelines-manual/2015-chapter-8)

Covered entities participating in an Organized Health Care Arrangement are permitted to: A. act as a single covered entity. B. utilize a single notice of privacy practices. C. share psychotherapy notes. D. operate as a hybrid entity.

B. utilize a single notice of privacy practices.

A privacy official is asked to approve a transfer form that would have the patient's SS# on the top of the page to read as "ABC12345679" to go with a patient from the privacy officer's facility to another facility when a patient is transferred. The nursing leadership at the facility is insisting that they "have to have" the patient's SS# when making transfer arrangements from one facility to another. The BEST course of action for the privacy officer to take is: A. Ask the nursing leadership to update the policy on transfers to include that social security numbers must be included on transfer paperwork. B. Have the appropriate forms updated/revised/edited so that they can now accommodate the social security numbers. C. Confirm with nursing any regulations or other requirements that state social security numbers must be included on transfer forms D. Contact the legal department.

C. Confirm with nursing any regulations or other requirements that state social security numbers must be included on transfer forms

Since 1981, ____ has had the authority to levy administrative penalties and assessments against providers as punishment for filing false or improper claims or as a collateral consequence of prior bad acts. A. DHS B. OIG C. HHS D. SSA E. USC

C. HHS (refer to the Civil Monetary Penalty Law)

Which of the following elements is included in the Anti-Kickback Statute? A. whistleblower provisions B. exclusions C. safe harbors D. compliance guidance

C. safe harbors

Home health coverage criteria include the beneficiary must: A. have been hospitalized within the past 72 hours and under the care of a physician. B. be currently enrolled in a Medicare managed care plan and have a condition needing skilled services. C. require the services of a skilled nurse and not be able to leave place of residence. D. be homebound, require skilled services and be under the care of a physician.

D. be homebound, require skilled services and be under the care of a physician.

True or False: Under the Anti-Kickback Statute, it is illegal to provide free or discounted services to uninsured people

FALSE

TRUE or FALSE: The PHRMA CODE is an adopted voluntary code and is considered a law.

FALSE Adherence to the Code is voluntary, not a law or mandatory

TRUE or FALSE: Public Health Service (PHS) regulations define a significant financial interest as: Income which when aggregated for the investigator, and investigator's spouse or dependent children exceeds $10,000 over twelve months

FALSE ref 42 CFR § 50.603 (1)(ii) and § 50.604

This act provides financial incentives for private citizens to come forward in qui tam suit

False Claims Act (FCA)

Which of the Fraud and Abuse laws contains the whistleblower provision?

False Claims Act (FCA)

Fill in the blank: The Healthcare Fraud and Abuse Control (HFCA) program requires ___ and ___ to coordinate federal, state, and local health care law enforcement activities, provide guidance to providers on fraudulent practices, and establish a national data bank to receive and report final adverse actions against providers.

HHS-OIG and DOJ

FSG suggests offering ________ to those who follow the compliance and ethics program

Incentives

What is prohibited by the Physician Self-Referral Law?

It prohibits physicians from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.

What is Fiscal Intermediary (FC)

It refers to an entity or a private company that has a contract with the center for Medicare and Medicaid services (CMS) to determine and to pay part A and some part B bills such as bills from hospitals, on a cost basis and to perform other related functions

What's Anti Trust?

Laws to protect competition (i.e. price fixing)

Who is responsible for enforcing rules and regulations under Medicare/Medicaid laws?

OIG and Justice Department

CMS Questions Part A covers what? Part B covers what? Part C covers what? Part D covers what?

Part A - inpatient hospital (i.e. home health, SNF) Part B - outpatient services (i.e. physician billing, PFS) Part C - Medicare Advantage Part D - prescription drugs/pharmacy

The Stark Law is also commonly referred to as:

Physician Self-Referral Law

When physicians are billing for services that are performed by residents, what is this called?

Physicians at a Teaching Hospital

What is the purpose of the Sarbanes Oxley Act? Why was it enacted?

Purpose of the SOX is to protect shareholders, improving corporate governance and accountability. It was enacted in response to a series of high-profile financial scandals that occurred in the early 2000s (i.e. Enron). Learn more: https://www.congress.gov/bill/107th-congress/house-bill/3763

Who can bring suit under the False Claims Act?

QuiTam plaintiff or Whistleblower, and Attorney General

Under the Anti-Kickback Statute, there are explicit regulatory exceptions or _____ _______ regulations that specify certain joint ventures and other arrangements concerning hospitals and/or physicians which do not violate Medicare fraud and abuse laws

Safe Harbors

Name a few key differences between Anti-Kick Back statute and Stark Law?

Stark: prohibits referrals from physicians; applies to Medicare DHS only; strict liability/no proof of intent to violate the law; mandatory "exceptions"; civil penalty only. AKS: prohibits referrals from anyone; applies to all federal services; proof of intent knowingly/willfully violated the law; voluntary "safe harbors"; both criminal and civil penalties. HHS-OIG comparison table: https://oig.hhs.gov/compliance/provider-compliance-training/files/StarkandAKSChartHandout508.pdf

TRUE or FALSE: The OIG requests that you post on your website whether or not the PHRMA CODE is followed.

TRUE

True or False: In the AKS, OIG has promulgated certain "safe harbors" (arrangements that are legal)

TRUE

True or False: The Anti-kickback prohibition applies to referrals from patients

TRUE

True or False: The Stark Law prohibits entities from presenting any claim for payment with respect to designated health services rendered pursuant to a tainted referral

TRUE

TRUE or FALSE: STARK indicates no Medicare payments may be made for DHS referred by the physician, and the Entity must refund all money collected for DHS referred by the physician

TRUE In other words, Stark law bans physician from referring patients to the 10 designated healthcare services that are payable by Medicare/Medicaid from any entity with which physician (and immediate family member) has a financial relationship, unless referral is protected by an exception.

True or False: Regarding Attorney-Client Privilege, the procedure called "Upjohn warning," in which a company's lawyer explains that the lawyer represents the company and not the individual employee with whom the lawyer is dealing.

TRUE The Upjohn Co. v. United States case (1981), a Supreme Court case that gave rise to the procedure called "Upjohn warning," in which a company's lawyer explains that the lawyer represents the company and not the individual employee with whom the lawyer is dealing. In other words, communications between company counsel and employees of the company are privileged, but the privilege is owned by the company and not the individual employee. The Court made clear that the corporate attorney-client privilege applied to the company.

Why is Caremark International Derivative Litigation important in Corporate Compliance?

The 1996 U.S. Civil settlement of Caremark International, Inc. Decision established Corporate directors breached their oversight duty by failing to adequately supervise their employees when they knew/should've known a violation of law was occurring. Ref: 698 A.2d 959 (Del. Ch. 1996). Org entered into a 5-year imposed CIA. It increased significance of Compliance Programs and the duty of oversight to Board and Directors.

What Act included a new requirement that providers repay identified overpayments to Medicare and Medicaid within 60 days or be subject to penalties?

The Affordable Care Act

This Act mandates compliance programs for Medicare, Medicaid and Children's Health Insurance Program (CHIP) providers

The Affordable Care Act (ACA) Section 6401 of the ACA provides that a "provider of medical or other items or services or supplier within a particular industry sector or category" shall establish a compliance program as a condition of enrollment in Medicare, Medicaid, or the Children's Health Insurance Program (CHIP) Also ref: 42 CRF 422.503(b)(4)(vi) and 42 CFR 423.504(b)(4)(vi)

What is Physician Payment Sunshine Act?

The Physician Payments Sunshine Act (Sunshine Act) of 2013 requires manufacturers, group purchasing organizations (GPOs) and health care providers (physicians and teaching hospitals) to report certain payments to promote a more transparent and accountable health care system, including but not limited to stocks, money for research, gifts, speaking fees, meals and other payments. This information is publicly available via the CMS Open Payments Program - https://www.cms.gov/OpenPayments/

Are providers financially liable if their billing services commit fraud without the provider's knowledge? Yes No

Yes - they are financially liable for all claims submitted on their behalf that contain their identification number

Which of the following resources are MOST relevant for developing and updating a research compliance work plan? 1. FDA warning letters 2. OIG inspection reports 3. OHRP determination letters 4. OSHA inspection reports a. 1, 2, and 3 b. 1, 2, and 4 c. 1, 3, and 4 d. 2, 3, and 4

a. 1, 2, and 3

The lowest dollar amount of a potential federal civil monetary penalty for a HIPAA violation is: a. 100.00 b. 200,000 c. 50,000 d. 1.5 million cap

a. 100.00

What year did OSHA publish the Bloodborne Pathogens Standard? a. 1991 b. 1996 c. 2001 d. 2002

a. 1991 OSHA published the Occupational Exposure to Bloodborne Pathogens standard in 1991 because of a significant health risk associated with exposure to viruses and other micro-organisms. Note: practice question from AAPC CPCO Ch7

Deficit Reduction Act (DRA) requires that providers who have more than $5 million either received or paid to the reimbursement from state Medicaid programs inform employees of their ability to__________? a. Bring a whistleblower action b. File paper claims c. E-prescribe medications to reduce errors d. Self-disclose overpayments within 90 days

a. Bring a whistleblower action DRA also requires that providers who have more than $5 million dollars either received or paid to the reimbursement from state Medicaid programs to provide training and educate employees on the FCA and inform employees of their ability to bring a whistleblower action. Note: practice question from AAPC CPCO Ch4

The CMP fine amounts are increased annually based on what act? a. Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 b. Medicare Modernization Act of 2003 c. Health Insurance Portability and Accountability Act of 1996 d. Deficit Reduction Act of 2005

a. Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 The Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 (the 2015 Act) (Public Law 114-74, Sec. 701), which further amended the Federal Civil Penalties Inflation Adjustment Act of 1990 (the Inflation Adjustment Act) (Public Law 101-410) was enacted on November 2, 2015. The 2015 Act requires agencies to adjust the level of applicable CMPs with an initial "catch-up" adjustment, through interim final rulemaking (IFR); and, make subsequent annual adjustments for inflation. The Office of Management and Budget (OMB) publishes the adjustment multiplier based on the Consumer Price Index for All Urban Consumers (CPI-U). The catch-up adjustment was published in 2016. The annual adjustments are to be published in the Federal Register no later than January 15 of each calendar year. Note: practice question from AAPC CPCO Ch4

A provider intentionally upcodes services to a higher level in order to receive a larger reimbursement from Medicare/Medicaid. Is this violation fraud, abuse, or neither? a. Fraud b. Abuse c. Neither

a. Fraud Upcoding - is a type of fraud (knowing/intentionally) coding more expensive codes for higher reimbursement

The purpose of EMTALA is to prevent: a. Hospitals from rejecting patients in a discriminatory manner by, refusing treatment, or transferring patients to "charity hospitals" or "county hospitals," because they are unable to pay. b. Hospitals from admitting patients unable to pay and then transferring them to "charity hospitals" or "county hospitals." c. A hospital from incurring a large debt when a patient cannot afford to pay. d. On-call physicians from not showing up when there is an emergency.

a. Hospitals from rejecting patients in a discriminatory manner by, refusing treatment, or transferring patients to "charity hospitals" or "county hospitals," because they are unable to pay. EMTALA requires Medicare-participating hospitals with emergency departments to screen and treat the emergency medical conditions of patients in a non discriminatory manner to anyone, regardless of their ability to pay, insurance status, national origin, race, creed or color. Note: practice question from AAPC CPCO Ch6

When should counsel be involved during an internal investigation? a. If corporation may have to disclose inappropriate conduct and take remedial action. b. If there is an inadvertent billing error. c. If there is a question about the training program. d. If there is fraudulent behavior that the CCO wants to cover up.

a. If corporation may have to disclose inappropriate conduct and take remedial action.

Which Act of 2003 gave momentum to the e-prescribing movement, and was put in place to reduce medication errors due to illegible physician handwriting, etc.? a. Medicare Modernization Act (MMA) b. Deficit Reduction Act (DEFRA) c. False Claims Act (FCA) d. Fraud Enforcement and Recovery Act (FERA)

a. Medicare Modernization Act (MMA) MMA of 2003 was put in place to reduce medication errors due to illegible physician handwriting, etc., and gave momentum to the e-prescribing movement. Note: practice question from AAPC CPCO Ch4

If I'm only doing blood draws, do I need a CLIA number? a. No, a CLIA number is not required if the facility only collects specimens and performs no testing. b. No, a CLIA number is not required if the facility only collects specimens and performs minor testing. c. Yes, a CLIA number is required if the facility only collects specimens, even if they perform no testing. d. Yes, a Medicare-participating provider that only collects specimens requires a CLIA number.

a. No, a CLIA number is not required if the facility only collects specimens and performs no testing. Note: practice question from AAPC CPCO Ch6

In a home health agency, the compliance officer will find that which of the following is identified by the OIG as one of the most risk prone areas for fraud, waste and abuse: a. Services provided by individuals who do not have appropriate credentials b. Home Health Orders being signed by the certifying physician in a timely manner c. Homebound status verification d. All of the above e. None of the above

a. Services provided by individuals who do not have appropriate credentials

Routine waiver of co-pays would be considered a violation of which law? a. The Anti-Kickback Statute b. Stark Law c. False Claims Act d. HIPAA

a. The Anti-Kickback Statute Examples of Anti-Kickback Statute violations include: • A hospital providing rental rates that are below fair market value to a physician who refers business to their hospital • Routine waiver of copayments or deductibles for patients under Medicare Part B • A drug or equipment supplier providing free benefits for a provider who utilizes their product • A physician who is paid exorbitantly for speaking engagements by a company to whom the provider refers business Note: practice question from AAPC CPCO Ch4

Which of the following represents a violation of the Stark Law? a. The referring physician, or an immediate member of the referring physician's family, has a financial relationship with the entity receiving the referral. b. The referring physician's best friend from medical school owns the entity receiving the referral. c. The referring physician's neighbor owns the entity receiving the referral. d. The referring physician's chiropractor owns the entity receiving the referral.

a. The referring physician, or an immediate member of the referring physician's family, has a financial relationship with the entity receiving the referral. Note: practice question from AAPC CPCO Ch4

Regarding OSHA, which of the following is considered the primary means of minimizing employee exposure? a. Policies and procedures b. Engineering controls c. Personal protective equipment d. Drills

b. Engineering controls. Engineering controls remove the hazard from the workplace or create a barrier between the worker and the hazard. Engineering controls are the primary means of eliminating or minimizing employee exposure, and include training and the use of safer medical devices, such as needleless devices, shielded needle devices, and plastic capillary tubes. Note: practice question from AAPC CPCO Ch7

What law(s) does not require that nursing facilities conduct state FBI criminal background checks? a. False Claims Act b. Federal law c. Federal and state laws d. State law

b. Federal law Federal law does not require that nursing facilities conduct state or FBI criminal background checks. State laws may, however. It is important to confirm both sources for applicable laws. State rules differ regarding background checks: 43 states require nursing homes to perform background checks against state records, 10 of those require an additional FBI background check, and eight states don't require background checks at all. Note: practice question from AAPC CPCO Ch3

A privacy professional is reviewing a program for an academic medical center that include a faculty group practice, hospital, student health center, and self-funded group health plan. The privacy professional should evaluate if the program has notices for: a. GINA b. FMLA c. HIPAA d. FISMA

b. HIPAA

A privacy professional is preparing an education session in follow-up to a recent increase of lost or misplaced thumb drives that may have contained PHI including patient SSNs. Which of the following would be the MOST beneficial for the privacy professional to review when preparing the education session? a. GINA b. HITECH c. Sarbanes-Oxley d. Social Security Act

b. HITECH

Which of the following is responsible for clinical trial billing compliance and enforcement: a. FDA b. OIG c. ORI d. OCR

b. OIG

A private physician signed a clinical trial agreement with a drug company to receive funds from trial sponsors for research services that must be conducted at a hospital. The physician contacted the hospital and requested $25 per subject referred to the hospital. On which of the following should the physician be educated: a. HIPAA b. Stark Law c. Sarbanes-Oxley Act d. Medicare Modernization Act

b. Stark Law

Related to Corporate Integrity Agreements with the government, what is an IRO and what are the details of how it works? Choose 2 answers. a. Independent Reorganization Operation. b. They do the auditing required by a CIA. c. The OIG hires them. d. They need to be fair and unbiased and can't have a financial relationship with the hospital.

b. They do the auditing required by a CIA. d. They need to be fair and unbiased and can't have a financial relationship with the hospital. Explanation: IROs need to meet criteria and follow the AICPA and SEC guidance (unbiased judgement, honest neutrality, and demonstrate independence among other requirements)

Primary safety concerns in the medical setting include bloodborne pathogens, radiation, bio-hazardous waste, and ________. a. closed spaces b. chemicals c. patient care equipment d. non-patient care equipment

b. chemicals Key issues in a medical setting are bloodborne pathogens, radiation, chemicals, and bio-hazardous waste. Note: practice question from AAPC CPCO Ch7

How many states require nursing facilities to perform FBI checks on employees? a. 3 b. 5 c. 10 d. 27

c. 10 Note: State rules differ regarding background checks: 43 states require nursing homes to perform background checks against state records, 10 of those require an additional FBI background check, and eight states don't require background checks at all. Note: practice question from AAPC CPCO Ch3

In a qui tam action in which the government intervenes, the relator is entitled to receive a monetary settlement between? a. 5-10% b. 10-20% c. 15-25% d. 31-40%

c. 15-25% 15-25% (if DOJ assumes case) 25-30% (if DOJ declines case) Note: practice question from AAPC CPCO Ch4

According to CDC, how many percutaneous injuries involving contaminated sharps occur annually? a. 400,000 b. 550,000 c. 600,000 d. 625,000

c. 600,000 CDC estimates that healthcare workers sustain nearly 600,000 percutaneous injuries annually involving contaminated sharps. In response to continued concerns, Congress passed the Needle Stick Safety and Prevention Act directing OSHA to revise the Bloodborne Pathogens Standards. The revision was then published in 2001. Note: practice question from AAPC CPCO Ch7

Re: Service Animal: If a patient walks into your practice with a leashed dog, what should you do? a. Advise the patient that animals are not allowed inside the practice. b. Ask the patient if the dog is a service animal. c. Ask the patient if the dog is a service animal and, if the patient states yes, allow the animal on the premises. d. Ask the patient for the dog's ID tag indicating that it is a service animal.

c. Ask the patient if the dog is a service animal and, if the patient states yes, allow the animal on the premises. There should be a clear policy about service animals to help ensure staff is aware of its obligation to allow access to patients with service animals. https://www.ada.gov/service_animals_2010.htm Note: practice question from AAPC CPCO Ch8

Any laboratory performing testing on specimens derived from a human being for purposes of providing diagnosis, prevention, treatment, or assessment of health, regardless of whether they participate in Medicare, must: a. Participate in a quality assurance program b. Maintain adequate hours of operation for the underserved community c. Enroll in the CLIA program d. Have a certificate of compliance

c. Enroll in the CLIA program. Note: practice question from AAPC CPCO Ch6 The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations include federal standards applicable to all U.S. facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. https://www.cdc.gov/clia/index.html

The OIG is a division of which agency? a. CMS b. Medicaid c. HHS d. NGS

c. HHS Note: practice question from AAPC CPCO Ch4

A privacy professional has been notified that there had been a data breach of a clinical system containing PHI. Which of the following is the source of the notification requirements? a. FERPA Provisions b. HIPAA Security Rule c. HITECH Act d. Privacy Act

c. HITECH Act Breach notification was passed as part of ARRA of 2009. HITECH is part of ARRA

Which of the following governmental bodies has enforcement authority for HIPAA privacy? a. OIG b. FDA c. OCR d. OSHA

c. OCR

What federal agency is in charge of employee safety? a. Department of Health and Human Services b. National Institute for Employee Health c. Occupational Safety and Health Administration d. Centers for Disease Control and Prevention

c. Occupational Safety and Health Administration. OSHA is the federal agency charged with ensuring employee safety in the workplace. Note: practice question from AAPC CPCO Ch7

The RICO Act is a law that increases the severity of penalties for violations of what? a. HIPAA b. Human resources c. Organized crime d. Improper claim submissions

c. Organized crime The Racketeer Influenced and Corrupt Organizations (RICO) Act (18 U.S.C. § 1961) increases the severity of penalties for violations involving organized crime. The law covers crimes such as bribery, extortion, money laundering, counterfeiting, gambling, murder, arson, robbery, kidnapping, harboring certain illegal aliens, obstruction of justice, slavery, and others. Note: practice question from AAPC CPCO Ch4

The False Claims Act contains a whistleblower-protection provision for persons reporting fraud and abuse. What does this mean? a. Persons reporting fraud or abuse may be subject to the same penalties as the persons committing the fraud or abuse. b. Persons reporting fraud or abuse can be discharged or demoted. c. Persons reporting fraud and abuse who are discharged, demoted, suspended, harassed, or discriminated against have protection from such actions. d. Persons reporting fraud and abuse will be guaranteed another position if they are discharged from their current position.

c. Persons reporting fraud and abuse who are discharged, demoted, suspended, harassed, or discriminated against have protection from such actions.

Related to Legal Doctrines for Protection from Disclosure to protect certain documents during the course of discovery. What is the work product doctrine? a. Ensures that attorney documentation is accessible to the hospital. b. Ensures that attorney documentation is accessible to the OIG. c. Protects attorney documents that were prepared for litigation purposes. d. Allows the hospital to protect documents sent to the attorney.

c. Protects attorney documents that were prepared for litigation purposes. Differs from attorney-client privilege (ACP) in that it protects only documents from discovery including interviews, memos, correspondence, notes and briefs, which evidence "mental impressions, conclusions, opinions or legal theories of any attorney. Documents must have been prepared in anticipation of litigation or in anticipation of a disclosure to the government.

If a referred patient to your practice has hearing deficit and needs an appointment, what steps should your practice take when scheduling? a. Ask the patient to bring an interpreter with them to the visit. b. Kindly explain to the patient that he or she can't be seen because the practice doesn't have the ability to communicate with the hearing impaired. c. Schedule the appointment a few days ahead and make arrangements for an interpreter. d. Schedule the appointment, advise the patient of the charge for the interpreter, and ask how he or she will pay for the services.

c. Schedule the appointment a few days ahead to make arrangements for an interpreter. The ADA requires businesses to take steps necessary to communicate effectively with patients with vision, hearing, and speech disabilities. Note: practice question from AAPC CPCO Ch8

Which is a strict liability statute (no proof of intent): a. the False Claims Act, b. the Anti-Kickback Statute, or c. the Stark Law

c. Stark Law (physician self-referral)

Which is the underlying principal of the Equal Employment Opportunity law? a. This law requires all persons to be entitled to equal employment opportunity regardless of race, religion, or national origin. b. This law requires all minorities to be entitled to equal employment opportunity regardless of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by law. c. This law requires all persons to be entitled to equal employment opportunity regardless of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by law. d. This law requires all persons be entitled to equal employment opportunity regardless of sex, age, or disability.

c. This law requires all persons to be entitled to equal employment opportunity regardless of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by law. It is important for a compliance officer to understand that all persons are legally entitled to equal employment regardless of their race, color, religion, sex, national origin, age, disability, or any other characteristic protected by law. Failure to abide by the Equal Employment Opportunity law can bring forth lawsuits based on unlawful discrimination. Note: practice question from AAPC CPCO Ch8

What is the best definition of Medicare/Medicaid abuse? a. Knowingly defrauding the Medicare/Medicaid program b. Intentionally violating Medicare/Medicaid guidelines c. Unknowingly violating Medicare/Medicaid guidelines d. None of the above

c. Unknowingly violating Medicare/Medicaid guidelines FRAUD is intentional (knowingly/willfully); WASTE is overuse/misuse of resources carelessly; ABUSE on the other hand, does not require poof of intent, but it's improper practice leading to unnecessary expenses

Examples of "outliers" that OIG might identify in certain hospital relationships or arrangements with greatest risk of non-compliance: a. audit processes that includes e-visits, interviews, trend analysis, etc. b. medical office building leases consistent with fair market value c. large and inconsistent payments made to physicians without a written contract d. none of the above

c. large and inconsistent payments made to physicians without a written contract

Proof of intent is not required for: a. false claims act b. antikickback statute c. stark law d. affordable care act

c. stark law (not an intent based statute)

A study coordinator inform a research compliance professional that a sponsor has offered a $100 incentive for every patient recruited for an IRB-approved clinical trial in recognition of the efforts. The is no institutional policy that directly addresses study recruitment incentives, and nothing in the clinical research agreement (CRA) would prohibit such payments. The research compliance professional should instruct the coordinator: a. not to accept the payment because they violate COI regulations b. not to accept the payments because they are prohibited under AKS c. to have the CRA amended to reflect actual work performed in return for any payments, and have payments made to the institution d. to submit a protocol amendment to the IRB reflecting the incentive program, and accept the payments if the IRB approves them

c. to have the CRA amended to reflect work performed in return for any payments, and have payments made to the institution. Explanation: A clinical research agreement (CRA) need to reflect actual work performed in return for any payments. AND Payments need to be made to the institution References: https://oig.hhs.gov/oei/reports/oei-01-97-00195.pdf OIG report on Recruiting Human Subjects (2000) https://www.partners.org/Assets/Documents/Medical-Researc h/Clinical-Research/Bonus-Payments-in-CTA.pdf

Civil Monetary Penalties Law: Since 1981, ____ has had the authority to levy administrative penalties and assessments against providers as punishment for filing false or improper claims or as a collateral consequence of prior bad acts. A. DHS B. OIG C. HHS D. SSA

c: HHS

The ACA requires providers to refund an overpayment to Medicare within how many days of identification? a. 10 b. 30 c. 45 d. 60

d. 60

What key item(s) can protect a medical practice from harassment liability? a. Keys to the office b. Management plans c. Physical safeguards d. A zero tolerance policy for harassment

d. A zero tolerance policy for harassment. Having a zero tolerance policy on harassment protects a company from liability. Note: practice question from AAPC CPCO Ch8

What are designated health services? a. Clinical Laboratory services b. Physical therapy services c. Home health services d. All of the above

d. All of the above Designated health services (DSH) include: • Clinical laboratory services; • Physical therapy services; • Radiology services, including magnetic resonance imaging, computerized axial tomography scans, and ultrasound services; • Radiation therapy services including supplies; • Parenteral and enteral nutrients, equipment, and supplies; • Prosthetics, orthotics, and prosthetic devices and supplies; • Home health services; • Outpatient prescription drugs; • Inpatient and outpatient hospital services. Note: practice question from AAPC CPCO Ch4

What is the best definition of Medicare/Medicaid fraud? a. Attempting a scheme against the Medicare/Medicaid program b. Knowingly executing a scheme against the Medicare/Medicaid program c. Willfully executing a scheme against the Medicare/Medicaid program d. All of the above

d. All of the above Remember: Fraud is generally defined as knowingly and willfully executing, or attempting to execute, a scheme. FRAUD is intentional; WASTE is overuse/misuse of resources carelessly; ABUSE on the other hand, does not require poof of intent, but it's improper practice leading to unnecessary expenses

The PhRMA Code prohibits which of the following: a. Pharmaceutical companies that bring free lunches to a healthcare organization weekly to promote the use of their product b. Pharmaceutical companies paying for trip expenses and stipend for a physician to come and speak at conference because he prescribes their product often and has had much success treating his patients with it c. Pharmaceutical companies providing lunches to the providers and their wives, while providing an educational session about a particular new drug d. All of the above e. None of the above

d. All of the above See the most updated PhRMA Code of Interactions: https://www.phrma.org/-/media/Project/PhRMA/PhRMA-Org/PhRMA-Org/PDF/A-C/Code-of-Interaction_FINAL21.pdf

An Organization identifies a potential issue when reviewing personal services and management contracts. Which of the following should the compliance professional consider in analyzing the issue? a. Deficit Reduction Act (DRA) b. Conditions of Participation (CoP) c. IRS tax-exempt guidelines d. Anti-Kickback (AKS) Safe Harbors

d. Anti-Kickback (AKS) Safe Harbors

Under what circumstances can a relator not file or pursue a qui tam action? a. If they are a new employee b. The qui tam action is based upon information that has been disclosed to the public c. The government already is a party to a civil or administrative money proceeding d. Both b and c

d. Both b and c The FCA provides several circumstances in which a relator cannot file or pursue a qui tam action: 1. The relator was convicted of criminal conduct arising from his or her role in the FCA violation. 2. Another qui tam concerning the same conduct already has been filed (this is known as the "first to file bar"). 3. The government already is a party to a civil or administrative money proceeding concerning the same conduct. 4. The qui tam action is based on information that has been disclosed to the public through various means (this is known as the "public disclosure bar"). Note: practice question from AAPC CPCO Ch4

What is the maximum amount of money an employer can charge for personal protective equipment (PPE)? a. $5 per pay b. $10 per pay c. Free of charge for the first year of employment d. Free of charge

d. Free of charge. PPE will need to be provided to your employees at no expense to them. Note: practice question from AAPC CPCO Ch7

Which of the following privacy laws relates to protection of financial information? a. ADA b. HIPAA c. HITECH d. GLBA

d. GLBA Gramm-Leach-Bliley Act (GLBA), also known as the Financial Services Modernization Act of 1999, includes The Financial Privacy Rule and The Safeguards Rule requires all financial institutions to protect customer's personal financial information. https://en.wikipedia.org/wiki/Gramm%E2%80%93Leach%E2%80%93Bliley_Act

Which of the following is not required in a written hazard communication program for the workplace? a. A list of hazardous chemical present. b. Training on protective measures of hazardous material. c. Distribution of safety data sheets. d. List of prior hazardous material incidents.

d. List of prior hazardous material incidents. Classifying the potential hazards of chemicals and communicating information concerning hazards and appropriate protective measures to employees, includes: •Maintaining lists of hazardous chemicals present; •Labeling containers; •Preparation and distribution of safety data sheets (or MSDS) • Employee training programs regarding hazards of chemicals and protective measures. Ref. https://www.osha.gov/hazcom Note: practice question from AAPC CPCO Ch7

Corporate Integrity Agreements (CIA) are negotiated primarily between the: a. US attorneys and the hospital b. DOJ and the provider c. Federal Sentencing Commission and the organization d. OIG and the healthcare entity

d. OIG and the healthcare entity

Which of the following are common examples of AKS violations: a. Free rental space of equipment deals or way below fair market value b. Excessive compensation deals to physicians c. A bribe or incentive to induce or reward patient referrals d. all of the above

d. all of the above

Quitam actions enable any person to bring forth an action to the a. employer, based upon original knowledge b. employer, based upon public information c. government, based upon public knowledge d. government, based upon original information

d. government, based upon original information

With regard to the handling of possible violations of law, OIG compliance guidance indicates that a violation may warrant IMMEDIATE notification to the government along wit commencing an internal investigation if it: a. is a civil violation b. is a quality of care issue c. indicates a violation of the Stark Law d. indicates a systemic failure to comply with laws

d. indicates a systemic failure to comply with laws

Which of the following does EMTALA require? a. Appropriate signage in all hospital waiting areas b. Acute patient to be stabilized before being transferred to another hospital c. Attestation by the treating physician or other appropriate licensed independent personnel that the patient is stable d. Receiving hospital must have resources available and appropriate licensed personnel to treat the patient e. B and C f. All of the above

f. All of the above http://www.emtala.com/faq.htm

GINA (Genetic Information Nondiscrimination Act) of 2008 prohibits discrimination when using genetic information to make decisions regarding _______ ____________ (coverage) and ______________ (hiring, promotion, etc.)

health insurance - and - employment.

The Physician Payment Sunshine Act must report ______to a covered recipient which is defined as a ______or teaching hospital

payment/anything of value; physician