Healthcare Compliance, Common Laws and Regulations Questions and Answers

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) 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 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 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 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 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 "ABC" 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 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 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 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. CIAs require regular monitoring how often? - At least annually 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 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 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. 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 OIG is a division of which agency? a. CMS b. Medicaid c. HHS d. NGS - c. HHS Note: practice question from AAPC CPCO Ch4 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 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 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 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 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 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. 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 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) 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