AAPC CPCO Certification: Questions With Clear
Solutions
The OIG consists of 6 departments: Right Ans - 1.Immediate OIG —
responsible for the overall fulfillment of the OIG's mission and for promoting
effective management and quality of the agency's processes and products.
2.Office of Audit Services — performs independent audits of HHS programs
and/or HHS grantees and contractors to examine their performance.
3.Office of Evaluation and Inspections — conducts national evaluations of HHS
programs from a broad issue-based perspective.
4.Office of Management and Policy — provides mission and administrative
support to the OIG.
5.Office of Investigations (OI) — conducts criminal, civil, and administrative
investigations of fraud and misconduct related to HHS programs, operations,
and beneficiaries. The OI also operates an OIG hotline.
6.Office of Counsel to the Inspector General — provides legal advocacy and
counsel to the Inspector General and OIG's other components.
1976 Right Ans - OIG was created to fight FWA in Medicare, Medicaid and
more than 300 other HHS programs.
1998 Right Ans - HHS OIG created the 1st compliance guidance document:
Compliance Program Guidance for Hospitals for HH, Clinical Labs and 3rd
Party Medical billing Companies.
1999 Right Ans - Compliance Program Guidance for DME industry,
Hospices and Medicare+Choice Organization.
2000 Right Ans - Compliance Program Guidance for Nsg Facilities &
Individual & Small Grp Physician Practices.
2005 Right Ans - Supplemental Guidance Program Guidance for Hospitals.
2010 Right Ans - Patient Protection & Affordable Care Act (PPACA), AKA
Obamacare was created.
Health Care Education Reconciliation Act which is AKA Healthcare Reform
Law.
,The DOJ consists of numerous agencies, including: Right Ans - the Federal
Bureau of Investigation (FBI) and the Drug Enforcement Administration
(DEA). A list of all the agencies can be found at
https://www.justice.gov/agencies/chart.
The DOJ's current strategic plan (2018-2022) includes the following
overarching goals: Right Ans - - Enhance national security and counter the
threat of terrorism;
- Secure the borders and enhance immigration enforcement and adjudication;
- Reduce violent crime and promote public safety; and
- Promote rule of law, integrity, and good government.
What are CIA (Corporate Integrity Agreements)? Right Ans - Used to
enforce compliance within a healthcare organization. Used as a part of a civil
settlement with a provider or organization when there has been an
investigation into the claims submitted to a federal payer. I
What is HHS OCR (Office of Civil Rights)? Right Ans - Responsible to
enforce the HIPAA Privacy Rule and Security Rule provisions. The Civil Rights
Act of 1964 as it applies to limited English proficiency (see below), the
confidentiality provisions of the Patient Safety Act and Rule, the Church
Amendments, section 245 of the Public Health Service Act, and the Weldon
Amendment.
What is required for a compliance program to be effective?
a. The compliance program needs to be reviewed daily for any compliance
updates.
b. Regularly review and update the compliance program.
c. The compliance program must be reviewed by healthcare lawyers.
d. The compliance program needs to be reviewed weekly for any compliance
updates. Right Ans - b. Regularly review and update the compliance
program.
Rationale: Simply implementing a compliance program is not enough. It will
need to be reviewed and updated on a regular basis.
Which federal government departments is the OIG NOT responsible for
overseeing?
a. Centers for Medicare & Medicaid Services
b. Centers for Disease Control and Prevention
,c. U.S. Food & Drug Administration
d. Drug Enforcement Agency Right Ans - d. Drug Enforcement Agency
Rationale: 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). The Drug
Enforcement Agency (DEA) is overseen by DOJ.
In what year did the OIG post guidance for hospitals?
a. 1996
b. 1997
c. 1998
d. 1999 Right Ans - c. 1998
Rationale: The first set of OIG guidance for hospitals was created in 1998.
Which of the following can be a result of an effective compliance program?
a. Keep a provider from facing criminal penalties
b. Make sure a practice or medical organization is 100 percent compliant with
federal regulations
c. Help create financial success, customer loyalty, community support, and
employee satisfaction
d. Require starting fresh with new policies and procedures and expensive
changes Right Ans - c. Help create financial success, customer loyalty,
community support, and employee satisfaction
Rationale: 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.
Which entity below could NOT bill for medically unnecessary services?
a. Hospitals
b. Physicians
c. Ancillary providers
d. Patients Right Ans - d. Patients
Rationale: 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.
, Which government department is comprised thousands of employees who
enforce the nation's federal criminal laws and help develop and implement
criminal law policies?
a. Office of Inspector General
b. Centers for Medicare & Medicaid Services
c. Health Care Lawyers Association
d. Department of Justice Right Ans - d. Department of Justice
Rationale: 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 department is the largest inspector general's office in the federal
government?
a. HHS Office of Inspector General
b. Office of Civil Rights
c. Department of Justice
d. Centers for Medicare & Medicaid Services Right Ans - a. HHS Office of
Inspector General
Rationale: The HHS OIG is the largest inspector general's office in the federal
government, with approximately 1,600 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?
a. Employment Equality Agency
b. Office for Civil Rights
c. Department of Justice
d. Office of Inspector General Right Ans - b. Office for Civil Rights
Rationale: Civil rights help to protect individuals from unfair treatment or
discrimination because of race, color, national origin, disability, age, sex
(gender), or religion.
What term would be used for actions that, either directly or indirectly, result
in unnecessary costs to the Medicare program?
a. Fraud
b. Mistake
Solutions
The OIG consists of 6 departments: Right Ans - 1.Immediate OIG —
responsible for the overall fulfillment of the OIG's mission and for promoting
effective management and quality of the agency's processes and products.
2.Office of Audit Services — performs independent audits of HHS programs
and/or HHS grantees and contractors to examine their performance.
3.Office of Evaluation and Inspections — conducts national evaluations of HHS
programs from a broad issue-based perspective.
4.Office of Management and Policy — provides mission and administrative
support to the OIG.
5.Office of Investigations (OI) — conducts criminal, civil, and administrative
investigations of fraud and misconduct related to HHS programs, operations,
and beneficiaries. The OI also operates an OIG hotline.
6.Office of Counsel to the Inspector General — provides legal advocacy and
counsel to the Inspector General and OIG's other components.
1976 Right Ans - OIG was created to fight FWA in Medicare, Medicaid and
more than 300 other HHS programs.
1998 Right Ans - HHS OIG created the 1st compliance guidance document:
Compliance Program Guidance for Hospitals for HH, Clinical Labs and 3rd
Party Medical billing Companies.
1999 Right Ans - Compliance Program Guidance for DME industry,
Hospices and Medicare+Choice Organization.
2000 Right Ans - Compliance Program Guidance for Nsg Facilities &
Individual & Small Grp Physician Practices.
2005 Right Ans - Supplemental Guidance Program Guidance for Hospitals.
2010 Right Ans - Patient Protection & Affordable Care Act (PPACA), AKA
Obamacare was created.
Health Care Education Reconciliation Act which is AKA Healthcare Reform
Law.
,The DOJ consists of numerous agencies, including: Right Ans - the Federal
Bureau of Investigation (FBI) and the Drug Enforcement Administration
(DEA). A list of all the agencies can be found at
https://www.justice.gov/agencies/chart.
The DOJ's current strategic plan (2018-2022) includes the following
overarching goals: Right Ans - - Enhance national security and counter the
threat of terrorism;
- Secure the borders and enhance immigration enforcement and adjudication;
- Reduce violent crime and promote public safety; and
- Promote rule of law, integrity, and good government.
What are CIA (Corporate Integrity Agreements)? Right Ans - Used to
enforce compliance within a healthcare organization. Used as a part of a civil
settlement with a provider or organization when there has been an
investigation into the claims submitted to a federal payer. I
What is HHS OCR (Office of Civil Rights)? Right Ans - Responsible to
enforce the HIPAA Privacy Rule and Security Rule provisions. The Civil Rights
Act of 1964 as it applies to limited English proficiency (see below), the
confidentiality provisions of the Patient Safety Act and Rule, the Church
Amendments, section 245 of the Public Health Service Act, and the Weldon
Amendment.
What is required for a compliance program to be effective?
a. The compliance program needs to be reviewed daily for any compliance
updates.
b. Regularly review and update the compliance program.
c. The compliance program must be reviewed by healthcare lawyers.
d. The compliance program needs to be reviewed weekly for any compliance
updates. Right Ans - b. Regularly review and update the compliance
program.
Rationale: Simply implementing a compliance program is not enough. It will
need to be reviewed and updated on a regular basis.
Which federal government departments is the OIG NOT responsible for
overseeing?
a. Centers for Medicare & Medicaid Services
b. Centers for Disease Control and Prevention
,c. U.S. Food & Drug Administration
d. Drug Enforcement Agency Right Ans - d. Drug Enforcement Agency
Rationale: 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). The Drug
Enforcement Agency (DEA) is overseen by DOJ.
In what year did the OIG post guidance for hospitals?
a. 1996
b. 1997
c. 1998
d. 1999 Right Ans - c. 1998
Rationale: The first set of OIG guidance for hospitals was created in 1998.
Which of the following can be a result of an effective compliance program?
a. Keep a provider from facing criminal penalties
b. Make sure a practice or medical organization is 100 percent compliant with
federal regulations
c. Help create financial success, customer loyalty, community support, and
employee satisfaction
d. Require starting fresh with new policies and procedures and expensive
changes Right Ans - c. Help create financial success, customer loyalty,
community support, and employee satisfaction
Rationale: 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.
Which entity below could NOT bill for medically unnecessary services?
a. Hospitals
b. Physicians
c. Ancillary providers
d. Patients Right Ans - d. Patients
Rationale: 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.
, Which government department is comprised thousands of employees who
enforce the nation's federal criminal laws and help develop and implement
criminal law policies?
a. Office of Inspector General
b. Centers for Medicare & Medicaid Services
c. Health Care Lawyers Association
d. Department of Justice Right Ans - d. Department of Justice
Rationale: 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 department is the largest inspector general's office in the federal
government?
a. HHS Office of Inspector General
b. Office of Civil Rights
c. Department of Justice
d. Centers for Medicare & Medicaid Services Right Ans - a. HHS Office of
Inspector General
Rationale: The HHS OIG is the largest inspector general's office in the federal
government, with approximately 1,600 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?
a. Employment Equality Agency
b. Office for Civil Rights
c. Department of Justice
d. Office of Inspector General Right Ans - b. Office for Civil Rights
Rationale: Civil rights help to protect individuals from unfair treatment or
discrimination because of race, color, national origin, disability, age, sex
(gender), or religion.
What term would be used for actions that, either directly or indirectly, result
in unnecessary costs to the Medicare program?
a. Fraud
b. Mistake
