HCCA CHC Study Set UPDATED ACTUAL
Exam Questions and CORRECT Answers
Deficit Reduction Act of 2005 - CORRECT ANSWER - Requires that organizations
receiving more than $5 million in Medicaid funds must provide education on the False Claims
Act.
Corporate Integrity Agreement (CIA) - CORRECT ANSWER - A compliance program
imposed by the government, which involves substantial government oversight and outside expert
involvement in the organization's compliance activities and is generally required as a condition
of settling a fraud and abuse investigation. Negotiated primarily between the OIG and the health
care entity.
Seven Elements of a Compliance Program - CORRECT ANSWER - 1. Standards of
Conduct
2. Oversight & Resources
3. Education & Training
4. Auditing and Monitoring
5. Consistent and appropriate discipline
6. Reporting Processes
7. Response and Prevention of Problems
LEIE (List of Excluded Individuals) - CORRECT ANSWER - A list of individuals and
organizations that are excluded from participating/billing the federal healthcare program (i.e.
Medicare). This list is updated monthly and is the responsibility of the organization to check
their list of physicians, employees, etc. against this to prevent a violation of the False Claims
Act.
Medicare Cost Report - CORRECT ANSWER - A report that contains provider
information such as facility characteristics, utilization data, cost and charges by the cost center. If
administrator's or business associate pay appears on this that is excluded from the LEIE, it may
be liable as a FCA.
, 5 to 50 Years - CORRECT ANSWER - Mandatory Exclusion (felony) length
Up to 5 Years - CORRECT ANSWER - Permissive exclusion (misdemeanor) length
State Medicaid Exclusion List - CORRECT ANSWER - State Version of LEIE, also
monitored monthly
False Claims Act - CORRECT ANSWER - Prohibits anyone from knowingly submitting
or causing to be submitted a false or fraudulent claim to the government.
Anti-Kickback Law - CORRECT ANSWER - Prohibits the solicitation, receiving,
offering, or paying of any remuneration directly or indirectly in cash or in kind in exchange that
are payable by a federal Healthcare program.
Anti-Kickback Safe Harbors - CORRECT ANSWER - 1. Referrals made as part of an
employment or professional services agreement
2. Payments made for the lease equipment or of office space
3. Certain payments made for the purposes of health practitioner recruitment.
Stark Law - CORRECT ANSWER - Part of OBRA, bans physicians from referring lab
specimens or other DHS to any entity with which the physician has a financial relationship.
Balance Budget Act - CORRECT ANSWER - Legislation containing major reform of
Medicare and Medicaid programs especially in the areas of home health and patient transfers. It
mandates permanent exclusion from participation in federally funded healthcare programs of
those convicted of three healthcare related crimes.
HITECH - CORRECT ANSWER - Enacted as part of ARRA, HITECH is designed to
encourage healthcare providers to adopt health information technology that establish electronic
health records in a standardized manner that protects patients private health information.
Exam Questions and CORRECT Answers
Deficit Reduction Act of 2005 - CORRECT ANSWER - Requires that organizations
receiving more than $5 million in Medicaid funds must provide education on the False Claims
Act.
Corporate Integrity Agreement (CIA) - CORRECT ANSWER - A compliance program
imposed by the government, which involves substantial government oversight and outside expert
involvement in the organization's compliance activities and is generally required as a condition
of settling a fraud and abuse investigation. Negotiated primarily between the OIG and the health
care entity.
Seven Elements of a Compliance Program - CORRECT ANSWER - 1. Standards of
Conduct
2. Oversight & Resources
3. Education & Training
4. Auditing and Monitoring
5. Consistent and appropriate discipline
6. Reporting Processes
7. Response and Prevention of Problems
LEIE (List of Excluded Individuals) - CORRECT ANSWER - A list of individuals and
organizations that are excluded from participating/billing the federal healthcare program (i.e.
Medicare). This list is updated monthly and is the responsibility of the organization to check
their list of physicians, employees, etc. against this to prevent a violation of the False Claims
Act.
Medicare Cost Report - CORRECT ANSWER - A report that contains provider
information such as facility characteristics, utilization data, cost and charges by the cost center. If
administrator's or business associate pay appears on this that is excluded from the LEIE, it may
be liable as a FCA.
, 5 to 50 Years - CORRECT ANSWER - Mandatory Exclusion (felony) length
Up to 5 Years - CORRECT ANSWER - Permissive exclusion (misdemeanor) length
State Medicaid Exclusion List - CORRECT ANSWER - State Version of LEIE, also
monitored monthly
False Claims Act - CORRECT ANSWER - Prohibits anyone from knowingly submitting
or causing to be submitted a false or fraudulent claim to the government.
Anti-Kickback Law - CORRECT ANSWER - Prohibits the solicitation, receiving,
offering, or paying of any remuneration directly or indirectly in cash or in kind in exchange that
are payable by a federal Healthcare program.
Anti-Kickback Safe Harbors - CORRECT ANSWER - 1. Referrals made as part of an
employment or professional services agreement
2. Payments made for the lease equipment or of office space
3. Certain payments made for the purposes of health practitioner recruitment.
Stark Law - CORRECT ANSWER - Part of OBRA, bans physicians from referring lab
specimens or other DHS to any entity with which the physician has a financial relationship.
Balance Budget Act - CORRECT ANSWER - Legislation containing major reform of
Medicare and Medicaid programs especially in the areas of home health and patient transfers. It
mandates permanent exclusion from participation in federally funded healthcare programs of
those convicted of three healthcare related crimes.
HITECH - CORRECT ANSWER - Enacted as part of ARRA, HITECH is designed to
encourage healthcare providers to adopt health information technology that establish electronic
health records in a standardized manner that protects patients private health information.
