HCCA CHC Exam Prep
1. Stark or Physician Self-Referral Law
ANSWER The Omnibus Budget Reconciliation Act bans physicians from referring patients to receive
"designated health services" to any entity with which the physician has a financial relationship. Designated health
services include lab testing, imaging services, physical or occupational therapy, etc. (civil only, medicare/medicaid
only, strict liability)
2. Anti-Kickback Statute (AKS)
ANSWER Prohibits the solicitation, receiving, ottering, or paying any remuneration
directly or indirectly in cash or in kind in exchange. Essentially it prohibits the exchange of anything of value in exchange
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,for or in an ettort to gain the referral of business reimbursable by federal healthcare programs. (intent, any federal
program, civil or criminal)
3. Physician Payments Sunshine Act (PPSA)
ANSWER Requires that detailed information about payments
or other "transfers of value" worth over $10 from manufacturers of drugs, medical devices and biologics to physicians
and teaching hospitals be made available to the public. (Open payment data).
4. Deficit Reduction Act
ANSWER A Federal law that grants states the ability to modify their Medicaid programs.
This allows individual states to reform their Medicaid programs to fit with the present health care environment while
maintaining federal guidelines.
5. False Claims Act
ANSWER Originally adopted byt U.S. Congress to discourage suppliers from overcharging the
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, government, it is now legislation that prohibits anyone from knowingly submitting or causing to be submitted a false
or fraudulent claim. DOJ.
6. Qui Tam Action
ANSWER Allows persons and entities with evidence of fraud against federal programs or contracts to
sue the wrongdoer on behalf of the United States Government - based upon private information.
7. 7 Elements of an Effective Compliance Program
ANSWER 1. Policies and Procedures
2. Compliance Oversight
3. Ettective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
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1. Stark or Physician Self-Referral Law
ANSWER The Omnibus Budget Reconciliation Act bans physicians from referring patients to receive
"designated health services" to any entity with which the physician has a financial relationship. Designated health
services include lab testing, imaging services, physical or occupational therapy, etc. (civil only, medicare/medicaid
only, strict liability)
2. Anti-Kickback Statute (AKS)
ANSWER Prohibits the solicitation, receiving, ottering, or paying any remuneration
directly or indirectly in cash or in kind in exchange. Essentially it prohibits the exchange of anything of value in exchange
1/
26
,for or in an ettort to gain the referral of business reimbursable by federal healthcare programs. (intent, any federal
program, civil or criminal)
3. Physician Payments Sunshine Act (PPSA)
ANSWER Requires that detailed information about payments
or other "transfers of value" worth over $10 from manufacturers of drugs, medical devices and biologics to physicians
and teaching hospitals be made available to the public. (Open payment data).
4. Deficit Reduction Act
ANSWER A Federal law that grants states the ability to modify their Medicaid programs.
This allows individual states to reform their Medicaid programs to fit with the present health care environment while
maintaining federal guidelines.
5. False Claims Act
ANSWER Originally adopted byt U.S. Congress to discourage suppliers from overcharging the
2/
26
, government, it is now legislation that prohibits anyone from knowingly submitting or causing to be submitted a false
or fraudulent claim. DOJ.
6. Qui Tam Action
ANSWER Allows persons and entities with evidence of fraud against federal programs or contracts to
sue the wrongdoer on behalf of the United States Government - based upon private information.
7. 7 Elements of an Effective Compliance Program
ANSWER 1. Policies and Procedures
2. Compliance Oversight
3. Ettective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
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