Chapter 4
Healthcare Reform Act set the stage for moving away from rewards for healthcare providers who can
achieve superior outcomes for their patients to fee-for-service payments. - correct answer ✔✔False
OIG recommends adopting a corporate compliance plan. - correct answer ✔✔True
Healthcare Reform Act requires all healthcare providers participating in Medicare to have a compliance
program in place. - correct answer ✔✔True
Medicaid covers health and long-term care services for many of the sickest and poorest Americans. -
correct answer ✔✔True
Double billing is an example of fraud. - correct answer ✔✔True
It is not a crime to transfer assets to gain Medicaid eligibility. - correct answer ✔✔False
A fine of $5,500 to $11,000 per claim plus up to three times the amount of damages caused to a federal
program can be assessed under the False Claim Act. - correct answer ✔✔True
ERISA regulates self-insurance plans. - correct answer ✔✔True
Healthcare provider is not considered a creditor. - correct answer ✔✔False
UBIT is imposed on income to a tax-exempt organization from an unrelated trade or business. - correct
answer ✔✔True
Stark Law allows a physician to refer a patient for certain "designated health services" to an entity with
which the physician has a "financial relationship". - correct answer ✔✔False
, Anti-Kickback Statue applies to all healthcare providers. - correct answer ✔✔True
HIPAA rules do not apply to healthcare providers, healthplans, and healthcare clearing houses. - correct
answer ✔✔False
Insurance plans are regulated at the state level. - correct answer ✔✔True
Whistleblower suit brought by individual under False Claims Act is Qui Tam Action. - correct answer
✔✔True
Internal control is a process effected by an entity's board of directors, management, and other personnel
designed to provide reasonable assurance regarding compliance with applicable laws and regulations. -
correct answer ✔✔True
Risk assessment is a process that assesses the quality of internal control performance over time. -
correct answer ✔✔False
Medicare is a significant part of the growth of both federal spending and healthcare spending in the
United States. - correct answer ✔✔True
Outpatient services received by Medicare enrollees are reimbursed through Part A of Medicare. - correct
answer ✔✔False
Medicare reimbursement for a physician calculation does not include relative units for the practice
expense. - correct answer ✔✔False
Medicare is the largest source of public funding for mental health care. - correct answer ✔✔False
Abuse consists of intentional acts of deception whereas fraud involves improper acts that are
inconsistent with the standard practice and may result in overpayment or over utilization. - correct
answer ✔✔False
Healthcare Reform Act set the stage for moving away from rewards for healthcare providers who can
achieve superior outcomes for their patients to fee-for-service payments. - correct answer ✔✔False
OIG recommends adopting a corporate compliance plan. - correct answer ✔✔True
Healthcare Reform Act requires all healthcare providers participating in Medicare to have a compliance
program in place. - correct answer ✔✔True
Medicaid covers health and long-term care services for many of the sickest and poorest Americans. -
correct answer ✔✔True
Double billing is an example of fraud. - correct answer ✔✔True
It is not a crime to transfer assets to gain Medicaid eligibility. - correct answer ✔✔False
A fine of $5,500 to $11,000 per claim plus up to three times the amount of damages caused to a federal
program can be assessed under the False Claim Act. - correct answer ✔✔True
ERISA regulates self-insurance plans. - correct answer ✔✔True
Healthcare provider is not considered a creditor. - correct answer ✔✔False
UBIT is imposed on income to a tax-exempt organization from an unrelated trade or business. - correct
answer ✔✔True
Stark Law allows a physician to refer a patient for certain "designated health services" to an entity with
which the physician has a "financial relationship". - correct answer ✔✔False
, Anti-Kickback Statue applies to all healthcare providers. - correct answer ✔✔True
HIPAA rules do not apply to healthcare providers, healthplans, and healthcare clearing houses. - correct
answer ✔✔False
Insurance plans are regulated at the state level. - correct answer ✔✔True
Whistleblower suit brought by individual under False Claims Act is Qui Tam Action. - correct answer
✔✔True
Internal control is a process effected by an entity's board of directors, management, and other personnel
designed to provide reasonable assurance regarding compliance with applicable laws and regulations. -
correct answer ✔✔True
Risk assessment is a process that assesses the quality of internal control performance over time. -
correct answer ✔✔False
Medicare is a significant part of the growth of both federal spending and healthcare spending in the
United States. - correct answer ✔✔True
Outpatient services received by Medicare enrollees are reimbursed through Part A of Medicare. - correct
answer ✔✔False
Medicare reimbursement for a physician calculation does not include relative units for the practice
expense. - correct answer ✔✔False
Medicare is the largest source of public funding for mental health care. - correct answer ✔✔False
Abuse consists of intentional acts of deception whereas fraud involves improper acts that are
inconsistent with the standard practice and may result in overpayment or over utilization. - correct
answer ✔✔False
