Compliance 101 Exam Questions and Answers 100% Pass

Compliance 101 Exam Questions and Answers 100% Pass compliance program - prevention, detection, collaboration, and enforcement Effective compliance program - must be an ongoing process and commitment to an ethical way of conducting business Office of Inspector General and Justice Department - is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws outline as part of the SSA by CMS. Benefits of compliance program addressed by OIG - safeguards the organizations' legal responsibility to abide by applicable laws and regulations. Corporate Integrity Agreement (CIA) - government imposed compliance program Why compliance programs are essential - prevent paybacks, probation, government designed programs, exclusion, reduce threat of lawsuits from whistleblowers (qui tam). OIG Top 10 reasons to implement a compliance program - demonstrates a strong commitment to honesty and responsible corporate relations, reinforces employees sense of right and wrong, fulfill legal duty to payers, cost effective, more accurate view of what is going on, quality of care to clients, provides procedures to promptly correct misconduct, mitigate any sanction imposed by government. Health Insurance Portability and Accountability Act of 1996 (HIPAA) - a criminal offense to submit claims based on incorrect codes or medically unnecessary services, and government has the power to exclude an organization from Medicare/caid and other govt programs. 2 | P a g e Created by Katelyn Whitman © 2025, All Rights Reserved. 100% PASS GUARANTEE Balanced Budget Act of 1997 - three strikes and your out clause , requiring permanent expulsion if found guilty of fraud a third time. False Claims Act (FCA) - empowers the govt to investigate and bring civil action in fraud cases. Implemented in Civil War to control price gouging. Qui tam - is a whistleblower who brings the fraud to light. A whistleblower can receive a % of the govt's total award - 15-25% if DOJ assumes the case or 25-30% if DOJ declines To avoid lengthy and expensive litigation, an organization can negotiate a ____________with the govt admits no fault or liability but does submit to a govt plan for corrective action. - CIA Length of CIAs - 3-5 yrs with some lasting up to 8 yrs 1984 Congress enacted Sentencing reform act which includes FSG - act designed to correct inequities in federal sentencing and give guidance for assessing fines and methods for calculation of culpability score. The culpability score - calculation of the degree of blame or guilt used to determine fines, restitution, forfeiture, and probation. If an upper level employee has participated in or was willfully ignorant of an offense, - the likelihood of culpability score will be increased. If an organization reports a violation promptly, - the culpability score may be mitigated. An aggravating factor in FSG - is that the organization has had a repeated offense A mitigating factor for FSG - is that the organization cooperated with the govt investigators 3 | P a g e Created by Katelyn Whitman © 2025, All Rights Reserved. 100% PASS GUARANTEE 2010 FSG amendment changes includes way to further reduce culpability scores: - C&E program has responsibility- to report directly to board or appropriate subgroup, to detected offense before external discovery, prompt reporting, no one with OP responsibility participated in, condoned, or was willfully ignorant of the offense. Which of the following is an aggravating factor to a culpability score in the Federal Sentencing Commission released "Chapter 8 Part B - Remedying Harm from Criminal Conduct, and Effective Compliance and Ethics Program?" - If the violation was a repeat offense; The OIG believes every effective compliance Program begins with a formal commitment to seven basic elements, based on and expanding upon the seven steps of the Federal Sentencing Guidelines. Which of the following is not one of the seven elements in the guidance for hospitals? - Terminating employees who have been investigated and found to have committed prior fraudulent acts According to the text, which of the following are "overlooked groups" when it comes to Standards of Conduct/Policies and Procedures? (Choose all that apply) - Suppli