HCCA CHC Study Set UPDATED
ACTUAL Exam Questions and
CORRECT Answers
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Terms in this set (61)
Requires that organizations
Deficit
receiving more than $5 million in
Reduction Act of
Medicaid funds must provide
2005
education on the False Claims Act.
, A compliance program imposed by
the government, which involves
substantial government oversight
and outside expert involvement in
Corporate
the organization's compliance
Integrity
activities and is generally required
Agreement (CIA)
as a condition of settling a fraud and
abuse investigation. Negotiated
primarily between the OIG and the
health care entity.
1. Standards of Conduct
2. Oversight & Resources
3. Education & Training
Seven Elements 4. Auditing and Monitoring
of a Compliance 5. Consistent and appropriate
Program discipline
6. Reporting Processes
7. Response and Prevention of
Problems
, A list of individuals and
organizations that are excluded
from participating/billing the federal
healthcare program (i.e. Medicare).
LEIE (List of
This list is updated monthly and is
Excluded
the responsibility of the organization
Individuals)
to check their list of physicians,
employees, etc. against this to
prevent a violation of the False
Claims Act.
A report that contains provider
information such as facility
characteristics, utilization data, cost
Medicare Cost and charges by the cost center. If
Report 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 Mandatory Exclusion (felony) length
Permissive exclusion (misdemeanor)
Up to 5 Years
length
State Medicaid State Version of LEIE, also
Exclusion List monitored monthly
ACTUAL Exam Questions and
CORRECT Answers
Save
Terms in this set (61)
Requires that organizations
Deficit
receiving more than $5 million in
Reduction Act of
Medicaid funds must provide
2005
education on the False Claims Act.
, A compliance program imposed by
the government, which involves
substantial government oversight
and outside expert involvement in
Corporate
the organization's compliance
Integrity
activities and is generally required
Agreement (CIA)
as a condition of settling a fraud and
abuse investigation. Negotiated
primarily between the OIG and the
health care entity.
1. Standards of Conduct
2. Oversight & Resources
3. Education & Training
Seven Elements 4. Auditing and Monitoring
of a Compliance 5. Consistent and appropriate
Program discipline
6. Reporting Processes
7. Response and Prevention of
Problems
, A list of individuals and
organizations that are excluded
from participating/billing the federal
healthcare program (i.e. Medicare).
LEIE (List of
This list is updated monthly and is
Excluded
the responsibility of the organization
Individuals)
to check their list of physicians,
employees, etc. against this to
prevent a violation of the False
Claims Act.
A report that contains provider
information such as facility
characteristics, utilization data, cost
Medicare Cost and charges by the cost center. If
Report 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 Mandatory Exclusion (felony) length
Permissive exclusion (misdemeanor)
Up to 5 Years
length
State Medicaid State Version of LEIE, also
Exclusion List monitored monthly
