ALREADY PASSED GRADED A+.
◍ HIPAA. Ans: HEALTH INS PORTABILITY &
ACCOUNTIBILITY ACT
◍ FRAUD. Ans: FALSIFYING DOCUMENTATION
◍ ABUSE. Ans: OVER CHARGING FOR SERVICES &
SUPPLIES
◍ FALSE CLAIMS ACT (FCA). Ans: PROTECTS THE GOV
FROM BEING OVERCHARGED FOR GOODS/SEVICES
◍ STARK LAW. Ans: NO PHYSICIAN SELF-REFERRAL
◍ ANTI-KICKBACK LAW. Ans: ITEMS RECEIVED AS
PAYMENT (CASH, GIFTS, FREE RENT) IS VIOLATION OF LAW
◍ TRUTH AND LENDING ACT AKA CONSUMER CRED
PROTECTION ACT. Ans: PROTECT CONSUMERS WHEN
DEALING WITH LENDER & CREDITORS
, ◍ CONDITIONS OF PARTICIPATION (COP). Ans:
CONDITIONS HEALTHCARE ORG MUST MEET TO
PARTICIPATE WITH PLAN OR PROGRAM
◍ COVERED ENTITY. Ans: HEALTH PLANS,
CLEARINGHOUSES, PROVIDERS
◍ PPO. Ans: PROVIDER/FACILITY WHO AGREE WITH
INSURER TO PROVIDE HEALTH CARE AT REDUCED RATE
◍ QUI TAM ACTION. Ans: LAWSUIT BETWEEN PERSON AND
COMPANY WHO HAS VIOLATED GOV REGULATION
◍ CDPH. Ans: CONSUMER DRIVEN HEALTH PLAN
◍ PATIENT PROTECTION & AFFORDABLE CARE ACT. Ans:
FEDERAL MADATE EVERYONE HAVE A MIN OF ESSENTIAL
COVERAGE
◍ INDIVIDUAL HEALTH PLAN. Ans: PURCHASED BY
INDIVIDUALS (MOSTLY SELF-EMPLOYED)
◍ GROUP HEATLH PLANS. Ans: EMPLOYER DECIDES
COVERAGE TYPE & COSTS