AHFI Exam Questions with Complete
Solutions29
Anti-Kickback Statute (42 US SS 1320a-7b (b) prohibitions - ANSWERS-Prohibits offering, paying,
soliciting or reviving anything of value to induce or reward referrals or generate Federal health
care program business
Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals - ANSWERS-Referrals from anyone
Anti-Kickback Statute (42 US SS 1320a-7b (b) - ANSWERS-Any items or services
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent) - ANSWERS-Intent MUST be proven
(knowing and willful)
Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties - ANSWERS-Fines up to
$25,000/violation
Up to a 5-yr prison term/violation
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - ANSWERS-False Claims act
liability
Civil monetary penalties and program exclusions
Potential $50,000 CMP/violation
,Civil assessment of up to 3x amount of kickback
Anti-Kickback Statute (42 US SS 1320a-7b (b) Exceptions - ANSWERS-Voluntary safe harbors
Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies to... - ANSWERS-All Federal Health
Care Programs
The Stark Law (42 US SS 139nn) Prohibition - ANSWERS-Prohibits a physician from referring
Medicare patients for designated health services to an entity with which the physician (or
immediate family member) has a financial relationship, unless an exception applies)
Prohibits the designated health services entity from submitting claims to Medicare for those
services resulting from a prohibited referral
The Stark Law (42 US SS 139nn) Referrals - ANSWERS-Referrals from a physician
The Stark Law (42 US SS 139nn) (Items/Services) - ANSWERS-Designated health services
The Stark Law (42 US SS 139nn) (Intent) - ANSWERS-No intent standard for overpayment (strict
liability)
Intent required for civil monetary penalties for knowing violations
The Stark Law (42 US SS 139nn) (Civil Penalties) only - ANSWERS-Overpayment/refund
obligation
False Claims Act liability
, Civil monetary penalties and program exclusion for knowing violations
Potential $15,000 CMP for each service
Civil assessment of up to 3x the amount claimed.
The Stark Law (42 US SS 139nn) (Exceptions) - ANSWERS-Mandatory exceptions
The Stark Law (42 US SS 139nn) applies to - ANSWERS-Medicare and Medicaid
(No commercial or tricare)
MACs: - ANSWERS-Medicare Administrative Contractors
They analyze claims to determine provider compliance with Medicare coverage, coding, and
billing rules and take appropriate corrective action when providers are found to be non-
compliant.
The goal of Mac administrative actions - ANSWERS-To correct the behavior in need of change
and prevent future inappropriate billing
The priority of MACs - ANSWERS-To minimize potential future losses to the Medicare Trust Fund
through targeted claims review while using resource efficiently and treating providers and
beneficiaries fairly.
For repeated infractions, MACs have - ANSWERS-The discretion to initiate progressively more
severe administrative action, commensurate with the seriousness of the identified problem.
(See Program Integrity Manual (PIM) chapter 3, SS3. 7.1)
Solutions29
Anti-Kickback Statute (42 US SS 1320a-7b (b) prohibitions - ANSWERS-Prohibits offering, paying,
soliciting or reviving anything of value to induce or reward referrals or generate Federal health
care program business
Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals - ANSWERS-Referrals from anyone
Anti-Kickback Statute (42 US SS 1320a-7b (b) - ANSWERS-Any items or services
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent) - ANSWERS-Intent MUST be proven
(knowing and willful)
Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties - ANSWERS-Fines up to
$25,000/violation
Up to a 5-yr prison term/violation
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - ANSWERS-False Claims act
liability
Civil monetary penalties and program exclusions
Potential $50,000 CMP/violation
,Civil assessment of up to 3x amount of kickback
Anti-Kickback Statute (42 US SS 1320a-7b (b) Exceptions - ANSWERS-Voluntary safe harbors
Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies to... - ANSWERS-All Federal Health
Care Programs
The Stark Law (42 US SS 139nn) Prohibition - ANSWERS-Prohibits a physician from referring
Medicare patients for designated health services to an entity with which the physician (or
immediate family member) has a financial relationship, unless an exception applies)
Prohibits the designated health services entity from submitting claims to Medicare for those
services resulting from a prohibited referral
The Stark Law (42 US SS 139nn) Referrals - ANSWERS-Referrals from a physician
The Stark Law (42 US SS 139nn) (Items/Services) - ANSWERS-Designated health services
The Stark Law (42 US SS 139nn) (Intent) - ANSWERS-No intent standard for overpayment (strict
liability)
Intent required for civil monetary penalties for knowing violations
The Stark Law (42 US SS 139nn) (Civil Penalties) only - ANSWERS-Overpayment/refund
obligation
False Claims Act liability
, Civil monetary penalties and program exclusion for knowing violations
Potential $15,000 CMP for each service
Civil assessment of up to 3x the amount claimed.
The Stark Law (42 US SS 139nn) (Exceptions) - ANSWERS-Mandatory exceptions
The Stark Law (42 US SS 139nn) applies to - ANSWERS-Medicare and Medicaid
(No commercial or tricare)
MACs: - ANSWERS-Medicare Administrative Contractors
They analyze claims to determine provider compliance with Medicare coverage, coding, and
billing rules and take appropriate corrective action when providers are found to be non-
compliant.
The goal of Mac administrative actions - ANSWERS-To correct the behavior in need of change
and prevent future inappropriate billing
The priority of MACs - ANSWERS-To minimize potential future losses to the Medicare Trust Fund
through targeted claims review while using resource efficiently and treating providers and
beneficiaries fairly.
For repeated infractions, MACs have - ANSWERS-The discretion to initiate progressively more
severe administrative action, commensurate with the seriousness of the identified problem.
(See Program Integrity Manual (PIM) chapter 3, SS3. 7.1)
