AHFI CERTIFICATION EVALUATION COMPLETE
QUESTIONS WITH VERIFIED SOLUTIONS
◉ Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals.
Answer: Referrals from anyone
◉ Anti-Kickback Statute (42 US SS 1320a-7b (b).
Answer: Any items or services
◉ Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent).
Answer: Intent MUST be proven (knowing and willful)
◉ Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties.
Answer: 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).
Answer: 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.
Answer: Voluntary safe harbors
◉ Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies
to....
Answer: All Federal Health Care Programs
◉ The Stark Law (42 US SS 139nn) Prohibition.
Answer: 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.
Answer: Referrals from a physician
◉ The Stark Law (42 US SS 139nn) (Items/Services).
Answer: Designated health services
◉ The Stark Law (42 US SS 139nn) (Intent).
Answer: 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.
Answer: 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).
Answer: Mandatory exceptions
◉ The Stark Law (42 US SS 139nn) applies to.
Answer: Medicare and Medicaid
(No commercial or tricare)
◉ MACs:.
Answer: 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.
Answer: To correct the behavior in need of change and prevent
future inappropriate billing
◉ The priority of MACs.
QUESTIONS WITH VERIFIED SOLUTIONS
◉ Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals.
Answer: Referrals from anyone
◉ Anti-Kickback Statute (42 US SS 1320a-7b (b).
Answer: Any items or services
◉ Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent).
Answer: Intent MUST be proven (knowing and willful)
◉ Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties.
Answer: 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).
Answer: 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.
Answer: Voluntary safe harbors
◉ Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies
to....
Answer: All Federal Health Care Programs
◉ The Stark Law (42 US SS 139nn) Prohibition.
Answer: 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.
Answer: Referrals from a physician
◉ The Stark Law (42 US SS 139nn) (Items/Services).
Answer: Designated health services
◉ The Stark Law (42 US SS 139nn) (Intent).
Answer: 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.
Answer: 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).
Answer: Mandatory exceptions
◉ The Stark Law (42 US SS 139nn) applies to.
Answer: Medicare and Medicaid
(No commercial or tricare)
◉ MACs:.
Answer: 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.
Answer: To correct the behavior in need of change and prevent
future inappropriate billing
◉ The priority of MACs.
