CPCO Chapter 4 Review Key
Enforcement Laws ¼ Exam 20-25
Questions and Answers
The Office of Inspector General (OIG) works from within what organization to identify
vulnerabilities in the health care system? - ....ANSWER ...-HHS
Response Feedback:
The Office of Inspector General (OIG) works from within HHS to identify vulnerabilities
in the health care system to offer compliance guidance to health care facilities and
professionals, and to promote accountability and enforce regulation.
Which type of fraud covers any criminal fraudulent activity that has been determined to
have involved electronic communications of any kind? - ....ANSWER ...-Federal
wire fraud (18 USC1343)
Response Feedback:
Federal wire fraud (18 USC1343) covers any criminal fraudulent activity that has been
determined to have involved electronic communications of any kind.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,Hannah is afraid that if she reports the allegation of fraud that she thinks is occurring at
her medical office that she will be fired. Could this occur? - ....ANSWER ...-Yes,
but the employer would be in violation of the Whistleblower Protection Law.
Response Feedback:
The FCA provides protection to qui tam relators who are discharged, demoted,
suspended, threatened, harassed, or in any other manner discriminated against in the
terms and conditions of their employment as a result of their furtherance of an action.
The Health Reform Act requires providers to refund an overpayment to Medicare within
how many days of "identifying" it - ....ANSWER ...-60
Response Feedback:
The Health Reform Act now requires providers to refund an overpayment to Medicare
within 60 days of "identifying" it, and provides that an overpayment retained beyond
that deadline is an "obligation" under the FCA (discussed in more detail, below).
FERA expands the grounds for liability under which Act. - ....ANSWER ...-False
Claims Act
Response Feedback:
FERA expands the grounds for liability under the FCA.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
, Circumnavigation schemes can occur when a physician or other entity enters into an
arrangement that the entity /physician knows that ____________will occur. -
....ANSWER ...-referrals
Response Feedback:
So called "circumnavigation schemes" may result in monetary penalties of up to
$100,000 for each arrangement or scheme, and exclusion from government programs.
These occur when a physician or other entity enters an arrangement or scheme (such as
a cross-referral arrangement) that the entity or person knew, or should have known, had
the principal purpose of assuring referrals (which, if they had been made directly, would
have been prohibited).
A board member of XYZ Family Practice Group asks the Compliance Officer "What two
laws relate primarily to the relationships between referral sources, such as physicians and
hospitals?" What is the answer? - ....ANSWER ...-Anti-kickback and Stark laws
Response Feedback:
Two additional laws—the Anti-Kickback and Stark laws—relate primarily to the
relationships between referral sources, such as physicians and hospitals.
Texas orthopedics submits false Medicare claims through its electronic data interchange
to its Medicare Administrative contractor based in Oklahoma. Can the orthopedic office
be charged with federal wire fraud? - ....ANSWER ...-Yes, because false claims
were submitted electronically across state lines.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
Enforcement Laws ¼ Exam 20-25
Questions and Answers
The Office of Inspector General (OIG) works from within what organization to identify
vulnerabilities in the health care system? - ....ANSWER ...-HHS
Response Feedback:
The Office of Inspector General (OIG) works from within HHS to identify vulnerabilities
in the health care system to offer compliance guidance to health care facilities and
professionals, and to promote accountability and enforce regulation.
Which type of fraud covers any criminal fraudulent activity that has been determined to
have involved electronic communications of any kind? - ....ANSWER ...-Federal
wire fraud (18 USC1343)
Response Feedback:
Federal wire fraud (18 USC1343) covers any criminal fraudulent activity that has been
determined to have involved electronic communications of any kind.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,Hannah is afraid that if she reports the allegation of fraud that she thinks is occurring at
her medical office that she will be fired. Could this occur? - ....ANSWER ...-Yes,
but the employer would be in violation of the Whistleblower Protection Law.
Response Feedback:
The FCA provides protection to qui tam relators who are discharged, demoted,
suspended, threatened, harassed, or in any other manner discriminated against in the
terms and conditions of their employment as a result of their furtherance of an action.
The Health Reform Act requires providers to refund an overpayment to Medicare within
how many days of "identifying" it - ....ANSWER ...-60
Response Feedback:
The Health Reform Act now requires providers to refund an overpayment to Medicare
within 60 days of "identifying" it, and provides that an overpayment retained beyond
that deadline is an "obligation" under the FCA (discussed in more detail, below).
FERA expands the grounds for liability under which Act. - ....ANSWER ...-False
Claims Act
Response Feedback:
FERA expands the grounds for liability under the FCA.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
, Circumnavigation schemes can occur when a physician or other entity enters into an
arrangement that the entity /physician knows that ____________will occur. -
....ANSWER ...-referrals
Response Feedback:
So called "circumnavigation schemes" may result in monetary penalties of up to
$100,000 for each arrangement or scheme, and exclusion from government programs.
These occur when a physician or other entity enters an arrangement or scheme (such as
a cross-referral arrangement) that the entity or person knew, or should have known, had
the principal purpose of assuring referrals (which, if they had been made directly, would
have been prohibited).
A board member of XYZ Family Practice Group asks the Compliance Officer "What two
laws relate primarily to the relationships between referral sources, such as physicians and
hospitals?" What is the answer? - ....ANSWER ...-Anti-kickback and Stark laws
Response Feedback:
Two additional laws—the Anti-Kickback and Stark laws—relate primarily to the
relationships between referral sources, such as physicians and hospitals.
Texas orthopedics submits false Medicare claims through its electronic data interchange
to its Medicare Administrative contractor based in Oklahoma. Can the orthopedic office
be charged with federal wire fraud? - ....ANSWER ...-Yes, because false claims
were submitted electronically across state lines.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
