AAPC Chapter 1 CPB Exam with complete solutions

A physician received office space at a reduced rate for referring patients to the hospital's outpatient physical therapy center. What Law does this violate? 1. Anti-kickback Statute 2. Stark Law 3. False Claims Act 4. Truth in Lending Act - Answer- Anti-Kickback Statute Rationale: The anti-kickback Laws states that anyone who knowingly or willing accept or offer any items or services to induce referral is a violation of the law. Federal healthcare plans include what payers? 1. Blue Cross, Medicare, Humana 2. Medicare, Medicaid, Tricare 3. Medicare, Tricare, Blue Cross 4. Humana, VA, Tricare - Answer- Medicare, Medicaid, Tricare Rationale: Federal health care plans are any plans paid through government reimbursement-Medicare, Medicaid, Tricare, and VA programs are all administered by the Federal government. One of the most severe penalties that can be associated with violations of the Social Security Act is exclusion from federal healthcare plans. Which of the following statements is true of excluded individuals? 1. Physicians that have been excluded can bill the patient for services but cannot bill federal health plans. 2. Physicians that been excluded can refer their patients to other facilities for treatment. 3. Physicians that have been excluded are prohibited from billing for any services to a federally administered health plan. 4. Physicians that have been excluded are exempt from billing for services but are allowed to write prescriptions and order tests. - Answer- 3. Physicians that have been excluded are prohibited from billing for any services to a federally administered health plan. Rationale: One of the most severe penalties associated with the Social Security Act is the ability of the Office of Inspector General (OIG) to exclude an entity or an individual from participation in any and all federal healthcare programs. This includes Medicare, Medicaid, VA programs, and Tricare. An excluded individual cannot bill for services, provide referrals or prescribe medications or order services for any beneficiary of a federally administered health plan. A physican billed claims to MCR and MCD for procedures that were not performed on 800 patients resulting in loss of $2.6 million. Is this fraud or abuse? 1. Fraud; subject to the Anti-Kickback Statute 2. Fraud; subject to the False Claims Act 3. Abuse; subject only to education of the provider 4. Abuse; subject to the Start Law - Answer- Fraud; subject to the False Claims Act Rationale: Fraud is defined as making false statements or making misrepresenting facts to obtain an undeserved benefit or payment from a federal health care program. This creates unnecessary costs to the federal plan. In this example billing for services that were not furnished or provided. The regulation of finance charges or interest applied to outstanding balances in the medical practices under what law? 1. Truth in Lending Act 2. Criminal Healthcare Act 3. HIPAA 4. Conditions of Participation - Answer- Truth in Lending Act Rationale: The Truth in Lending Act is also called the Consumer Credit Protection Act of 1968 that is designed to protect consumers dealing with lenders and creditors. Abuse - Answer- An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly Anti-kickback - Answer- Knowingly and willfully offering or accepting rewards or remuneration for services that are billable to a federa