HIPAA & Healthcare Compliance Regulations Flashcards
6 cards from real AAPC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 HIPAA & Healthcare Compliance Regulations flashcards as text
The False Claims Act (FCA) penalizes providers who:
Answer: Knowingly submit false or fraudulent claims for payment to the federal government
The FCA imposes civil penalties and treble damages for submitting fraudulent claims to Medicare, Medicaid, or other federal healthcare programs.
What does the federal Anti-Kickback Statute (AKS) prohibit?
Answer: Offering, paying, soliciting, or receiving anything of value to induce or reward referrals of federal healthcare program business
The AKS makes it illegal to exchange remuneration to induce referrals for services covered by Medicare, Medicaid, or other federal programs.
What does the Stark Law (Physician Self-Referral Law) prohibit?
Answer: Physicians from referring patients to entities for designated health services in which the physician has a financial relationship
The Stark Law prohibits physicians from referring Medicare patients to entities where the physician or an immediate family member has a financial interest, unless an exception applies.
What is the primary function of the Office of Inspector General (OIG) in healthcare?
Answer: Protecting federal healthcare programs from fraud, waste, and abuse through audits and investigations
The OIG conducts audits, evaluations, and investigations to identify and combat fraud and abuse in HHS programs, including Medicare and Medicaid.
What is the purpose of a healthcare compliance program?
Answer: To prevent, detect, and correct violations of legal and ethical standards in healthcare billing and operations
A compliance program establishes policies, training, and monitoring systems to ensure the practice adheres to federal and state healthcare laws and regulations.
What is the Qui Tam provision of the False Claims Act?
Answer: A provision allowing private individuals to file lawsuits on behalf of the government and receive a share of the recovery
The Qui Tam provision enables whistleblowers (relators) to sue on behalf of the government and receive 15-30% of the recovered funds for reporting fraud.