AAPC HIPAA & Healthcare Compliance Regulations 3

Question 1

The False Claims Act (FCA) penalizes providers who:

Accepted Answer

Knowingly submit false or fraudulent claims for payment to the federal government

Answer

File claims after the timely filing deadline

Answer

Fail to verify insurance eligibility

Answer

Use outdated CPT codes

Question 2

What does the federal Anti-Kickback Statute (AKS) prohibit?

Accepted Answer

Offering, paying, soliciting, or receiving anything of value to induce or reward referrals of federal healthcare program business

Answer

Billing for services not rendered

Answer

Upcoding diagnosis codes

Answer

Using a clearinghouse for claim submission

Question 3

What does the Stark Law (Physician Self-Referral Law) prohibit?

Accepted Answer

Physicians from referring patients to entities for designated health services in which the physician has a financial relationship

Answer

Physicians from treating Medicare patients

Answer

Billing for unlisted procedures

Answer

Providing free samples to patients

Question 4

What is the primary function of the Office of Inspector General (OIG) in healthcare?

Accepted Answer

Protecting federal healthcare programs from fraud, waste, and abuse through audits and investigations

Answer

Processing Medicare claims

Answer

Setting Medicare reimbursement rates

Answer

Credentialing healthcare providers

Question 5

What is the purpose of a healthcare compliance program?

Accepted Answer

To prevent, detect, and correct violations of legal and ethical standards in healthcare billing and operations

Answer

To increase billing charges

Answer

To negotiate payer contracts

Answer

To manage patient appointments

Question 6

What is the Qui Tam provision of the False Claims Act?

Accepted Answer

A provision allowing private individuals to file lawsuits on behalf of the government and receive a share of the recovery

Answer

A coding guideline for surgical procedures

Answer

A Medicare cost-sharing arrangement

Answer

A HIPAA exemption for small practices