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

The FCA imposes civil penalties and treble damages for submitting fraudulent claims to Medicare, Medicaid, or other federal healthcare programs.

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

The AKS makes it illegal to exchange remuneration to induce referrals for services covered by Medicare, Medicaid, or other federal programs.

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

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.

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

The OIG conducts audits, evaluations, and investigations to identify and combat fraud and abuse in HHS programs, including Medicare and Medicaid.

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

A compliance program establishes policies, training, and monitoring systems to ensure the practice adheres to federal and state healthcare laws and regulations.

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

AAPC HIPAA & Healthcare Compliance Regulations 3