Compliance and Legal Flashcards

A healthcare organization implements a zero-tolerance policy against retaliation toward employees who report compliance concerns. This reflects which OIG compliance program element?

Answer: Open lines of communication

Non-retaliation policies encourage employees to report concerns through open communication channels, a core element of OIG's seven-component compliance program framework.

A patient's psychotherapy notes receive special protection under HIPAA because:

Answer: They require a specific authorization separate from general PHI authorization

Psychotherapy notes (process notes) receive heightened HIPAA protection and require a specific, separate patient authorization for disclosure — they cannot be released under a general PHI authorization.

When a covered entity uses PHI for fundraising activities, HIPAA requires that:

Answer: Patients must be given an opportunity to opt out of receiving fundraising communications

HIPAA permits limited use of PHI for fundraising but requires that all fundraising communications include a clear description of how to opt out of future contacts.

Under the HIPAA Privacy Rule, a covered entity's 'workforce' includes:

Answer: Employees, volunteers, trainees, and others under direct control of the covered entity

HIPAA's definition of workforce broadly includes employees, volunteers, trainees, and other persons under the direct control of a covered entity, regardless of compensation.

The concept of 'incidental disclosure' under HIPAA refers to:

Answer: A secondary disclosure that cannot reasonably be prevented and is limited in nature

An incidental disclosure is a by-product of an otherwise permissible disclosure that is limited and cannot reasonably be prevented, such as overhearing staff discuss a patient in a hallway.

Which statute established the legal authority for Medicare and Medicaid and is the primary source of federal healthcare entitlement law?

Answer: Title XVIII and XIX of the Social Security Act

Medicare (Title XVIII) and Medicaid (Title XIX) were established as amendments to the Social Security Act in 1965 and remain the statutory foundation for these federal healthcare programs.

A health information manager discovers that a physician has been documenting patient encounters using copy-paste from previous visits without updating clinical findings. This practice primarily raises concern related to:

Answer: Healthcare fraud, documentation integrity, and potential false claims liability

Cloning or copy-paste documentation without clinical verification constitutes fraudulent documentation, threatens record integrity, and can create false claims liability under the False Claims Act.