CCT - Certified Compliance Technician Enforcement and Penalties Questions and Answers

Question 1

As part of a civil settlement to resolve allegations of healthcare fraud, a hospital system agrees to a set of stringent compliance obligations monitored by the OIG for five years.
This arrangement, which allows the hospital to continue participating in federal healthcare programs, is known as a:

Accepted Answer

Corporate Integrity Agreement (CIA)

Answer

Corrective Action Plan (CAP)

Answer

Settlement Compliance Mandate (SCM)

Answer

Federal Participation Decree (FPD)

Question 2

An internal audit at a physician practice uncovers that a non-physician practitioner has been submitting claims under the supervising physician's provider number for services performed without the physician present, a practice known as 'incident-to' billing abuse. Besides repaying the funds and potential exclusion, which of the following is the OIG most likely to impose?

Accepted Answer

Civil Monetary Penalties (CMPs)

Answer

Mandatory criminal indictment

Answer

Immediate revocation of the practice's license

Answer

A federally-mandated staff reduction

Question 3

Which of the following would be grounds for a *permissive* exclusion from federal healthcare programs by the OIG, rather than a mandatory one?

Accepted Answer

A misdemeanor conviction for obstructing a healthcare investigation.

Answer

A felony conviction for healthcare fraud related to Medicare.

Answer

A felony conviction related to the unlawful distribution of controlled substances.

Answer

A conviction for patient abuse or neglect.

Question 4

A large-scale, multi-state investigation into a complex criminal healthcare fraud enterprise is underway. While the HHS OIG provides investigative expertise, which government agency is primarily responsible for leading the criminal prosecution and bringing charges against the defendants?

Accepted Answer

Department of Justice (DOJ)

Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

Federal Bureau of Investigation (FBI) exclusively

Answer

The state's Medicaid Fraud Control Unit (MFCU)

Question 5

An internal investigation confirms a manager intentionally falsified documentation to support medically unnecessary services, leading to significant improper payments. The organization's disciplinary guidelines call for termination for willful misconduct. To align with effective compliance enforcement, what is the organization's most critical action regarding the manager?

Accepted Answer

Consistently apply the disciplinary guidelines and terminate the employment.

Answer

Provide a written warning and require additional training.

Answer

Suspend the manager for 30 days without pay.

Answer

Reassign the manager to a non-billing role.

Question 6

A medical device company is found to have paid physicians for sham consulting agreements with the intent to induce them to use its products. Which of the following represents the full range of potential penalties under the Anti-Kickback Statute (AKS)?

Accepted Answer

Criminal fines, imprisonment, civil monetary penalties, and exclusion from federal healthcare programs.

Answer

Civil monetary penalties and mandatory compliance training only.

Answer

Criminal fines, imprisonment, and civil monetary penalties, but not program exclusion.

Answer

Repayment of profits and a public letter of reprimand from the OIG.

As part of a civil settlement to resolve allegations of healthcare fraud, a hospital system agrees to a set of stringent compliance obligations monitored by the OIG for five years.This arrangement, which allows the hospital to continue participating in federal healthcare programs, is known as a:

As part of a civil settlement to resolve allegations of healthcare fraud, a hospital system agrees to a set of stringent compliance obligations monitored by the OIG for five years.
This arrangement, which allows the hospital to continue participating in federal healthcare programs, is known as a: