CCT - Certified Compliance Technician Healthcare Fraud and Abuse Questions and Answers

Question 1

A medical device company offers a physician a paid speaking engagement.
The payment is significantly above fair market value and the physician is expected to predominantly use the company's devices.
Which federal law is most likely implicated by this arrangement?

Accepted Answer

The Anti-Kickback Statute (AKS)

Answer

The Health Insurance Portability and Accountability Act (HIPAA)

Answer

The Stark Law (Physician Self-Referral Law)

Answer

The False Claims Act (FCA)

Question 2

A hospital compliance officer discovers that a billing department employee has been intentionally using incorrect billing codes ('upcoding') to receive higher reimbursements from Medicare for the past year. Under which law can a private individual, such as a whistleblower, file a lawsuit on behalf of the government?

Accepted Answer

The False Claims Act (FCA)

Answer

The Physician Self-Referral Law (Stark Law)

Answer

The Civil Monetary Penalties Law (CMPL)

Answer

The Health Care Fraud Statute

Question 3

Which of the following situations would trigger a mandatory exclusion from participation in all Federal health care programs by the Office of Inspector General (OIG)?

Accepted Answer

A felony conviction for Medicare fraud.

Answer

A misdemeanor conviction related to health care fraud.

Answer

Defaulting on a health education loan.

Answer

Losing a medical license for reasons of professional incompetence.

Question 4

A radiologist has an ownership interest in a standalone imaging center. She refers her Medicare patients to this center for all their MRI needs. This arrangement, without a specific exception, would most likely violate which law?

Accepted Answer

The Stark Law (Physician Self-Referral Law)

Answer

The Anti-Kickback Statute (AKS)

Answer

The Emergency Medical Treatment and Labor Act (EMTALA)

Answer

The Health Insurance Portability and Accountability Act (HIPAA)

Question 5

What is the key distinction between healthcare 'fraud' and 'abuse'?

Accepted Answer

The intent and knowledge of the individual committing the act.

Answer

The financial amount involved in the misconduct.

Answer

Whether the act was committed by a physician or an administrator.

Answer

Whether the service was medically necessary for the patient.

Question 6

A compliance technician is reviewing a proposed agreement with a local home health agency. The hospital would provide the agency with free office space within the hospital in exchange for the agency accepting all of the hospital's patient referrals. Which of the following is the PRIMARY compliance concern with this arrangement?

Accepted Answer

Potential violation of the Anti-Kickback Statute.

Answer

Violation of the False Claims Act due to inaccurate cost reporting.

Answer

Non-compliance with HIPAA's privacy regulations.

Answer

Breach of the hospital's internal code of conduct.

A medical device company offers a physician a paid speaking engagement.The payment is significantly above fair market value and the physician is expected to predominantly use the company's devices.Which federal law is most likely implicated by this arrangement?

A medical device company offers a physician a paid speaking engagement.
The payment is significantly above fair market value and the physician is expected to predominantly use the company's devices.
Which federal law is most likely implicated by this arrangement?