CCT Healthcare Fraud and Abuse 2

Question 1

Which federal statute prohibits offering, paying, soliciting, or receiving anything of value to induce referrals of items or services covered by federal healthcare programs?

Accepted Answer

Anti-Kickback Statute

Answer

False Claims Act

Answer

Stark Law

Answer

HIPAA Privacy Rule

Question 2

A hospital gives physicians free office space below fair market value in exchange for referrals. This arrangement most likely violates which law?

Accepted Answer

Stark Law

Answer

EMTALA

Answer

ERISA

Answer

Bayh-Dole Act

Question 3

What is 'upcoding' in the context of healthcare fraud?

Accepted Answer

Billing for a more expensive service than was actually provided

Answer

Using outdated billing codes

Answer

Submitting duplicate claims

Answer

Failing to document services rendered

Question 4

Under the False Claims Act, what is the penalty range per false claim submitted to the government?

Accepted Answer

$13,946–$27,894 (adjusted for inflation)

Answer

$1,000–$5,000

Answer

$5,000–$10,000

Answer

$50,000–$100,000

Question 5

Which exclusion authority allows the OIG to exclude individuals or entities convicted of program-related crimes from participation in federal healthcare programs?

Accepted Answer

Mandatory exclusion under 42 U.S.C. § 1320a-7(a)

Answer

Permissive exclusion under 42 U.S.C. § 1320a-7(b)

Answer

Civil Monetary Penalties Law

Answer

Corporate Integrity Agreement

Question 6

A compliance officer discovers that a physician has been receiving free sports tickets from a medical device vendor. Under the Anti-Kickback Statute, this arrangement is best described as:

Accepted Answer

Potential remuneration that could trigger AKS liability

Answer

A de minimis exception that requires no action

Answer

Permissible under the personal services safe harbor

Answer

Compliant if disclosed to the hospital

Question 7

Which program allows states to bring fraud and abuse actions against Medicaid providers under the authority of the Social Security Act?

Accepted Answer

Medicaid Fraud Control Units (MFCUs)

Answer

State Attorney General Civil Division

Answer

Medicaid Integrity Program

Answer

Federal Bureau of Investigation Healthcare Fraud Unit