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

The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive remuneration to induce referrals covered by federal healthcare programs.

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

Stark Law (42 U.S.C. § 1395nn) prohibits physicians from referring Medicare/Medicaid patients for designated health services to entities with which the physician has a financial relationship, including below-market rent.

Question 3

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

Accepted Answer

Billing for a more expensive service than was actually provided

Answer

Upcoding occurs when a provider submits a billing code for a higher-level or more expensive service than was actually provided, resulting in inflated reimbursement.

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

FCA civil penalties are inflation-adjusted; as of recent updates, penalties range from approximately $13,946 to $27,894 per false claim, plus treble damages.

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

Mandatory exclusion under 42 U.S.C. § 1320a-7(a) requires the OIG to exclude individuals convicted of Medicare/Medicaid fraud, patient abuse, or felony drug offenses for a minimum of five years.

(CCT) Certified Compliance Technician Practice Test

(CCT) Certified Compliance Technician Practice Test

CCT Healthcare Fraud and Abuse 2