CCT Healthcare Fraud and Abuse 4

Question 1

A Corporate Integrity Agreement (CIA) is typically entered into between a healthcare provider and which government agency?

Accepted Answer

Office of Inspector General (OIG)

Answer

CIAs are negotiated between healthcare providers and the OIG as part of civil settlement agreements, requiring the provider to implement compliance measures in exchange for continued program participation.

Question 2

Under the Exclusion Statute, what is the minimum mandatory exclusion period for an individual convicted of a felony related to Medicare or Medicaid fraud?

Accepted Answer

5 years

Answer

42 U.S.C. § 1320a-7(a) requires a minimum 5-year mandatory exclusion for individuals convicted of program-related crimes, patient abuse, or felony drug offenses.

Question 3

Which element distinguishes 'fraud' from 'abuse' in federal healthcare program enforcement?

Accepted Answer

Intentional deception or misrepresentation versus inadvertent billing errors

Answer

Healthcare fraud requires intentional deception or misrepresentation to obtain unauthorized benefits, while abuse involves practices that are inconsistent with sound business or medical practices but may lack criminal intent.

Question 4

The Health Care Fraud Prevention and Enforcement Action Team (HEAT) was created to:

Accepted Answer

Coordinate joint DOJ and HHS efforts to combat Medicare and Medicaid fraud

Answer

HEAT is a joint initiative between the DOJ and HHS that coordinates federal efforts to prevent fraud, waste, and abuse in Medicare and Medicaid through Strike Force teams and data analytics.

Question 5

A physician refers patients exclusively to a lab in which he owns a 15% equity stake. Under Stark Law, this arrangement:

Accepted Answer

Triggers the self-referral prohibition regardless of ownership percentage

Answer

Stark Law prohibits referrals to entities in which the physician (or immediate family) has any financial relationship, including any ownership interest, without a qualifying exception.

(CCT) Certified Compliance Technician Practice Test

(CCT) Certified Compliance Technician Practice Test

CCT Healthcare Fraud and Abuse 4