CCT Healthcare Fraud and Abuse 5

Question 1

A hospital enters a management services agreement with a physician group and pays above-fair-market-value fees. This arrangement raises concerns primarily under which statute?

Accepted Answer

Anti-Kickback Statute

Answer

Payments above fair market value in management or service agreements can constitute illegal remuneration under the AKS if they are intended to induce referrals of federal healthcare program business.

Question 2

Under the False Claims Act, what is the meaning of 'reverse false claims'?

Accepted Answer

Knowingly avoiding or concealing an obligation to pay money to the government

Answer

The 2009 Fraud Enforcement and Recovery Act clarified that reverse false claims cover situations where a person knowingly conceals or improperly avoids a financial obligation owed to the government, such as failing to return overpayments.

Question 3

A compliance officer receives a hotline report that a sales representative is providing free meals exceeding $150 to physicians weekly. The first step should be to:

Accepted Answer

Conduct a prompt and thorough internal investigation

Answer

Best practice requires the compliance officer to promptly investigate the allegation through a structured internal review before taking disciplinary action or external reporting.

Question 4

Which exception to Stark Law allows physicians to refer patients to an entity for designated health services if those services are provided within the physician's own practice?

Accepted Answer

In-office ancillary services exception

Answer

The in-office ancillary services exception permits physicians to refer within their own group practice for certain designated health services if specific supervision, location, and billing requirements are met.

Question 5

What is the significance of the '60-day rule' in healthcare compliance?

Accepted Answer

Identified Medicare/Medicaid overpayments must be reported and returned within 60 days

Answer

Under the ACA and CMS regulations, once a provider identifies a Medicare or Medicaid overpayment, it must be reported and returned within 60 days or it may become a false claim under the FCA.

(CCT) Certified Compliance Technician Practice Test

(CCT) Certified Compliance Technician Practice Test

CCT Healthcare Fraud and Abuse 5