CCT OIG Compliance Guidance 3 — Questions and Answers
Question 1: The OIG's Corporate Integrity Agreements (CIAs) are typically entered into as a condition of:
- Obtaining a new Medicare provider number
- Settling civil or administrative fraud and abuse matters with the OIG (Correct answer)
- Receiving Meaningful Use incentive payments under HITECH
- Completing an OIG-mandated internal audit
Correct answer: Settling civil or administrative fraud and abuse matters with the OIG
CIAs are negotiated as part of civil settlements and require organizations to implement specific compliance measures in exchange for not being excluded from federal programs.
Question 2: Under OIG guidance, what is the significance of the 'one purpose test' in Anti-Kickback Statute cases?
- A transaction is illegal if even one purpose of the remuneration is to induce federal program referrals (Correct answer)
- A safe harbor applies if the primary purpose of the arrangement is legitimate business
- An arrangement must have only one stated purpose to qualify for protection
- Providers must document one purpose per agreement to demonstrate compliance
Correct answer: A transaction is illegal if even one purpose of the remuneration is to induce federal program referrals
Courts applying the 'one purpose test' hold that the AKS is violated if any one purpose—even if not the primary one—of a payment is to induce referrals.
Question 3: Which OIG Work Plan tool allows compliance officers to monitor what areas the OIG will review in a given fiscal year?
- The OIG Annual Report to Congress
- The OIG Work Plan, updated throughout the year (Correct answer)
- The HHS Strategic Plan
- The Medicare Quarterly Provider Compliance Newsletter
Correct answer: The OIG Work Plan, updated throughout the year
The OIG Work Plan is updated continuously and identifies the specific audits, evaluations, and inspections OIG plans to conduct, helping providers focus internal reviews.
Question 4: OIG guidance states that a compliance program's training should be:
- Conducted only for new employees during onboarding
- Limited to clinical staff who submit claims
- Tailored to the specific roles and risk areas of employees receiving it (Correct answer)
- Identical across all departments to ensure consistency
Correct answer: Tailored to the specific roles and risk areas of employees receiving it
Effective training under OIG guidance must be role-specific, addressing the compliance risks most relevant to each employee's function.
Question 5: What does the OIG's exclusion authority allow it to do?
- Bar individuals and entities from participating in federal healthcare programs (Correct answer)
- Revoke a provider's DEA registration for drug-related offenses
- Impose criminal fines for Medicare fraud without a jury trial
- Suspend a hospital's accreditation pending an investigation
Correct answer: Bar individuals and entities from participating in federal healthcare programs
The OIG can exclude individuals and entities from Medicare, Medicaid, and other federal healthcare programs, making it unlawful for programs to pay claims they submit.
Question 6: Which of the following is a mandatory exclusion offense under 42 U.S.C. § 1320a-7?
- Submitting a single erroneous claim due to billing staff error
- Conviction of a program-related crime such as Medicare fraud (Correct answer)
- Failing to respond to an OIG subpoena within 30 days
- Receiving a civil monetary penalty for a first-time billing error
Correct answer: Conviction of a program-related crime such as Medicare fraud
Conviction of a criminal offense related to the delivery of a healthcare item or service under a federal or state program triggers mandatory exclusion with no OIG discretion.
Question 7: Under OIG compliance guidance, a 'hotline' or reporting mechanism should guarantee:
- That all reports result in immediate termination of the subject employee
- Anonymity and non-retaliation for good-faith reporters (Correct answer)
- Direct reporting to the OIG rather than internal management
- Mandatory disclosure to law enforcement within 72 hours
Correct answer: Anonymity and non-retaliation for good-faith reporters
OIG guidance stresses that reporting mechanisms must offer anonymity and protect good-faith reporters from retaliation to encourage internal disclosure.
CCT OIG Compliance Guidance 3
The OIG's Corporate Integrity Agreements (CIAs) are typically entered into as a condition of: