Healthcare Compliance and Ethics Flashcards
7 cards from real CDIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Healthcare Compliance and Ethics flashcards as text
Which federal agency is primarily responsible for investigating healthcare fraud and abuse under the Medicare and Medicaid programs?
Answer: Office of Inspector General (OIG)
The OIG is the primary federal agency responsible for investigating healthcare fraud, waste, and abuse in federal health programs.
What is the purpose of the OIG's Work Plan in relation to CDI and coding compliance?
Answer: It identifies areas of focus for audits and investigations that coders and CDI specialists should prioritize for compliance review
The OIG Work Plan identifies audit targets and areas of concern, helping compliance programs proactively assess and mitigate risk.
Under HIPAA, a covered entity experiences a breach affecting 600 patients. What notification is required?
Answer: Notify affected individuals, HHS, and prominent media outlets in the affected state
For breaches affecting 500 or more residents of a state, HIPAA requires notification to affected individuals, HHS, and prominent media outlets in that state.
A CDI specialist is asked by a physician to add a diagnosis to a record to justify a procedure already performed. What is the ethical obligation?
Answer: Refuse the request and explain that documentation must reflect the actual clinical circumstances
CDI professionals must refuse requests to add unsupported diagnoses, as doing so would constitute falsification of medical records and potential fraud.
What is the 'exclusion' penalty that the OIG can impose on healthcare providers found guilty of fraud?
Answer: Prohibition from participating in federal healthcare programs such as Medicare and Medicaid
OIG exclusion bars a provider from participating in Medicare, Medicaid, and other federal healthcare programs, effectively ending their ability to receive federal reimbursement.
Which documentation practice violates the prohibition against 'cloning' in electronic health records?
Answer: Copying and pasting prior notes without updating them to reflect the current patient encounter
Cloning occurs when documentation from a prior encounter is copied forward without being updated, creating inaccurate and potentially fraudulent records.
The principle of 'nonmaleficence' in healthcare ethics is best described as:
Answer: The obligation to avoid causing harm to patients
Nonmaleficence is the ethical obligation to 'do no harm,' avoiding actions that cause unnecessary injury or risk to patients.