CDIP Healthcare Compliance and Ethics 2

Question 1

Under the False Claims Act, what is the term for a private individual who files a lawsuit on behalf of the government alleging healthcare fraud?

Accepted Answer

Relator

Answer

Arbitrator

Answer

Ombudsman

Answer

Mediator

Question 2

Which federal statute prohibits healthcare providers from referring patients to entities in which they have a financial relationship, unless an exception applies?

Accepted Answer

Stark Law

Answer

Anti-Kickback Statute

Answer

False Claims Act

Answer

HIPAA Privacy Rule

Question 3

A CDI specialist notices a physician consistently documents 'pneumonia' without specifying the type. What is the MOST appropriate first step?

Accepted Answer

Submit a physician query requesting clarification of the pneumonia type

Answer

Code the case as unspecified pneumonia without querying

Answer

Report the physician to the compliance officer immediately

Answer

Change the documentation to bacterial pneumonia based on clinical indicators

Question 4

Which element is REQUIRED for a physician query to be considered compliant according to AHIMA guidelines?

Accepted Answer

The query must be clear, concise, and not leading

Answer

The query must suggest the highest-severity diagnosis

Answer

The query must be submitted only after discharge

Answer

The query must be approved by the compliance officer first

Question 5

What does the term 'upcoding' refer to in the context of healthcare billing compliance?

Accepted Answer

Billing for a more complex or higher-reimbursement service than was actually provided

Answer

Assigning codes that are more specific than the documentation supports

Answer

Adding modifier codes to increase reimbursement legitimately

Answer

Updating outdated codes to current ICD versions

Question 6

A hospital's compliance program identifies a pattern of incomplete surgical documentation. Under OIG guidelines, what is the recommended corrective action?

Accepted Answer

Conduct physician education, implement monitoring, and document corrective steps taken

Answer

Immediately suspend the physicians involved from surgical privileges

Answer

Report all affected cases to CMS for investigation

Answer

Retroactively amend all operative reports

Question 7

Which principle of healthcare ethics requires clinicians and coders to act in the best interest of the patient?

Accepted Answer

Beneficence

Answer

Autonomy

Answer

Justice

Answer

Nonmaleficence