CHC - Certified in Healthcare Compliance Healthcare Fraud and Abuse Questions and Answers

Question 1

A hospital provides a physician with free office space in a medical office building it owns.
The physician, in turn, refers a significant number of Medicare patients to the hospital for various services.
This arrangement is not structured to fit within any safe harbor.
Which of the following federal laws is most likely implicated by this arrangement?

Accepted Answer

The Anti-Kickback Statute (AKS)

Answer

The Health Insurance Portability and Accountability Act (HIPAA)

Answer

The Emergency Medical Treatment and Labor Act (EMTALA)

Answer

The Civil Monetary Penalties Law (CMPL)

Question 2

A key distinction between the Stark Law and the Anti-Kickback Statute (AKS) is that the Stark Law:

Accepted Answer

applies only to referrals made by physicians for designated health services (DHS).

Answer

requires proof of specific intent to violate the law for penalties to be imposed.

Answer

carries both criminal and civil penalties for violations.

Answer

is enforced exclusively by the Department of Justice (DOJ).

Question 3

An employee in a hospital's billing department discovers a systematic software error that has caused the hospital to 'upcode' claims for a specific outpatient procedure for the past two years, resulting in significant overpayments from Medicare. Under the False Claims Act (FCA), what is the employee's best course of action to report this and potentially receive a percentage of the recovery?

Accepted Answer

File a 'qui tam' lawsuit on behalf of the government.

Answer

Report the issue to the local news media to create public pressure.

Answer

Anonymously report the issue directly to the hospital's CEO.

Answer

Wait for a government audit to discover the error independently.

Question 4

The Office of Inspector General (OIG) has the authority to exclude individuals and entities from participation in federal healthcare programs. Which of the following would trigger a MANDATORY exclusion?

Accepted Answer

A felony conviction for patient abuse or neglect.

Answer

A misdemeanor conviction for healthcare fraud.

Answer

Suspension of a medical license for professional incompetence.

Answer

Defaulting on a federal health education loan.

Question 5

A diagnostic imaging center owned by a group of physicians refers its Medicare patients exclusively to an affiliated physical therapy practice in which the same physicians also hold an ownership interest. To comply with the Stark Law, this financial relationship must:

Accepted Answer

fit squarely within a designated statutory or regulatory exception.

Answer

be verbally agreed upon by all physician-owners.

Answer

generate less than $5,000 per year in revenue from referrals.

Answer

be reported to the local medical society.

Question 6

Which of the following best describes the 'knowing' standard under the civil False Claims Act (FCA)?

Accepted Answer

The individual acted with deliberate ignorance or reckless disregard of the truth.

Answer

The individual must have a specific intent to defraud the government.

Answer

The individual must have actual knowledge of the falsity of the information.

Answer

The individual was negligent in failing to verify the information's accuracy.