Compliance Program Administration Flashcards
7 cards from real CHC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Compliance Program Administration flashcards as text
A healthcare compliance officer receives an anonymous hotline report alleging that a supervisor is falsifying patient records. What is the correct FIRST step?
Answer: Conduct a preliminary assessment to determine if an investigation is warranted
All hotline reports, including anonymous ones, require a preliminary assessment to determine scope, severity, and whether a formal investigation is needed.
Under the False Claims Act, what is 'qui tam' litigation?
Answer: A whistleblower lawsuit filed on behalf of the government by a private individual
Qui tam provisions of the False Claims Act allow private individuals (relators) to sue on behalf of the government and share in any recovery.
Which of the following is a key characteristic of an effective compliance hotline?
Answer: It allows for anonymous reporting and is available 24/7
An effective compliance hotline must allow anonymous reporting and be accessible around the clock to encourage employees to report concerns without fear.
A compliance program's work plan should PRIMARILY be based on which of the following?
Answer: Results of the organization's current risk assessment
The annual work plan should be driven by the current risk assessment to ensure compliance activities address the organization's most significant and timely risks.
What is the primary function of compliance monitoring as distinct from compliance auditing?
Answer: Monitoring is ongoing and routine; auditing involves in-depth, periodic review of specific areas
Monitoring is a continuous, routine process to detect potential issues early, while auditing is a more structured, periodic examination of specific risk areas.
Which of the following scenarios would MOST likely require a self-disclosure to the OIG's Self-Disclosure Protocol?
Answer: Potential violations of the Anti-Kickback Statute involving physician arrangements
The OIG Self-Disclosure Protocol is designed for providers who identify potential fraud violations, particularly Anti-Kickback Statute or False Claims Act issues.
In the context of healthcare compliance, what does 'downstream risk' refer to?
Answer: Compliance risks passed to an organization through its business partners and vendors
Downstream risk refers to compliance liability that an organization may inherit from its business associates, contractors, or referral partners who engage in non-compliant behavior.