CHC Regulatory Compliance and Government Oversight Questions and Answers 2 — Questions and Answers
Question 1: Which regulation requires healthcare organizations to screen employees against federal exclusion databases prior to hire?
- HIPAA Security Rule
- OIG exclusion screening requirements under the Social Security Act (Correct answer)
- Stark Law
- Joint Commission accreditation standards
Correct answer: OIG exclusion screening requirements under the Social Security Act
The Social Security Act prohibits federal healthcare programs from paying for services rendered by excluded individuals, making pre-hire exclusion screening a compliance necessity.
Question 2: The 'Yates Memo' issued by the DOJ in 2015 primarily focused healthcare compliance on which area?
- Expanding qui tam whistleblower protections
- Holding individual employees accountable for corporate misconduct (Correct answer)
- Strengthening HIPAA enforcement
- Requiring board-level compliance oversight
Correct answer: Holding individual employees accountable for corporate misconduct
The Yates Memo directed DOJ attorneys to focus on individual accountability in corporate misconduct cases, emphasizing that individuals—not just organizations—should be held responsible.
Question 3: Under the Civil Monetary Penalties Law (CMPL), what is the maximum per-claim penalty for knowingly presenting a false claim to Medicare?
- $5,000
- $10,000 (Correct answer)
- $25,000
- $50,000
Correct answer: $10,000
The CMPL imposes penalties of up to $10,000 per false or fraudulent claim submitted to Medicare or Medicaid, in addition to three times the amount claimed.
Question 4: What is the role of the Compliance and Ethics Officer in relation to the governing board of a healthcare organization?
- To report only to the CEO and shield the board from compliance matters
- To provide regular compliance updates directly to the board to ensure independent oversight (Correct answer)
- To manage legal counsel on the board's behalf
- To handle only billing compliance without board involvement
Correct answer: To provide regular compliance updates directly to the board to ensure independent oversight
Effective compliance programs require the Compliance Officer to report directly to the governing board, ensuring independent oversight separate from operational management.
Question 5: Which federal law created the mandatory exclusion authority for convictions related to Medicare or Medicaid fraud?
- Balanced Budget Act of 1997
- Social Security Act Section 1128 (Correct answer)
- False Claims Act
- Deficit Reduction Act of 2005
Correct answer: Social Security Act Section 1128
Section 1128 of the Social Security Act grants the OIG mandatory and permissive exclusion authority over individuals and entities convicted of healthcare fraud.
Question 6: A healthcare entity receives a subpoena from the DOJ for billing records. What is the compliance officer's first priority?
- Immediately produce all records to avoid penalties
- Notify the CEO and preserve all relevant documents under a litigation hold (Correct answer)
- Destroy any records that may be incriminating
- Contact CMS to report the investigation
Correct answer: Notify the CEO and preserve all relevant documents under a litigation hold
Upon receiving a government subpoena, the compliance officer must issue a litigation hold to preserve all relevant documents and promptly notify senior leadership and legal counsel.
CHC Regulatory Compliance and Government Oversight Questions and Answers 2
Which regulation requires healthcare organizations to screen employees against federal exclusion databases prior to hire?