CHC Regulatory Compliance and Government Oversight Questions and Answers 2

Question 1

Which regulation requires healthcare organizations to screen employees against federal exclusion databases prior to hire?

Accepted Answer

OIG exclusion screening requirements under the Social Security Act

Answer

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?

Accepted Answer

Holding individual employees accountable for corporate misconduct

Answer

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?

Accepted Answer

$10,000

Answer

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?

Accepted Answer

To provide regular compliance updates directly to the board to ensure independent oversight

Answer

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?

Accepted Answer

Social Security Act Section 1128

Answer

Section 1128 of the Social Security Act grants the OIG mandatory and permissive exclusion authority over individuals and entities convicted of healthcare fraud.

CHC - Certified in Healthcare Compliance Practice Test

CHC - Certified in Healthcare Compliance Practice Test

CHC Regulatory Compliance and Government Oversight Questions and Answers 2