CHC Regulatory Compliance and Government Oversight Questions and Answers

Question 1

Which federal agency publishes the OIG Work Plan that healthcare compliance officers use to prioritize audit areas each year?

Accepted Answer

Office of Inspector General (OIG)

Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

Department of Justice (DOJ)

Answer

Office for Civil Rights (OCR)

Question 2

What is the primary purpose of the OIG's List of Excluded Individuals and Entities (LEIE)?

Accepted Answer

To identify parties excluded from participating in federal healthcare programs

Answer

To identify providers with malpractice judgments

Answer

To list healthcare entities with HIPAA violations

Answer

To track providers under active DOJ investigation

Question 3

A Corporate Integrity Agreement (CIA) is typically entered into between a healthcare entity and which agency?

Accepted Answer

OIG

Answer

CMS

Answer

DOJ

Answer

Joint Commission

Question 4

Under the Stark Law (42 U.S.C. § 1395nn), which of the following best describes a 'designated health service'?

Accepted Answer

Specific services including clinical laboratory and physical therapy that trigger the self-referral prohibition

Answer

Any service billed to a commercial insurer

Answer

Any service provided in a hospital setting

Answer

Services provided exclusively by physicians

Question 5

Which statute imposes criminal and civil penalties for knowingly submitting false claims to federal healthcare programs?

Accepted Answer

False Claims Act

Answer

Anti-Kickback Statute

Answer

Stark Law

Answer

HIPAA Privacy Rule

Question 6

What does 'safe harbor' mean in the context of the Anti-Kickback Statute?

Accepted Answer

Specific arrangements that are protected from prosecution under the AKS

Answer

A clause protecting patients from billing disputes

Answer

A HIPAA exemption for small providers

Answer

An OIG-approved compliance program framework