CHC Healthcare Compliance Laws 3 — Questions and Answers
Question 1: Under the Exclusion Statute, which OIG exclusion type is mandatory and has no discretion for waiver?
- Exclusion for default on health education loans
- Exclusion for licensure revocation related to patient care
- Exclusion following conviction of program-related crimes (Correct answer)
- Exclusion for improper billing practices
Correct answer: Exclusion following conviction of program-related crimes
Mandatory exclusions under 42 U.S.C. § 1320a-7(a) are triggered by convictions for program-related crimes, patient abuse, felony healthcare fraud, and controlled substance felonies — the OIG has no discretion to waive these.
Question 2: The HITECH Act extended HIPAA obligations directly to which class of entities that were not previously directly regulated?
- Health information exchanges
- Business associates (Correct answer)
- Self-insured employers
- Pharmacy benefit managers
Correct answer: Business associates
HITECH made business associates directly subject to HIPAA's Security Rule and many Privacy Rule provisions, and created direct liability for breaches caused by business associates.
Question 3: A hospital discovers a billing error that resulted in overpayments from Medicare over the past 18 months. Under the 60-day rule, when must repayment be initiated?
- Within 60 days of the date the overpayment occurred
- Within 60 days of identification and quantification of the overpayment (Correct answer)
- Within 60 days of the next scheduled Medicare cost report
- Within 60 days of receiving a RAC demand letter
Correct answer: Within 60 days of identification and quantification of the overpayment
The 60-day rule (ACA Section 6402) requires that identified overpayments be reported and returned within 60 days of the date the overpayment is identified, or the date any corresponding cost report is due, whichever is later.
Question 4: Under the Deficit Reduction Act of 2005, which entities are required to establish written policies educating employees about the False Claims Act?
- All Medicare-certified providers regardless of size
- Entities receiving $5 million or more annually in Medicaid payments (Correct answer)
- Hospitals with more than 100 beds
- Any organization billing Medicare Part B
Correct answer: Entities receiving $5 million or more annually in Medicaid payments
The Deficit Reduction Act requires entities receiving $5 million or more in annual Medicaid payments to establish written policies informing employees about the FCA and the entity's policies for detecting fraud and abuse.
Question 5: Which standard governs how healthcare organizations must safeguard electronic protected health information (ePHI) under federal law?
- HIPAA Privacy Rule
- HIPAA Security Rule (Correct answer)
- HITECH Breach Notification Rule
- 21st Century Cures Act Information Blocking provisions
Correct answer: HIPAA Security Rule
The HIPAA Security Rule establishes national standards for protecting ePHI through administrative, physical, and technical safeguards.
Question 6: Under the Beneficiary Inducement provisions of the CMPL, offering Medicare beneficiaries free transportation to a clinic is generally permissible when it meets which condition?
- The transportation is provided only to established patients
- The beneficiary resides more than 25 miles from the facility
- It falls within an applicable safe harbor such as the local transportation safe harbor (Correct answer)
- Written consent is obtained and filed with CMS
Correct answer: It falls within an applicable safe harbor such as the local transportation safe harbor
OIG's local transportation safe harbor permits free or discounted transportation for beneficiaries to receive items or services, provided certain conditions including mileage limits and non-marketing restrictions are met.
Question 7: Which federal law prohibits discrimination by healthcare providers receiving federal financial assistance on the basis of race, color, or national origin?
- Americans with Disabilities Act
- Section 504 of the Rehabilitation Act
- Title VI of the Civil Rights Act of 1964 (Correct answer)
- Section 1557 of the Affordable Care Act
Correct answer: Title VI of the Civil Rights Act of 1964
Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color, and national origin in programs and activities receiving federal financial assistance, including most healthcare providers.
CHC Healthcare Compliance Laws 3
Under the Exclusion Statute, which OIG exclusion type is mandatory and has no discretion for waiver?