CHC Healthcare Compliance Laws 4 — Questions and Answers
Question 1: Under a Corporate Integrity Agreement (CIA), which reporting obligation is typically imposed on a healthcare organization?
- Quarterly pricing audits submitted to CMS
- Annual reports to the OIG documenting compliance program activities (Correct answer)
- Monthly claims error rate reports filed with the MAC
- Semi-annual staffing disclosures to the Joint Commission
Correct answer: Annual reports to the OIG documenting compliance program activities
CIAs typically require covered entities to submit annual reports to the OIG documenting their compliance program activities, claims audits, training completion, and any reportable events discovered during the year.
Question 2: The AKS safe harbor for personal services and management contracts requires that compensation be set in advance and be consistent with what standard?
- The Medicare fee schedule for equivalent services
- Fair market value and not determined based on referral volume (Correct answer)
- The median compensation reported in the most recent MGMA survey
- Rates approved by the state health department
Correct answer: Fair market value and not determined based on referral volume
Under the personal services safe harbor, aggregate compensation must be set in advance, be consistent with fair market value, and must not be determined in a manner that accounts for the volume or value of referrals.
Question 3: Which Affordable Care Act provision created the first federal requirement to screen and re-screen providers and suppliers before enrolling them in Medicare and Medicaid?
- Section 6401 — Provider Screening and Other Enrollment Requirements (Correct answer)
- Section 6402 — Enhanced Medicare and Medicaid Program Integrity
- Section 1557 — Nondiscrimination in Health Programs
- Section 3021 — Center for Medicare and Medicaid Innovation
Correct answer: Section 6401 — Provider Screening and Other Enrollment Requirements
ACA Section 6401 established categorical screening levels (limited, moderate, high) and mandated that CMS and states screen all providers and suppliers upon enrollment and periodically thereafter.
Question 4: A physician receives free tickets to a sporting event from a medical device company. Under the AKS, the primary risk is that these tickets may constitute what?
- An illegal assignment of benefits
- Remuneration intended to induce referrals or purchases (Correct answer)
- A Stark Law financial relationship
- A violation of the Beneficiary Inducement statute
Correct answer: Remuneration intended to induce referrals or purchases
Providing gifts of value to physicians can constitute remuneration under the AKS if given with the intent to induce or reward referrals of items or services reimbursable by federal healthcare programs.
Question 5: Under the HIPAA Breach Notification Rule, when must a covered entity notify HHS of a breach affecting fewer than 500 individuals?
- Within 60 days of discovery of the breach
- Within 30 days of notifying the affected individuals
- No later than 60 days after the end of the calendar year in which the breach occurred (Correct answer)
- Within 90 days of the start of the next fiscal year
Correct answer: No later than 60 days after the end of the calendar year in which the breach occurred
For breaches affecting fewer than 500 individuals, covered entities must notify HHS no later than 60 days after the end of the calendar year in which the breach occurred, via the HHS online log.
Question 6: The Sunshine Act (Open Payments program) requires manufacturers of drugs, devices, and biologicals to report transfers of value to physicians and teaching hospitals to which agency?
- The Office of Inspector General
- The Centers for Medicare and Medicaid Services (Correct answer)
- The Food and Drug Administration
- The Federal Trade Commission
Correct answer: The Centers for Medicare and Medicaid Services
The Physician Payments Sunshine Act requires applicable manufacturers and group purchasing organizations to report payments and transfers of value to covered recipients to CMS, which publishes the data publicly.
Question 7: Which term describes a compliance program component that enables employees to report suspected violations confidentially without fear of retaliation?
- Hotline or anonymous reporting mechanism (Correct answer)
- Corrective action plan
- Compliance audit protocol
- Risk assessment matrix
Correct answer: Hotline or anonymous reporting mechanism
An anonymous hotline or reporting mechanism is a core element of an effective compliance program, allowing employees to report concerns confidentially and reducing fear of retaliation.
CHC Healthcare Compliance Laws 4
Under a Corporate Integrity Agreement (CIA), which reporting obligation is typically imposed on a healthcare organization?