CHC Healthcare Compliance Laws 5 — Questions and Answers
Question 1: Under the Medicare Conditions of Participation, which document must hospitals provide patients that describes their rights during a hospital stay?
- The Medicare Summary Notice
- The Important Message from Medicare (IM) (Correct answer)
- The Patient Rights Notice
- The Advance Beneficiary Notice of Noncoverage
Correct answer: The Important Message from Medicare (IM)
CMS requires hospitals to deliver the Important Message from Medicare (IM) to all Medicare inpatients within two days of admission and again within two days before discharge, explaining their rights including the right to appeal a discharge decision.
Question 2: A healthcare organization conducts an internal investigation and finds evidence of FCA violations. Under the voluntary disclosure protocol, to which agency should it disclose?
- The Department of Justice only
- The relevant Medicare Administrative Contractor
- The OIG's Self-Disclosure Protocol or the DOJ's Civil Division (Correct answer)
- The state Medicaid Fraud Control Unit
Correct answer: The OIG's Self-Disclosure Protocol or the DOJ's Civil Division
Organizations with potential FCA violations can use the OIG's Self-Disclosure Protocol or, for matters involving the Civil Division, the DOJ's Voluntary Self-Disclosure Program to receive more favorable settlement terms.
Question 3: Which element distinguishes the Stark Law from the Anti-Kickback Statute with respect to intent?
- Stark requires proof of willful intent; AKS is strict liability
- Stark is strict liability; AKS requires proof of knowing and willful intent (Correct answer)
- Both statutes require proof of intentional misconduct
- Neither statute requires intent if the financial benefit exceeds $10,000
Correct answer: Stark is strict liability; AKS requires proof of knowing and willful intent
Stark Law is a strict liability civil statute — no proof of intent is needed — while the AKS requires the government to prove the defendant acted knowingly and willfully.
Question 4: Under EMTALA, a hospital that determines a patient has an emergency medical condition must do which of the following?
- Transfer the patient to the nearest Level I trauma center within one hour
- Provide stabilizing treatment within its capacity or arrange an appropriate transfer (Correct answer)
- Admit the patient as an inpatient regardless of the condition's severity
- Obtain prior authorization from the patient's insurer before initiating treatment
Correct answer: Provide stabilizing treatment within its capacity or arrange an appropriate transfer
Once an emergency medical condition is identified, EMTALA requires the hospital to provide stabilizing treatment within its capability or, if it lacks the capability, to arrange an appropriate transfer to another facility.
Question 5: Which federal statute specifically prohibits healthcare providers from retaliating against employees who report Medicare or Medicaid fraud?
- The False Claims Act's anti-retaliation provision (Correct answer)
- HIPAA's workforce sanction policy requirement
- The Occupational Safety and Health Act
- The National Labor Relations Act
Correct answer: The False Claims Act's anti-retaliation provision
The False Claims Act contains an explicit anti-retaliation provision (31 U.S.C. § 3730(h)) protecting employees, contractors, and agents who engage in protected activity related to FCA violations from discharge, demotion, or harassment.
Question 6: Under the 21st Century Cures Act, information blocking is defined as a practice by a healthcare provider, developer, or network that is likely to interfere with what?
- The timely submission of quality measure data to CMS
- Access, exchange, or use of electronic health information (Correct answer)
- Interoperability testing required by ONC certification standards
- Patient consent procedures for research data sharing
Correct answer: Access, exchange, or use of electronic health information
The 21st Century Cures Act defines information blocking as a practice that is likely to interfere with the access, exchange, or use of electronic health information, except as required by law or covered by a regulatory exception.
Question 7: A compliance officer learns that a manager discouraged an employee from using the compliance hotline. Which compliance program element has most directly failed?
- Written standards and policies
- Effective training and education
- Non-intimidation and non-retaliation protections (Correct answer)
- Response and prevention of detected offenses
Correct answer: Non-intimidation and non-retaliation protections
Discouraging use of the compliance hotline constitutes intimidation that undermines the non-retaliation protections, which are a core element of an effective compliance program under OIG guidance.
CHC Healthcare Compliance Laws 5
Under the Medicare Conditions of Participation, which document must hospitals provide patients that describes their rights during a hospital stay?