CHC Healthcare Fraud and Abuse 2

Question 1

Under the Stark Law, which of the following is a permissible financial relationship between a physician and a designated health service (DHS) entity?

Accepted Answer

A compensation arrangement that meets the fair market value exception

Answer

A direct ownership interest with no exceptions

Answer

A referral agreement based on the volume of referrals

Answer

A joint venture split based on anticipated DHS referrals

Question 2

Which federal agency primarily investigates and prosecutes healthcare fraud under the False Claims Act?

Accepted Answer

The Department of Justice (DOJ)

Answer

The Centers for Medicare & Medicaid Services (CMS)

Answer

The Office of Inspector General (OIG)

Answer

The Drug Enforcement Administration (DEA)

Question 3

A hospital discovers that a physician has been receiving free office space from the hospital in exchange for referrals. This most likely violates which law?

Accepted Answer

Anti-Kickback Statute

Answer

HIPAA Privacy Rule

Answer

Emergency Medical Treatment and Labor Act (EMTALA)

Answer

Clinical Laboratory Improvement Amendments (CLIA)

Question 4

Which element distinguishes 'fraud' from 'abuse' in healthcare compliance?

Accepted Answer

The intentional, knowing, or reckless nature of the conduct

Answer

The dollar amount of the improper claim

Answer

Whether the provider is a hospital or individual practitioner

Answer

Whether the payer is a government or commercial insurer

Question 5

Under the False Claims Act, what is the minimum per-claim civil penalty range (approximately) for a false claim submitted to the government?

Accepted Answer

$13,000 to $27,000

Answer

$500 to $1,000

Answer

$2,587 to $5,174

Answer

$50,000 to $100,000

Question 6

A medical equipment supplier bills Medicare for 'motorized wheelchairs' but delivers standard manual wheelchairs. This is an example of:

Accepted Answer

Upcoding

Answer

Unbundling

Answer

Phantom billing

Answer

Medically unnecessary services

Question 7

The 'safe harbor' regulations under the Anti-Kickback Statute are important because they:

Accepted Answer

Describe arrangements that will not be prosecuted as kickbacks even if they technically involve remuneration

Answer

Eliminate all civil and criminal liability for any healthcare arrangement

Answer

Apply only to arrangements involving government payers

Answer

Replace the Stark Law self-referral prohibitions