CHC Healthcare Fraud and Abuse 3

Question 1

A physician self-refers a patient to a physical therapy center in which the physician has an ownership interest. Under the Stark Law, which of the following must be true for this to be lawful?

Accepted Answer

The arrangement must fit within a recognized Stark Law exception

Answer

The physician must disclose the relationship to the patient only

Answer

The physical therapy center must be accredited by a national body

Answer

The referral must be approved by the hospital's medical staff

Question 2

Which of the following best describes 'phantom billing' in healthcare fraud?

Accepted Answer

Billing for services that were never provided to the patient

Answer

Billing for a more expensive procedure than performed

Answer

Billing separately for procedures that should be bundled

Answer

Billing for a non-covered service using a covered service code

Question 3

Which statute allows a private citizen (relator) to file a lawsuit on behalf of the U.S. government against a person who has submitted false claims?

Accepted Answer

The False Claims Act (qui tam provisions)

Answer

The Stark Law

Answer

The Anti-Kickback Statute

Answer

The Civil Monetary Penalties Law

Question 4

A home health agency provides free housekeeping services to patients who agree to use the agency for Medicare-covered skilled nursing services. This arrangement most likely violates:

Accepted Answer

Both the Anti-Kickback Statute and the False Claims Act

Answer

The Stark Law only

Answer

The Anti-Kickback Statute only

Answer

HIPAA and the Stark Law

Question 5

Under the Civil Monetary Penalties Law (CMPL), which of the following conduct can result in exclusion from federal healthcare programs?

Accepted Answer

Employing or contracting with an excluded individual

Answer

Failing to conduct annual compliance training

Answer

Not updating a provider enrollment record within 30 days

Answer

Billing a commercial payer for uncovered services

Question 6

Which of the following is a key difference between civil and criminal liability under the False Claims Act?

Accepted Answer

Criminal FCA can result in imprisonment, while civil FCA results in monetary penalties and treble damages

Answer

Criminal FCA requires proof of actual monetary loss to the government

Answer

Civil FCA requires proof of specific intent to defraud, while criminal does not

Answer

Civil FCA applies only to healthcare, while criminal FCA applies to all industries

Question 7

A lab bills Medicare for a comprehensive metabolic panel (CPT 80053) but only performs a basic metabolic panel (CPT 80048). This is an example of:

Accepted Answer

Upcoding

Answer

Unbundling

Answer

Duplicate billing

Answer

Balance billing