CHC Remedial Measures and Discipline 3

Question 1

A healthcare organization learns that a billing coder submitted false claims but passed all internal audits. The BEST long-term corrective measure is:

Accepted Answer

Strengthen audit methodologies to detect the type of falsification discovered

Answer

Terminate the coder and take no further action

Answer

Rely on external auditors exclusively going forward

Answer

Suspend all claim submissions for 90 days

Question 2

Which of the following BEST describes a 'corporate integrity agreement' (CIA) in the context of remedial measures?

Accepted Answer

A binding settlement with the OIG requiring compliance program enhancements and monitoring

Answer

A voluntary internal policy adopted after a risk assessment

Answer

An agreement between two competing healthcare entities

Answer

A state licensure requirement for new hospitals

Question 3

During a compliance investigation, legal counsel invokes attorney-client privilege over certain documents. The compliance officer should understand that privilege:

Accepted Answer

Covers communications between attorney and client made for the purpose of legal advice

Answer

Protects all documents created during an investigation regardless of author

Answer

Can be asserted by the compliance officer independently without attorney involvement

Answer

Automatically applies to all compliance committee meeting minutes

Question 4

An employee subject to discipline has the right to 'due process' in a healthcare compliance context. This PRIMARILY means:

Accepted Answer

The employee receives notice of allegations and an opportunity to respond before final action

Answer

The employee must be given a jury trial before any discipline is imposed

Answer

The employee can veto the disciplinary outcome

Answer

All discipline must be reviewed by the state medical board

Question 5

A compliance officer is designing a corrective action plan after an overpayment is identified. Which component is MOST important to include to satisfy CMS expectations?

Accepted Answer

Identification of the root cause and systemic controls to prevent recurrence

Answer

A plan to contest the overpayment finding in federal court

Answer

A commitment to hire additional physicians to offset financial loss

Answer

A media statement minimizing the significance of the overpayment

Question 6

Under the 60-day rule established in the ACA, once an organization has identified an overpayment it must report and return it within:

Accepted Answer

60 days of identification

Answer

30 days of identification

Answer

90 days of identification

Answer

180 days of identification

Question 7

When disciplining a licensed clinical professional for a compliance violation, the organization should also consider:

Accepted Answer

Whether the violation triggers mandatory reporting to the relevant state licensing board

Answer

Whether the employee's salary should be reduced retroactively

Answer

Whether all prior performance reviews should be destroyed

Answer

Whether the employee can be enrolled in a clinical research study