CHC Whistleblower Protections and Reporting Mechanisms 3

Question 1

Under which laws are healthcare employees protected from retaliation for reporting fraud or patient safety concerns to federal authorities?

Accepted Answer

False Claims Act and ACA Section 1558

Answer

HIPAA and EMTALA

Answer

ERISA and the Sarbanes-Oxley Act

Answer

EMTALA and the Anti-Kickback Statute

Question 2

What is the purpose of the 'public disclosure bar' under the False Claims Act?

Accepted Answer

To prevent qui tam suits based on publicly available information unless the relator is the original source

Answer

To require relators to publicly disclose their identity before filing suit

Answer

To mandate public disclosure of all fraud settlement agreements

Answer

To require public posting of an organization's compliance policies

Question 3

An employee who suffers retaliation for reporting healthcare compliance concerns under certain federal statutes may file a complaint with which agency within 180 days of the retaliatory action?

Accepted Answer

Occupational Safety and Health Administration (OSHA)

Answer

Equal Employment Opportunity Commission (EEOC)

Answer

Department of Labor Wage and Hour Division

Answer

Securities and Exchange Commission (SEC)

Question 4

Which of the OIG's seven elements of an effective compliance program specifically addresses reporting mechanisms?

Accepted Answer

Element 4: Open lines of communication

Answer

Element 1: Written standards of conduct and policies

Answer

Element 5: Response to detected offenses and corrective action

Answer

Element 3: Effective training and education

Question 5

What is 'reverse false claims' liability under the False Claims Act?

Accepted Answer

Liability for knowingly avoiding or concealing an obligation to repay money owed to the government

Answer

When the government files a fraudulent claim against a healthcare provider

Answer

Liability arising when a whistleblower files a demonstrably false complaint

Answer

Liability for submitting the same claim to multiple payers simultaneously

Question 6

Under the ACA's 60-day rule, what must a healthcare provider do upon identifying a Medicare or Medicaid overpayment?

Accepted Answer

Report and return the overpayment to the government within 60 days

Answer

File a qui tam lawsuit to document the overpayment within 60 days

Answer

Notify the OIG of the overpayment within 60 days without yet returning funds

Answer

Submit a corrected claim to the payer within 60 days of discovery

Question 7

Which of the following scenarios constitutes prohibited retaliation under the False Claims Act's anti-retaliation provisions?

Accepted Answer

Demoting an employee shortly after they reported billing irregularities to the compliance office

Answer

Placing an employee on a performance improvement plan for documented, pre-existing performance deficiencies

Answer

Terminating an employee who violated HIPAA privacy rules following a thorough investigation

Answer

Transferring an employee to a different department for documented operational restructuring reasons