Legal & Ethical Standards in Healthcare Flashcards

Which federal statute imposes liability on persons who knowingly submit false claims to the government and allows whistleblowers to file qui tam suits?

Answer: False Claims Act

The False Claims Act permits qui tam relators to sue on behalf of the government and share in recoveries.

Which federal database, in addition to the LEIE, should be checked for practitioners debarred from federal contracts?

Answer: SAM.gov exclusions

The System for Award Management (SAM) lists parties excluded from federal procurement and nonprocurement programs.

A practitioner may access their own NPDB report by:

Answer: Submitting a self-query to the NPDB

Practitioners can self-query the NPDB at any time to view reports about themselves.

Which action is most likely to support a defamation claim against a hospital?

Answer: Knowingly providing false negative information about a physician to another hospital

Knowingly false statements are not protected by HCQIA immunity and can support defamation claims.

Under the Anti-Kickback Statute, which arrangement raises the greatest concern?

Answer: Paying a physician for referrals of federal health care program patients

The AKS prohibits knowingly offering or paying remuneration to induce referrals of federally reimbursable business.

When a physician requests a fair hearing after an adverse recommendation, the hearing panel should generally consist of:

Answer: Members who are not in direct economic competition with the physician

HCQIA hearing standards call for a panel or officer not in direct economic competition with the physician.

Which HIPAA concept requires that credentialing staff access only the protected health information needed to perform their task?

Answer: Minimum necessary standard

The minimum necessary standard limits uses and disclosures of PHI to what is needed for the purpose.