CLC Laboratory Financial Management & Reimbursement 2

Question 1

The Anti-Kickback Statute (AKS) in the context of laboratory services prohibits:

Accepted Answer

Offering or receiving anything of value to induce test referrals for federal program patients

Answer

The AKS makes it a criminal offense to offer, pay, solicit, or receive remuneration to induce referrals of items or services covered by federal healthcare programs, including laboratory tests.

Question 2

The Stark Law (Physician Self-Referral Law) primarily restricts:

Accepted Answer

Physicians with financial relationships from referring patients for designated health services, including laboratory services

Answer

The Stark Law prohibits physicians who have a financial relationship with an entity from referring Medicare/Medicaid patients to that entity for designated health services including clinical laboratory services, unless a specific exception applies.

Question 3

Qui tam provisions of the False Claims Act allow:

Accepted Answer

Private individuals to file lawsuits on behalf of the government and share in financial recoveries

Answer

Qui tam provisions empower private individuals (relators/whistleblowers) to file suit on the government's behalf and receive 15–30% of any recovered funds.

Question 4

The OIG Work Plan is a valuable compliance tool for laboratory consultants primarily because it:

Accepted Answer

Identifies areas the Office of Inspector General is actively scrutinizing for fraud and abuse

Answer

The OIG Work Plan describes planned and ongoing reviews, audits, and investigations, alerting laboratories to the compliance risk areas receiving current government attention.

Question 5

'Upcoding' in laboratory billing is defined as:

Accepted Answer

Billing for a higher-complexity or more expensive test than what was actually performed

Answer

Upcoding involves intentionally billing a service at a higher code level than performed, resulting in higher reimbursement and constituting healthcare fraud.

(CLC) Certified Laboratory Consultant Practice Test

(CLC) Certified Laboratory Consultant Practice Test

CLC Laboratory Financial Management & Reimbursement 2