CMAS Risk Assessment & Mitigation 3 — Questions and Answers
Question 1: A CMAS notices that a physician has been signing blank prescription pads. What type of risk does this PRIMARILY represent?
- Coding compliance risk
- Drug diversion and prescription fraud risk (Correct answer)
- Credentialing noncompliance risk
- Workers' compensation fraud risk
Correct answer: Drug diversion and prescription fraud risk
Signing blank prescription pads creates a serious drug diversion and prescription fraud risk, as blank signed prescriptions can be stolen and misused to obtain controlled substances.
Question 2: Which federal law creates a risk of significant civil monetary penalties for medical practices that submit false claims to Medicare or Medicaid?
- HIPAA Privacy Rule
- False Claims Act (FCA) (Correct answer)
- Anti-Kickback Statute
- Stark Law
Correct answer: False Claims Act (FCA)
The False Claims Act imposes civil monetary penalties per false claim plus treble damages on entities that knowingly submit fraudulent claims to federal healthcare programs.
Question 3: A risk assessment reveals that the practice's fire suppression system has not been tested in over two years. This falls under which risk category?
- Clinical/patient safety risk
- Financial/billing risk
- Facilities/environmental risk (Correct answer)
- Workforce/HR risk
Correct answer: Facilities/environmental risk
An untested fire suppression system is a facilities or environmental safety risk that could result in physical harm to patients and staff and regulatory penalties.
Question 4: What does 'risk tolerance' mean in the context of healthcare risk management?
- The maximum financial loss a malpractice insurer will cover
- The level of risk an organization is willing to accept before taking action (Correct answer)
- A patient's ability to withstand treatment side effects
- The threshold at which OSHA requires incident reporting
Correct answer: The level of risk an organization is willing to accept before taking action
Risk tolerance defines the boundary of acceptable risk exposure; risks exceeding this threshold require active mitigation strategies.
Question 5: Which scenario BEST exemplifies a 'near miss' in a medical office risk management context?
- A patient receives the wrong medication and is hospitalized
- A staff member almost gives a patient the wrong chart but catches the error before any action is taken (Correct answer)
- A billing error results in an insurance overpayment
- A physician cancels a procedure due to patient no-show
Correct answer: A staff member almost gives a patient the wrong chart but catches the error before any action is taken
A near miss is an event that could have caused harm but was caught before reaching the patient, and it should be documented and analyzed to prevent future errors.
Question 6: Under the Emergency Medical Treatment and Labor Act (EMTALA), what is a key liability risk for practices with emergency departments?
- Failing to obtain prior authorization before emergency treatment
- Patient dumping — transferring or discharging patients without stabilizing them (Correct answer)
- Charging patients before rendering emergency services
- Not obtaining informed consent for emergency procedures
Correct answer: Patient dumping — transferring or discharging patients without stabilizing them
EMTALA prohibits patient dumping — transferring or refusing emergency care based on inability to pay — and violations can result in significant civil monetary penalties.
Question 7: A risk mitigation plan assigns each risk to a specific staff member. What is this person's role called?
- Risk sponsor
- Risk owner (Correct answer)
- Risk auditor
- Risk broker
Correct answer: Risk owner
A risk owner is the individual accountable for monitoring, managing, and reporting on a specific identified risk and its mitigation actions.
CMAS Risk Assessment & Mitigation 3
A CMAS notices that a physician has been signing blank prescription pads.
What type of risk does this PRIMARILY represent?