CMC Regulatory Compliance & Legal Framework 4

Question 1

Under the False Claims Act, a whistleblower (qui tam relator) who reports a cardiac hospital's fraudulent Medicare billing may receive:

Accepted Answer

A percentage (15–30%) of the government's recovery

Answer

The False Claims Act's qui tam provision allows whistleblowers to receive 15–30% of government recoveries from fraud actions they initiate.

Question 2

A cardiologist wants to discuss a patient's post-MI management with a specialist via email. Under HIPAA, this is permissible if:

Accepted Answer

Reasonable safeguards are in place, such as encryption

Answer

HIPAA permits PHI transmission via email for treatment purposes when reasonable safeguards like encryption are implemented.

Question 3

The Physician Payments Sunshine Act (Open Payments) requires manufacturers to report payments to physicians. This primarily aims to:

Accepted Answer

Increase transparency regarding financial relationships that may influence clinical decisions

Answer

Open Payments requires public disclosure of financial relationships between manufacturers and physicians to promote transparency and reduce conflicts of interest.

Question 4

A cardiac rehabilitation program wants to bill Medicare for services provided to a patient who did not have a qualifying event. This would constitute:

Accepted Answer

Medicare fraud

Answer

Billing Medicare for services when coverage criteria are not met constitutes fraud, potentially triggering False Claims Act liability.

Question 5

When a cardiac patient lacks decision-making capacity and has no advance directive, the legal surrogate decision-maker is typically prioritized in which order?

Accepted Answer

Spouse, adult child, parent (state law hierarchy)

Answer

Most state laws establish a hierarchy of surrogates beginning with a spouse, then adult children, then parents, in the absence of a designated healthcare proxy.

CMC - Cardiac Medicine Certification Practice Test

CMC - Cardiac Medicine Certification Practice Test

CMC Regulatory Compliance & Legal Framework 4