Professional Ethics & Regulatory Compliance Flashcards

Under the False Claims Act, a claim submitted to Medicare is considered false when:

Answer: A provider knowingly submits a claim for services not rendered or misrepresented

The FCA imposes liability for knowingly false claims, including misrepresenting services, diagnoses, or device specifications to obtain Medicare payment.

Which of the following activities would constitute a violation of patient confidentiality by an orthotic fitter?

Answer: Sharing a patient's gait analysis video on social media without consent

Sharing patient images or videos on social media without explicit written authorization is a HIPAA violation and breach of confidentiality.

An orthotist working in a hospital outpatient setting discovers a billing error that resulted in $3,000 in overpayments from Medicare over the past year. Under CMS guidelines, the provider must:

Answer: Report and return the overpayment within 60 days of identification

The CMS 60-Day Rule requires providers to report and return Medicare overpayments within 60 days of identification to avoid False Claims Act liability.

A patient who uses a wheelchair is requesting an upper extremity orthosis. The fitter's office is accessible only by stairs. According to the ADA, the provider is obligated to:

Answer: Make reasonable modifications to ensure the patient has equal access to services

The ADA requires healthcare providers to make reasonable modifications to ensure equal access for patients with disabilities.

Which of the following best describes the concept of 'assignment' in Medicare orthotic billing?

Answer: The provider agrees to accept Medicare's approved amount as payment in full

Accepting assignment means the provider agrees that Medicare's allowed amount is payment in full and cannot charge the patient more than the applicable cost-sharing amount.

A certified orthotic fitter who also holds a business interest in a home health agency refers patients to that agency after fitting orthoses. This arrangement is best described as:

Answer: A potential violation of the Stark Law requiring disclosure or restructuring

Referring patients to a home health agency in which the referring provider has a financial interest may trigger Stark Law and Anti-Kickback Statute prohibitions.

The principle of 'veracity' in professional ethics requires a certified orthotic fitter to:

Answer: Provide honest and accurate information to patients, payers, and colleagues

Veracity requires honesty and truthfulness in all professional communications, including clinical documentation, billing, and patient education.