Compliance and Regulatory Rules Flashcards
7 cards from real CPC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Compliance and Regulatory Rules flashcards as text
Which federal program allows private citizens (whistleblowers) to file lawsuits on behalf of the government and receive a portion of recovered funds?
Answer: Qui Tam provisions of the False Claims Act
The False Claims Act's qui tam provisions allow private individuals (relators) to file suit on the government's behalf and receive 15-30% of recovered funds.
A hospital provides free transportation services to Medicare patients to encourage them to use the hospital's services. This arrangement most likely violates:
Answer: Anti-Kickback Statute
Offering free services to induce patient referrals to a Medicare-covered entity likely violates the Anti-Kickback Statute.
Which of the following best describes 'medical necessity' in the context of Medicare billing compliance?
Answer: Services that are reasonable and necessary for diagnosis or treatment of illness or injury
Medicare defines medical necessity as services or items that are reasonable and necessary for the diagnosis or treatment of illness, injury, or to improve functioning.
A Corporate Integrity Agreement (CIA) is typically entered into between a healthcare provider and which federal agency?
Answer: Office of Inspector General (OIG) of HHS
CIAs are agreements between the OIG of HHS and healthcare providers as an alternative to exclusion from federal healthcare programs.
What is 'excluded provider' status in the context of Medicare and Medicaid compliance?
Answer: A provider barred from participation in federal healthcare programs
An excluded provider has been prohibited by the OIG from participating in Medicare, Medicaid, and other federal healthcare programs.
Routine waiver of Medicare copayments and deductibles without determining financial hardship is considered fraudulent because it:
Answer: Constitutes kickback inducements and misrepresents the actual charge
Routinely waiving cost-sharing can constitute an illegal inducement under the AKS and misrepresents the actual charge billed to Medicare.
Under the Health Care Fraud and Abuse Control (HCFAC) program, which two agencies jointly administer the program?
Answer: HHS and DOJ
The HCFAC program is jointly administered by the HHS Secretary and the Attorney General (DOJ) to combat healthcare fraud.