CPE Regulatory & Legal Compliance 2

Question 1

Under the False Claims Act, which standard of intent is required to establish liability for submitting a fraudulent claim to a federal healthcare program?

Accepted Answer

Knowingly, recklessly, or with deliberate ignorance

Answer

The False Claims Act requires proof that the defendant acted knowingly, which includes actual knowledge, deliberate ignorance, or reckless disregard of the truth.

Question 2

A physician executive discovers that a employed physician has been upcoding E&M visits for two years. Which regulatory body is primarily responsible for investigating Medicare billing fraud of this nature?

Accepted Answer

Office of Inspector General (OIG)

Answer

The OIG has primary responsibility for detecting and investigating fraud, waste, and abuse in Medicare and Medicaid programs.

Question 3

What is the maximum civil monetary penalty per false claim under the False Claims Act as periodically adjusted for inflation?

Accepted Answer

$13,000 to $26,000 per claim (approximate current range)

Answer

The FCA penalties are adjusted periodically for inflation; as of recent years, penalties range approximately $13,000–$26,000 per false claim, plus treble damages.

Question 4

Which Safe Harbor under the Anti-Kickback Statute protects payments made to bona fide employees of a healthcare entity?

Accepted Answer

Employee safe harbor

Answer

The employee safe harbor protects remuneration paid by an employer to a bona fide employee for furnishing covered items or services.

Question 5

A hospital is conducting a self-disclosure to the OIG regarding potential violations. Which program allows healthcare providers to voluntarily self-disclose conduct that may violate the AKS or other fraud statutes?

Accepted Answer

Provider Self-Disclosure Protocol (SDP)

Answer

The OIG's Provider Self-Disclosure Protocol allows providers to voluntarily identify, disclose, and resolve instances of potential fraud.

(CPE) Certified Physician Executive Practice Test

(CPE) Certified Physician Executive Practice Test

CPE Regulatory & Legal Compliance 2