CPE Regulatory & Legal Compliance 3 — Questions and Answers
Question 1: When a physician executive is notified of a potential HIPAA breach affecting 600 patients, what is the notification timeline required to the Secretary of HHS?
- Within 24 hours of discovery
- Within 30 days of discovery
- Within 60 days of discovery (Correct answer)
- Within 1 year, as part of an annual log
Correct answer: Within 60 days of discovery
HIPAA requires covered entities to notify the Secretary of HHS of breaches affecting 500 or more individuals within 60 days of discovery.
Question 2: The Stark Law's in-office ancillary services exception allows physician self-referrals provided certain conditions are met. Which of the following is NOT a required element of this exception?
- Services must be furnished personally by the referring physician or a member of the same group practice
- Services must be furnished in a building where the referring physician furnishes physician services
- The financial arrangement must be set in advance and not vary based on referral volume (Correct answer)
- Services must be billed by the physician, group practice, or an entity wholly owned by the group
Correct answer: The financial arrangement must be set in advance and not vary based on referral volume
The 'set in advance and not vary based on referrals' condition is an element of compensation exceptions, not the in-office ancillary services exception.
Question 3: A physician executive chairs a peer review committee that recommends suspension of a physician's privileges. The physician sues claiming the suspension was retaliatory. What federal law provides immunity to peer review committee members acting in good faith?
- Health Care Quality Improvement Act (HCQIA) (Correct answer)
- Patient Safety and Quality Improvement Act (PSQIA)
- National Practitioner Data Bank Improvement Act
- Healthcare Fraud Prevention and Enforcement Action Team Act
Correct answer: Health Care Quality Improvement Act (HCQIA)
The HCQIA provides immunity from damages to peer review participants acting in the reasonable belief that the action furthers quality healthcare.
Question 4: Under the Americans with Disabilities Act (ADA), a hospital must provide reasonable accommodations to employees with disabilities unless doing so would cause what?
- Any additional cost to the employer
- Undue hardship on the operation of the business (Correct answer)
- Disruption to existing employee schedules
- A need to hire additional staff
Correct answer: Undue hardship on the operation of the business
The ADA requires reasonable accommodations unless they impose an undue hardship, considering factors like cost and operational impact relative to the employer's resources.
Question 5: Which of the following constitutes a 'reportable event' requiring submission to the National Practitioner Data Bank (NPDB)?
- A physician voluntarily resigns before a formal investigation is opened
- A malpractice payment made on behalf of a physician (Correct answer)
- A negative peer review finding that does not affect clinical privileges
- An informal verbal warning from a department chief
Correct answer: A malpractice payment made on behalf of a physician
Any medical malpractice payment made on behalf of a licensed healthcare practitioner must be reported to the NPDB.
Question 6: A hospital receives an administrative subpoena from the OIG requesting patient records as part of a fraud investigation. What is the hospital's most appropriate immediate response?
- Refuse to comply until a court order is obtained
- Notify and consult legal counsel before responding (Correct answer)
- Immediately produce all requested records within 24 hours
- Notify the implicated physicians before producing any records
Correct answer: Notify and consult legal counsel before responding
The immediate appropriate response is to engage legal counsel to assess the subpoena's scope, validity, and implications before any records are produced.
Question 7: Which federal law prohibits hospitals from discriminating in the provision of care based on the source of payment when they have entered into Medicare participation agreements?
- Title VI of the Civil Rights Act of 1964
- Section 1557 of the ACA
- Conditions of Participation under Medicare (Correct answer)
- The Hill-Burton Act's community service obligation
Correct answer: Conditions of Participation under Medicare
Medicare Conditions of Participation explicitly prohibit participating hospitals from discriminating against beneficiaries based on source of payment.
CPE Regulatory & Legal Compliance 3
When a physician executive is notified of a potential HIPAA breach affecting 600 patients, what is the notification timeline required to the Secretary of HHS?