Healthcare Compliance and Regulations Flashcards
7 cards from real CRCR practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Healthcare Compliance and Regulations flashcards as text
Under the False Claims Act, what is the minimum civil penalty per false claim submitted to a federal healthcare program?
Answer: $13,946
The False Claims Act imposes civil penalties (inflation-adjusted) of approximately $13,946 to $27,894 per false claim, plus treble damages.
Which federal law prohibits a physician from referring Medicare or Medicaid patients to entities with which the physician has a financial relationship, unless an exception applies?
Answer: Stark Law
The Stark Law (Physician Self-Referral Law) prohibits self-referrals to entities with financial relationships absent a qualifying exception.
A hospital's compliance officer discovers that a coder routinely upcodes evaluation and management visits. Which type of fraud scheme does this represent?
Answer: Upcoding
Upcoding means billing for a higher-complexity or higher-cost service than was actually provided.
Under HIPAA's Breach Notification Rule, covered entities must notify affected individuals of an unsecured PHI breach within how many days of discovery?
Answer: 60 days
HIPAA requires covered entities to notify individuals no later than 60 calendar days after discovering a breach of unsecured PHI.
Which OIG tool provides guidance on whether a specific business arrangement could lead to sanctions under the Anti-Kickback Statute?
Answer: Advisory Opinion
OIG Advisory Opinions give parties a binding opinion on whether a proposed or existing arrangement would trigger Anti-Kickback Statute sanctions.
The Deficit Reduction Act of 2005 requires states to educate employees of Medicaid providers about which federal law?
Answer: False Claims Act
The DRA requires Medicaid providers receiving over $5 million annually to educate employees about the False Claims Act and state equivalents.
Which Medicare administrative contractor function involves post-payment review to identify and recover improper payments?
Answer: Recovery Audit Contractor (RAC)
Recovery Audit Contractors identify and recover improper Medicare payments through post-payment claim review on a contingency-fee basis.