CRCR CRCR - Certified Revenue Cycle Representative Program Healthcare Compliance and Regulations 3

Question 1

Under the False Claims Act, what is the minimum civil monetary penalty per false claim submitted to a federal healthcare program?

Accepted Answer

$21,916

Answer

As of recent adjustments for inflation, the False Claims Act penalty range is approximately $13,946 to $27,894 per false claim (the lower bound was ~$21,916 in recent years); the exact figure adjusts annually, but answer C reflects the updated floor most commonly tested.

Question 2

Which federal agency is primarily responsible for enforcing the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules?

Accepted Answer

Office for Civil Rights (OCR)

Answer

The HHS Office for Civil Rights (OCR) is the primary enforcer of HIPAA Privacy and Security Rules for covered entities and business associates.

Question 3

A revenue cycle employee discovers that a supervisor is upcoding claims to increase reimbursement. Under the False Claims Act's qui tam provisions, what can the employee do?

Accepted Answer

File a whistleblower lawsuit on behalf of the government and potentially receive a portion of recovered funds

Answer

Qui tam provisions allow private individuals (relators) to file suit on behalf of the government and receive 15–30% of recovered funds, with anti-retaliation protections.

Question 4

The Stark Law (Physician Self-Referral Law) prohibits physicians from referring patients for designated health services (DHS) to entities where the physician has a financial relationship UNLESS:

Accepted Answer

A specific statutory or regulatory exception applies

Answer

Stark Law is a strict liability statute — violations occur regardless of intent unless a specific exception (e.g., in-office ancillary services, bona fide employment) is met.

Question 5

What distinguishes the Anti-Kickback Statute (AKS) from the Stark Law in terms of intent?

Accepted Answer

AKS requires proof of intent to induce referrals; Stark Law is strict liability

Answer

The AKS is an intent-based criminal statute requiring knowing and willful conduct to induce referrals, while Stark Law is a strict civil liability statute requiring no proof of intent.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR CRCR - Certified Revenue Cycle Representative Program Healthcare Compliance and Regulations 3