CRCR Healthcare Compliance and Regulations 2 — Questions and Answers
Question 1: Under the False Claims Act, what is the minimum civil penalty per false claim submitted to a federal healthcare program?
- $1,000
- $5,000
- $13,946 (Correct answer)
- $50,000
Correct 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.
Question 2: 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?
- Anti-Kickback Statute
- Stark Law (Correct answer)
- False Claims Act
- EMTALA
Correct answer: Stark Law
The Stark Law (Physician Self-Referral Law) prohibits self-referrals to entities with financial relationships absent a qualifying exception.
Question 3: A hospital's compliance officer discovers that a coder routinely upcodes evaluation and management visits. Which type of fraud scheme does this represent?
- Unbundling
- Upcoding (Correct answer)
- Phantom billing
- Kickback arrangement
Correct answer: Upcoding
Upcoding means billing for a higher-complexity or higher-cost service than was actually provided.
Question 4: Under HIPAA's Breach Notification Rule, covered entities must notify affected individuals of an unsecured PHI breach within how many days of discovery?
- 30 days
- 45 days
- 60 days (Correct answer)
- 72 hours
Correct answer: 60 days
HIPAA requires covered entities to notify individuals no later than 60 calendar days after discovering a breach of unsecured PHI.
Question 5: Which OIG tool provides guidance on whether a specific business arrangement could lead to sanctions under the Anti-Kickback Statute?
- Corporate Integrity Agreement
- Advisory Opinion (Correct answer)
- Safe Harbor Regulation
- Compliance Program Guidance
Correct answer: Advisory Opinion
OIG Advisory Opinions give parties a binding opinion on whether a proposed or existing arrangement would trigger Anti-Kickback Statute sanctions.
Question 6: The Deficit Reduction Act of 2005 requires states to educate employees of Medicaid providers about which federal law?
- HIPAA Privacy Rule
- False Claims Act (Correct answer)
- Stark Law
- Anti-Kickback Statute
Correct 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.
Question 7: Which Medicare administrative contractor function involves post-payment review to identify and recover improper payments?
- Recovery Audit Contractor (RAC) (Correct answer)
- Zone Program Integrity Contractor (ZPIC)
- Comprehensive Error Rate Testing (CERT)
- Medicare Administrative Contractor (MAC)
Correct answer: Recovery Audit Contractor (RAC)
Recovery Audit Contractors identify and recover improper Medicare payments through post-payment claim review on a contingency-fee basis.
CRCR Healthcare Compliance and Regulations 2
Under the False Claims Act, what is the minimum civil penalty per false claim submitted to a federal healthcare program?