CRCR Healthcare Compliance and Regulations 2

Question 1

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

Accepted Answer

$13,946

Answer

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?

Accepted Answer

Stark Law

Answer

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?

Accepted Answer

Upcoding

Answer

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?

Accepted Answer

60 days

Answer

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?

Accepted Answer

Advisory Opinion

Answer

OIG Advisory Opinions give parties a binding opinion on whether a proposed or existing arrangement would trigger Anti-Kickback Statute sanctions.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Healthcare Compliance and Regulations 2