General Surgery Board Review Regulatory Frameworks & Compliance 3

Question 1

The False Claims Act (FCA) imposes liability on individuals or entities that submit fraudulent claims to federal health care programs. The FCA's 'qui tam' provision allows:

Accepted Answer

Private individuals to file suit on behalf of the government and share in any recovery

Answer

The FCA's qui tam provision enables whistleblowers (relators) to file suit in the government's name and receive 15–30% of any resulting recovery.

Question 2

A hospital's compliance program is auditing surgical billing. Which document published by the OIG provides guidance on billing risk areas specific to surgical services?

Accepted Answer

OIG Work Plan

Answer

The OIG Work Plan identifies compliance risk areas and audit priorities for federal health care programs, including surgical billing concerns.

Question 3

Under HIPAA, a 'covered entity' includes which of the following?

Accepted Answer

Health care providers who transmit health information electronically

Answer

HIPAA covered entities include health care providers that transmit PHI electronically, health plans, and health care clearinghouses.

Question 4

The Anti-Kickback Statute (AKS) is violated when remuneration is offered to induce referrals of items or services covered by federal health care programs. The AKS differs from the Stark Law in that AKS:

Accepted Answer

Requires proof of intent and applies to all health care providers, not just physicians

Answer

Unlike the strict-liability Stark Law, the AKS is an intent-based criminal statute that applies broadly to any person offering or receiving remuneration to induce federal program referrals.

Question 5

A surgeon is asked to use an implant supplied by a company in which she holds equity. Which compliance framework primarily governs this financial conflict of interest in a Medicare context?

Accepted Answer

The Stark Law and its device-implant exception criteria

Answer

The Stark Law governs physician financial relationships with entities providing designated health services to Medicare patients, including implantable devices, subject to specific exceptions.

General Surgery Board Review Practice Test

General Surgery Board Review Practice Test

General Surgery Board Review Regulatory Frameworks & Compliance 3