HAC Healthcare Accounting Regulatory Compliance & Auditing 2

Question 1

Under the False Claims Act, what is the minimum per-claim civil monetary penalty for knowingly submitting a false claim to Medicare or Medicaid?

Accepted Answer

$11,803

Answer

As of recent adjustments, the False Claims Act civil penalty range is approximately $13,946 to $27,894 per claim (inflation-adjusted), with the lower bound near $11,803 in earlier adjustment periods.

Question 2

Which OIG exclusion authority permanently excludes individuals convicted of patient abuse or neglect from participating in federal healthcare programs?

Accepted Answer

Mandatory exclusion under 42 U.S.C. § 1320a-7(a)

Answer

Mandatory exclusion under 42 U.S.C. § 1320a-7(a) requires OIG to exclude individuals convicted of patient abuse, neglect, or mistreatment with a minimum 5-year exclusion.

Question 3

A hospital's internal audit reveals that a physician is ordering diagnostic tests from a lab in which the physician holds a 20% ownership stake. Which law is most directly implicated?

Accepted Answer

Stark Law (Physician Self-Referral Law)

Answer

The Stark Law prohibits physicians from referring Medicare/Medicaid patients for designated health services to entities in which the physician or immediate family member has a financial relationship.

Question 4

In a Medicare RAC (Recovery Audit Contractor) audit, what is the standard look-back period for complex reviews?

Accepted Answer

3 years

Answer

RAC auditors may review claims up to 3 years from the date the claim was paid, aligning with CMS's standard look-back period for complex medical record reviews.

Question 5

Which financial statement audit standard do not-for-profit hospitals most commonly follow when preparing GAAP-compliant audited financial statements?

Accepted Answer

AICPA Statements on Auditing Standards (SAS)

Answer

Not-for-profit hospitals typically follow AICPA SAS (Generally Accepted Auditing Standards) for their annual audited financial statements prepared under US GAAP.

(HAC) Healthcare Accounting Certification Practice Test

(HAC) Healthcare Accounting Certification Practice Test

HAC Healthcare Accounting Regulatory Compliance & Auditing 2