HMCC Fraud & Abuse Prevention 2

Question 1

What is a risk assessment in healthcare compliance?

Accepted Answer

A systematic evaluation of an organization's compliance vulnerabilities and the likelihood and impact of potential violations

Answer

A patient's medical risk evaluation

Answer

An insurance underwriting process

Answer

A building safety inspection

Question 2

What is the role of internal auditing in healthcare compliance?

Accepted Answer

To independently evaluate the effectiveness of compliance controls, identify potential violations, and recommend corrective actions

Answer

To audit patient medical records for accuracy

Answer

To review employee attendance records

Answer

To inspect medical equipment

Question 3

What is a voluntary self-disclosure to the OIG?

Accepted Answer

An organization's proactive report to OIG about potential fraud or compliance violations, often resulting in more favorable resolution

Answer

A mandatory annual compliance report

Answer

A routine financial disclosure

Answer

A patient safety incident report

Question 4

What are common red flags for healthcare meeting compliance violations?

Accepted Answer

Lavish venues, entertainment components, attendee selection based on prescribing patterns, and speaker fees exceeding fair market value

Answer

Events held at conference centers

Answer

Having name badges for attendees

Answer

Providing educational handouts

Question 5

What is the importance of documentation in defending against fraud allegations?

Accepted Answer

Thorough documentation demonstrates that services were provided, medically necessary, properly coded, and compliant with regulations

Answer

Documentation is not relevant to fraud defense

Answer

Only billing records matter

Answer

Verbal explanations are sufficient

Question 6

What is the False Claims Act's treble damages provision?

Accepted Answer

Defendants found liable for false claims must pay three times the government's actual damages plus per-claim penalties

Answer

Damages are limited to the amount of the false claim

Answer

Defendants pay only a nominal fine

Answer

Treble damages apply only to criminal cases