HMCC Healthcare Compliance Fundamentals 2

Question 1

What is the False Claims Act and how does it apply to healthcare?

Accepted Answer

A federal law imposing liability on persons who defraud governmental programs, including submitting false claims for healthcare reimbursement

Answer

The False Claims Act imposes civil liability for knowingly submitting false or fraudulent claims for payment to federal healthcare programs. Violations can result in treble damages plus per-claim penalties.

Question 2

What is a qui tam provision?

Accepted Answer

A provision in the False Claims Act allowing private citizens (whistleblowers) to file lawsuits on behalf of the government and share in recovered funds

Answer

Qui tam (from Latin 'who sues on behalf of the king') allows individuals with knowledge of fraud to file suit against the fraudster. Successful whistleblowers receive 15-30% of recovered funds.

Question 3

What is the Sunshine Act (Open Payments Program)?

Accepted Answer

A federal law requiring pharmaceutical and medical device companies to report payments and transfers of value to physicians and teaching hospitals

Answer

The Physician Payments Sunshine Act requires manufacturers to report payments, gifts, meals, speaking fees, and research funding to physicians and teaching hospitals, with data publicly available on CMS's Open Payments website.

Question 4

What is a Corporate Integrity Agreement (CIA)?

Accepted Answer

A binding agreement between OIG and a healthcare entity resolving fraud allegations, requiring specific compliance measures for a set period

Answer

CIAs are negotiated settlements requiring organizations to implement specific compliance obligations (independent review, training, reporting) typically for 5 years, as an alternative to exclusion from federal healthcare programs.

Question 5

What is EMTALA and what does it require?

Accepted Answer

The Emergency Medical Treatment and Labor Act requiring hospitals with emergency departments to provide screening examinations and stabilizing treatment regardless of ability to pay

Answer

EMTALA requires Medicare-participating hospitals with emergency departments to provide medical screening exams and stabilizing treatment to anyone regardless of insurance status, citizenship, or ability to pay.

HMCC - Healthcare Meeting Compliance Certificate Practice Test

HMCC - Healthcare Meeting Compliance Certificate Practice Test

HMCC Healthcare Compliance Fundamentals 2