MHA Health Law and Regulations 3 — Questions and Answers
Question 1: The False Claims Act's 'qui tam' provision allows:
- The government to seize a hospital's assets without a court order
- Private individuals to file lawsuits on the government's behalf and share in recovered damages (Correct answer)
- CMS to withhold Medicare payments pending investigation
- Physicians to report billing fraud anonymously to the OIG
Correct answer: Private individuals to file lawsuits on the government's behalf and share in recovered damages
The qui tam provision of the False Claims Act allows whistleblowers (relators) to file suit on behalf of the government and receive 15–30% of recovered funds.
Question 2: Which of the following is NOT protected health information (PHI) under HIPAA?
- A patient's name combined with their diagnosis
- De-identified health data that meets Safe Harbor standards (Correct answer)
- A patient's medical record number
- A patient's appointment date linked to their name
Correct answer: De-identified health data that meets Safe Harbor standards
Health information that has been properly de-identified using the Safe Harbor or Expert Determination method is not considered PHI and is not subject to HIPAA protections.
Question 3: Under the Americans with Disabilities Act (ADA), a hospital must provide reasonable accommodations to a qualified employee with a disability UNLESS:
- The accommodation would alter the essential functions of the job (Correct answer)
- The employee has worked at the hospital for less than one year
- The disability is related to substance abuse
- The accommodation is requested verbally rather than in writing
Correct answer: The accommodation would alter the essential functions of the job
The ADA requires reasonable accommodations unless they impose an undue hardship or would eliminate essential functions of the position.
Question 4: A hospital's compliance program is found to have inadequately supervised billing staff, resulting in widespread Medicare fraud. The OIG may impose which sanction?
- Immediate revocation of the hospital's state license
- Exclusion from participation in federal healthcare programs (Correct answer)
- Criminal prosecution of the compliance officer personally
- Mandatory merger with a compliant health system
Correct answer: Exclusion from participation in federal healthcare programs
The OIG has authority to exclude providers from Medicare, Medicaid, and other federal healthcare programs for fraud, abuse, or program-related crimes.
Question 5: The concept of 'corporate negligence' in healthcare law holds that:
- Only individual physicians can be sued for malpractice, not hospitals
- Hospitals have an independent duty to ensure competent medical staff and maintain safe facilities (Correct answer)
- Corporations are immune from negligence claims under charitable immunity doctrines
- A hospital is only liable if it directly employs the negligent provider
Correct answer: Hospitals have an independent duty to ensure competent medical staff and maintain safe facilities
The doctrine of corporate negligence, established in Darling v. Charleston Community Hospital, holds hospitals directly liable for failing to ensure quality care.
Question 6: Which federal regulation establishes conditions that hospitals must meet to receive Medicare and Medicaid reimbursement?
- Stark Law Conditions of Participation
- Medicare Conditions of Participation (CoPs) (Correct answer)
- Joint Commission Accreditation Standards
- OSHA Healthcare Worker Safety Rules
Correct answer: Medicare Conditions of Participation (CoPs)
CMS's Medicare Conditions of Participation (CoPs) set the minimum health and safety standards hospitals must meet to receive Medicare and Medicaid reimbursement.
Question 7: A patient in a clinical trial suffers an unexpected serious adverse event. Under FDA regulations, the research sponsor must report this to the FDA within:
- 24 hours
- 7 calendar days
- 15 calendar days (Correct answer)
- 30 calendar days
Correct answer: 15 calendar days
FDA regulations require sponsors to report unexpected serious adverse events (non-fatal, non-life-threatening) within 15 calendar days; fatal or immediately life-threatening events require 7-day reporting.
MHA Health Law and Regulations 3
The False Claims Act's 'qui tam' provision allows: