Nurse Executive Test Regulatory Frameworks & Compliance 3 — Questions and Answers
Question 1: Under the False Claims Act, which concept allows private individuals with knowledge of fraud against the government to file a lawsuit on the government's behalf?
- Subrogation
- Qui tam provision (Correct answer)
- Sovereign immunity waiver
- Whistleblower indemnification
Correct answer: Qui tam provision
The qui tam provision of the False Claims Act permits private individuals (relators) to sue on behalf of the federal government and share in any recovery.
Question 2: A hospital's governing board asks the nurse executive to explain the significance of the Stark Law. Which statement BEST describes this law?
- It prohibits healthcare organizations from employing physicians who have been excluded from federal programs
- It bans physician self-referrals to designated health services entities in which the physician has a financial relationship (Correct answer)
- It requires disclosure of all financial relationships between hospitals and insurance companies
- It mandates that physician compensation be tied to quality metrics rather than volume
Correct answer: It bans physician self-referrals to designated health services entities in which the physician has a financial relationship
The Stark Law (Physician Self-Referral Law) prohibits physicians from referring patients to entities providing designated health services with which the physician has a financial relationship, unless an exception applies.
Question 3: Which regulatory standard requires hospitals to have an ongoing, systematic, organization-wide approach to performance improvement?
- OSHA bloodborne pathogens standard
- CMS Condition of Participation for Quality Assessment and Performance Improvement (QAPI) (Correct answer)
- HIPAA Security Rule
- DEA controlled substance registration requirements
Correct answer: CMS Condition of Participation for Quality Assessment and Performance Improvement (QAPI)
The CMS QAPI Condition of Participation requires hospitals to have a data-driven, systematic performance improvement program that is organization-wide.
Question 4: A nurse executive is informed that a staff member reported a workplace safety violation directly to OSHA without first using internal channels. Under the OSH Act, this employee:
- May be disciplined for bypassing internal reporting procedures
- Is protected from retaliation by the employer (Correct answer)
- Must provide written documentation to OSHA within 30 days
- Forfeits whistleblower protections by skipping internal reporting
Correct answer: Is protected from retaliation by the employer
Section 11(c) of the OSH Act prohibits employers from retaliating against employees who report safety concerns to OSHA, regardless of whether internal channels were used first.
Question 5: A nurse executive is reviewing compliance with the National Patient Safety Goals (NPSGs). These goals are established by:
- The Centers for Medicare & Medicaid Services as a condition of participation
- The Joint Commission based on analysis of sentinel event data (Correct answer)
- The Institute for Healthcare Improvement through voluntary consensus
- State boards of nursing through regulatory rulemaking
Correct answer: The Joint Commission based on analysis of sentinel event data
TJC develops NPSGs based on sentinel event data and expert panel recommendations to address the most critical safety issues in healthcare.
Question 6: Under the Anti-Kickback Statute (AKS), a hospital marketing arrangement with a physician group could constitute a violation if:
- The arrangement is disclosed in the hospital's annual report to CMS
- Remuneration is exchanged with the intent to induce referrals of federal program business (Correct answer)
- The physician group serves patients without regard to insurance status
- The marketing contract includes a fair market value assessment
Correct answer: Remuneration is exchanged with the intent to induce referrals of federal program business
The AKS prohibits offering, paying, soliciting, or receiving anything of value to induce referrals of items or services covered by federal healthcare programs.
Question 7: A nurse executive learns that the hospital will undergo a CMS survey. Unlike a TJC accreditation survey, a CMS survey is:
- Focused exclusively on nursing documentation standards
- Always unannounced and conducted by state survey agencies on behalf of CMS (Correct answer)
- Triggered only by patient complaints to the state health department
- Required only for facilities seeking Medicare Part D coverage
Correct answer: Always unannounced and conducted by state survey agencies on behalf of CMS
CMS surveys are typically unannounced and are conducted by state survey agencies (or CMS directly for cause) to assess compliance with Conditions of Participation.
Nurse Executive Test Regulatory Frameworks & Compliance 3
Under the False Claims Act, which concept allows private individuals with knowledge of fraud against the government to file a lawsuit on the government's behalf?