Relias Compliance and Regulatory Training 3 — Questions and Answers
Question 1: Which element is NOT typically part of the OIG's seven elements of an effective compliance program?
- Written policies and procedures
- Designation of a compliance officer
- Mandatory profit-sharing for compliance staff (Correct answer)
- Regular training and education
Correct answer: Mandatory profit-sharing for compliance staff
The OIG's seven elements focus on governance, policies, training, communication, monitoring, enforcement, and response — not financial incentives for compliance staff.
Question 2: What is 'upcoding' in healthcare billing compliance?
- Using electronic billing systems instead of paper claims
- Billing for a higher-level or more expensive service than was actually provided (Correct answer)
- Coding diagnoses in alphabetical rather than numerical order
- Submitting claims to multiple payers for the same service
Correct answer: Billing for a higher-level or more expensive service than was actually provided
Upcoding is a form of healthcare fraud where providers bill for more expensive services than were delivered, violating the False Claims Act.
Question 3: Under OSHA's Bloodborne Pathogens Standard, which item must employers provide at no cost to employees with occupational exposure?
- Personal health insurance coverage
- Hepatitis B vaccination series (Correct answer)
- Life insurance policies
- Annual physical examinations unrelated to exposure
Correct answer: Hepatitis B vaccination series
OSHA requires employers to offer the Hepatitis B vaccination series at no cost to all employees with occupational exposure to bloodborne pathogens.
Question 4: What action should a healthcare worker take first upon discovering a potential compliance violation?
- Immediately inform the media to ensure transparency
- Correct the issue independently without documentation
- Report it through established channels such as a supervisor or compliance hotline (Correct answer)
- Wait to see if the issue resolves itself before reporting
Correct answer: Report it through established channels such as a supervisor or compliance hotline
Employees should promptly report suspected violations through established reporting mechanisms like supervisors, compliance officers, or hotlines.
Question 5: The Stark Law (Physician Self-Referral Law) primarily prohibits physicians from:
- Practicing medicine without a valid state license
- Referring patients to facilities where the physician or immediate family has a financial interest (Correct answer)
- Accepting Medicare or Medicaid assignment
- Owning a private practice in a rural area
Correct answer: Referring patients to facilities where the physician or immediate family has a financial interest
The Stark Law bars physicians from referring patients to designated health service entities in which they or their immediate family members have a financial relationship.
Question 6: Which regulation specifically governs the handling and disposal of hazardous pharmaceutical waste in healthcare settings?
- HIPAA Privacy Rule
- Resource Conservation and Recovery Act (RCRA) (Correct answer)
- Fair Labor Standards Act
- Americans with Disabilities Act
Correct answer: Resource Conservation and Recovery Act (RCRA)
RCRA is the primary federal law governing hazardous waste management, including pharmaceutical waste disposal in healthcare facilities.
Question 7: In healthcare compliance, 'qui tam' provisions allow:
- Patients to sue for medical malpractice without an attorney
- Private individuals to file False Claims Act lawsuits on behalf of the government and share in any recovery (Correct answer)
- Hospitals to report competitor violations anonymously
- Employees to take paid leave for compliance training
Correct answer: Private individuals to file False Claims Act lawsuits on behalf of the government and share in any recovery
Qui tam provisions of the False Claims Act allow whistleblowers (relators) to sue on behalf of the government and receive a percentage of any recovered funds.
Relias Compliance and Regulatory Training 3
Which element is NOT typically part of the OIG's seven elements of an effective compliance program?