Trivium Quality Improvement and Compliance 3 — Questions and Answers
Question 1: Under the False Claims Act, whistleblowers who report Medicare/Medicaid fraud may receive:
- Immunity from all future audits
- A percentage of the government's recovery as a reward (Correct answer)
- Immediate promotion within their organization
- Permanent employment protection but no financial reward
Correct answer: A percentage of the government's recovery as a reward
The False Claims Act's qui tam provisions allow whistleblowers to receive 15–30% of the government's recovery in successful fraud cases.
Question 2: A healthcare organization's compliance program should include which of the following elements?
- Written policies, training, auditing, and a reporting mechanism (Correct answer)
- Only financial audits and documentation reviews
- Voluntary self-reporting of all adverse events to the media
- A list of employees with prior disciplinary history
Correct answer: Written policies, training, auditing, and a reporting mechanism
An effective compliance program includes written standards, training, auditing/monitoring, and mechanisms for employees to report concerns.
Question 3: Which statistical tool is commonly used in quality improvement to display variation in a process over time?
- Pareto chart
- Control chart (run chart) (Correct answer)
- Fishbone diagram
- Histogram
Correct answer: Control chart (run chart)
Control charts (also called run charts or Shewhart charts) plot data over time to distinguish normal process variation from special cause variation.
Question 4: A patient's protected health information (PHI) can be disclosed WITHOUT patient authorization for which purpose?
- Marketing a new pharmaceutical product
- Releasing records to the patient's employer
- Treatment, payment, and healthcare operations (TPO) (Correct answer)
- Sharing with a patient's family at their request only when the patient is present
Correct answer: Treatment, payment, and healthcare operations (TPO)
HIPAA permits disclosure of PHI without authorization for treatment, payment, and healthcare operations (TPO) activities.
Question 5: A fishbone (Ishikawa) diagram is used in quality improvement to:
- Track infection rates over a six-month period
- Identify and categorize potential causes of a problem (Correct answer)
- Compare outcomes across multiple departments
- Plot the frequency of adverse events on a timeline
Correct answer: Identify and categorize potential causes of a problem
A fishbone diagram visually maps cause-and-effect relationships to identify all potential root causes of a quality problem.
Question 6: The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard requires healthcare employers to:
- Test all patients for HIV before treatment
- Provide hepatitis B vaccination to at-risk employees at no cost (Correct answer)
- Require employees to purchase their own personal protective equipment
- Post OSHA violation notices in patient rooms
Correct answer: Provide hepatitis B vaccination to at-risk employees at no cost
OSHA's Bloodborne Pathogens Standard mandates that employers offer hepatitis B vaccination free of charge to employees with occupational exposure risk.
Question 7: Which term describes the systematic review of clinical records to ensure documentation supports the level of care billed?
- Concurrent review
- Retrospective coding audit (Correct answer)
- Utilization review
- Prospective payment analysis
Correct answer: Retrospective coding audit
A retrospective coding audit reviews medical records after care is delivered to verify that coding and billing accurately reflect the documented services.
Trivium Quality Improvement and Compliance 3
Under the False Claims Act, whistleblowers who report Medicare/Medicaid fraud may receive: