Ch 1 & 2 Flashcards
Ch 1 & 2
Feelgood Hospital is under a 5 year CIA, with government-imposed requirements for development and maintenance of an effective Compliance Program, and the requirement to use external auditors for periodic claims audits. Which of the following is true:
a. Costs incurred specifically related to meeting terms of the CIA are permitted to be included in the cost report, just like any other operational costs.
b. Because the hospital agreed to a settlement and was not convicted for the alleged violations, the Compliance Program is considered a voluntary program.
c. The government chooses and pays for the external auditors.
d. None of the above.
D. None of the above
Explanation: CIA-related costs cannot be included in the cost report; government-imposed Compliance Programs are not considered voluntary programs and has nothing to do with conviction status; the hospital is required to choose (with government review and right to object) and pay for any auditors called for in the CIA.
You are the new Compliance Officer, hired after I.M. Healthy Hospital reorganized and decided that the General Counsel should no longer also serve in that role. Upon review of the Code of Conduct, you find that it is written using lots of legal jargon. What action do you take:
a. Keep the Code of Conduct as it is, as with all the complex legal language it makes the hospital seem to be very knowledgeable about laws and regulations if it is reviewed by regulators or external auditors.
b. Pull a sample hospital Code of Conduct off the internet and insert the hospital name, as it will save time and it was most likely that an expert wrote it and covered all the requirements for a hospital Code of Conduct.
c. Rewrite the Code of Conduct in plain, concise language tailored to I.M. Well Hospital so that employees can use it as a general guide for decision making.
d. Rewrite the Code of Conduct with detailed restating of organizational policies and procedures and all the laws and regulations you can think of, so that employees can’t say they weren’t aware of requirements.
C. Rewrite the Code of Conduct…
Explanation: Code of Conduct should be written in clear, concise language so that it is understandable to the audience, and should be tailored to the specific issues of the organization.
What is the preferred method of monitoring and auditing?
A. Looking at coding records from 2 years ago for patterns of inconsistency.
B. Reviewing patient marketing material from the beginning of the program. The program has been in effect for 5 years.
C. A concurrent review of bad rebt reports.
D. A statistical sampling of claims that have already paid.
C. A concurrent review
Explanation:
Concurrent reviews (reviews of present claims) are better than retrospective reviews because they address issues as they arise. A,B, and D are all retrospective reviews. All of these areas are of interest in a monitoring program. This question was focused solely on the timing of the monitoring and auditing.
The River Hospital is attempting to open its files to a new Compliance Officer for review. What documentation is not critical for his review? A. The patient charts for the OB floor. B. The record of PHI breaches. C. The labs billing records. D. Contracts with Acme DME suppliers.
B. The record of PHI breaches
Explanation:
The book states that the compliance officer should have access to patient records, billing records, contracts with suppliers and hospital-based physicians. These are examples of documents relevant to compliance acrtivities. The book does not reference PHI. (Side note: At our hospital, PHI breaches fall under Information security not Compliance activities.)
The Federal Sentencing Guidelines uses 4 mitigating factors, which are:
a. Effective compliance program, reporting the violation promptly, awareness of the violation, and accepts responsibility for the violation.
b. Willfully ignorant of the offense, repeat violation, government investigation was hindered and tolerance of the violation was pervasive.
c. Effective compliance program, reporting the violation promptly, cooperate with government investigation and accepts responsibility for the violation.
d. Effective compliance program, first offense, cooperate with government investigation and accepts responsibility for the violation.
C. Effective compliance program, reporting the violation promptly, cooperate with government investigation and accepts responsibility for the violation
Source: Compliance 101 – Page 13
What are some obstacles to an effective compliance program?
a. Lack of funding
b. Resistance to change
c. Fear of retaliation
d. Lack of education and training
e. All of the above
e. All of the above
Source : Compliance 101 – Page 14
The OIG recommends that employees be required to have a specific number of educational hours per year, as appropriate. Many corporate integrity agreements require a minimum of:
a. 1 - 3hour
b. 2 – 4 hours
c. 5 or more hours
d. No specific amount
a. 1 – 3 hours
Source: Compliance 101 – Page 25
What is the term called for an organization’s commitment to compliance by the board, management, and employees? It summarizes ethical behavior and legal principles the healthcare organization operates.
A) Code of Conduct
B) Federal Sentencing Guidelines
C) Internal Controls
A) Code of Conduct
Who can bring suit under the False Claims Act? A) Employees B) Medicare, Medicaid C) Any referral source D) Whistleblower
D) Whistleblower
A Whistleblower recently identified a number of fraudulent Medicare claims. Her husband is asking about a potential reward, which statement is true.
a. She must inform the organization about the claims before notifying the government
b. If DOJ takes the case, she could receive at least 15% of government total award
c. She must at least try to resolve the claims issue
d. None of the above
b. If DOJ takes the case, she could receive at least 15% of government total award
Explanation: The government has no requirements about a whistleblower informing or resolving an issue first. The government wants to encourage an environment of trust where problems are brought forward.
Source : Compliance 101 3rd edition p. 14
A potential violation was identified by Compliance, what should be done first?
a. Meet with in-house legal counsel
b. Perform an internal investigation
c. Modify the source of the wrong doing
d. Create an investigative team
b. Perform an internal investigation…….
Explanation: Without knowing what the problem is, you cannot modify the problem or stop the bleeding. Once you do find a problem, you can proceed to next steps by “stoping bleeding,” getting legal involvement, HR involvement, etc.”
Source: Compliance 101 3rd edition p. 42
Obligations to the Employing Organization, during an investigation, it is important to keep all identities discreet as much possible to prevent and to protect the person who is being investigated and to protect the reputation of the entity.
a. True
b. False
c. None of the above
a. True
Explanation: During an investigation, it is important to keep all identities involved in the investigation discreet as much as possible, to prevent any damage.
Source: Compliance 101 book, Appendix J, Code of Ethics for Health Care Compliance Professionals.
Education, Adult learning styles, everyone learns differently. It is important to teach different ways to reach every specific staff learning styles. Others learn through seeing, touching and engaging in groups. The best approach is to develop a variety of education materials.
A. Develop power point to the visual learner
B. Hand out pam pletts and examples of scenerios
C. Provide lunch to engage everyone in the discussion
D. All of the above
E. All the above
Explanation: During training and education, it is important to be mindful of adult learning styles. Everyone learns different from others. An example one adult may learn within the three mechanism as far as hearing, seeing and touch, and another adult could just by hearing. It is highly important to accommodate each learning styles.
