Chapter 5

Question 1

Abuse

Answer 1

improper practices outside the acceptable standards of practice

Question 2

Anti-kickback statute

Answer 2

a federal law that prohibits the exchange or offer to exchange anything of value in an effort to induce or reward the referral of business

Question 3

Bias

Answer 3

A preference of one thing over another usually unfairly favoring one over another

Question 4

Clinical Laboratory Improvement Act of 1988(CLIA)

Answer 4

Regulates all laboratory facilities for safety and handling of specimens to ensure accuracy and timeliness of testing regardless of where the test is performed

Question 5

Compliance

Answer 5

adherence to guidelines and regulations set forth by an organization and/or governing body

Question 6

Compliance officer

Answer 6

an individual in an organization or practice who is designated to maintain and impact the adherence to all regulations and guidelines

Question 7

Compliance plan

Answer 7

policies and procedures used to ensure that guidelines and regulations are obeyed including auditing, monitoring and protocol for taking actions when infractions are discovered.

Question 8

Emergency Medical Treatment and active labor act of 1986(EMTALA)

Answer 8

federal law that any hospital emergency room that receives payments from federal healthcare programs to provide medical screening and treat and stabilize any patient regardless of insurance status

Question 9

False Claims act

Answer 9

Federal law that prevents an individual or organization from knowingly creating a false claim to any federal government payer

Question 10

Fraud

Answer 10

deliberate, intentional act for financial gain

Question 11

Medical Practice act

Answer 11

laws defined by each state that regulates the licensing and medical laws for that state and define the scope of practice for licensed and unlicensed individuals in the healthcare field.

Question 12

Officer of Inspector General (OIG)

Answer 12

Independent agent that functions under the department of justice to investigate and protect the integrity of the department of health and human services(HHS) and their recipients as well as all federal healthcare programs

Question 13

Patients bill of rights

Answer 13

basic rules of conduct between the patient and the caregivers

Question 14

Sanctions

Answer 14

penalties to serve as punishment or enforcement of rules and regulations

Question 15

Stark laws

Answer 15

a set of federal laws designed to maintain the integrity of the medical field; includes anti-trust laws to prevent physicians from gaining financially from solicitation of services or monopolizations of services

Question 16

Whistleblower

Answer 16

an individual; usually an employee who turns in his or her employer for potential fraud and abuse