Class 2:Fraud and Abuse/Licensing

Question 1

Licensure process assures

Answer 1

that whose who optometric services gets it from qualified well trained Ods

Question 2

Licensure Laws define

Answer 2

what optometry is, how you get a license to do it, what happends if you do it without a license

Question 3

Scope of Practice Laws

Answer 3

aka practice acts define what professionals can and can’t do
-may be overlap btwn professionals

Question 4

What three things do licensure laws do?

Answer 4

1. describe what is permitted
2. Describe what is prohibited
3. Describe limitations on what is permitted

Question 5

Who admistered the Alabama practice act of optometry

Answer 5

Alabama Board of Optometry; issues advisory opinions, conduct investigations, and hold disciplinary proceedings

Question 6

How do you get in trouble with the AL Board of Optometry ?

Answer 6

practicing w/out a license, helping someone to practicing w/out license, making false statements in application and renewal license apps, using drugs other than approved, unprofessional conduct

Question 7

Unprofessional conduct is

Answer 7

behavior placing pt at risk, misleading ads, not releasing patient info to patient, not providing emergency (sight-threatening) care to existing patient.

Question 8

Unprofessional conduct includes practicing beyond the scope of license and not meeting the minimum testing standards.

Answer 8

TRUE

Question 9

Anti-Kickback statue is a

Answer 9

federal criminal statute

Question 10

The anti-kickback statue to aplies to ALL federal healthcare programs.

Answer 10

True, it applies to all not just Medicare and Medicaid

Question 11

What does the ant-kickback statute say

Answer 11

Anyone who OFFERs, PAYS, SOLICITS OR RECEIVES any remunration (direct or indirect) in cash or in return for REFERRING someone for an item or service for which payment may be made under federal healthcare program

Question 12

The anti-kickback also applies to referalls in return for purchasing , leasing or ordering (arranging for recommending) any good, facility, service, or item for which payment may be made under federal health care program.

Answer 12

true.

Question 13

Remuneration means

Answer 13

anything of value tangible or intangible: cash, rent discount, free items or services

Question 14

Referral means

Answer 14

means referral of a patient or purchasing, leasing, ordering of ANY good, facility, service or any portion of the patients care may be paid in whole or in part by Federal healthcare program

Question 15

Violating the Antikickback Statute requires

Answer 15

intent to influence referrals, but a violation can occur even where there are legitimate purposes, present as well

Question 16

Can the Anti-Kickback statute form the bases of civil liability?

Answer 16

Yes, it can form the basis of civil liability. It has criminal penalities including prison.

Question 17

Can you get in trouble if there was only ONE purpose to obtain money for the referral of services or induce futher referrals?

Answer 17

Yes. The “one purpose test” applies to any of those arranagments. An arrangement with 99% good purposes and 1% bad purpose is a violation.

Question 18

We took the money but didn’t make the referals is NOT a violation of the anti-kickback.

Answer 18

False. The statute applies not just to consummated kickbacks, but offers and solicitations.

Question 19

Violations of anti-kickback mean that indviduals and corporations are liable.

Answer 19

TRUE

Question 20

Criminal Penalities for Anti-Kickback statute

Answer 20

Felony -up to 5 years in prison for each offense, criminal fine of up to 25,000, exclusion from government reimbursement programs

Question 21

If the person settles in the case of violation of ANTI-K they are sometimes required to

Answer 21

enter into a corporate integrity agreement (CIA).

Question 22

List the enforcement agencies for the ANTI-K

Answer 22

U.S. Dept of Health & Human Services Office of Inspector General (OIG), U.S. Department of Justice (DOJ), Whitstleblowers, Medicare & Medicaid Fraud Units in local US Attorney’s Offices

Question 23

Safe harbor regulations insulate certain types of arrangements. What are the safe harbors?

Answer 23

Speciality Referral Arrangement btwn providers, Space Rental, Equipment Rental, Space and Equipment Rental, and Personal Service and Management Contracts

Question 24

T/F Failure to fit with a safe harbor doesn’t mean there is a violation

Answer 24

True.

Question 25

Specialty Referral Arrangements Between Providers protects

Answer 25

protects certain arrangments when an individual or entity agrees to refer a patient to another individual or entity for speciality services in return for the part receiving the referral to the patient back at a certain or under certain circumstances

Question 26

Space Rentals/Equipment Rentals must have (list them) in order to limit opportunity absusive relationships with referrals.

Answer 26

lease written and signed; lease speification of premises, extent of lease, lease term must NOT be less than one year, charges must be consistent with the market value.

Question 27

Personal Service and Management Contracts are when

Answer 27

medical practitions and providers often have agreements to perform services for each other on a mutually benefical basis

Question 28

What are some of the AKS Danger Zones?***

Answer 28

provider joint ventures, space & equipment leases, personal service contracts, consulting/research/educational arrangments, ancillary service relationships

Question 29

The “Bright Line” of Stark is commonly referred to as the

Answer 29

“Stark Law”

Question 30

Stark law is a

Answer 30

strict liability statute

-intent does not matter

Question 31

What does the Stark Law cover

Answer 31

referrals by a physician, a provider with whom the physician has a financial relationship for designated services for which Medicare or medicaid make make payment

Question 32

The Bright Line of Stark applies only to

Answer 32

physicians and immediate (adoptive child, in laws, step parents, spouse of grandparent or grandchild) family members of physicians,applies only when a financial relationship exisits

Question 33

Referral in the Stark Law means

Answer 33

requesting ordering services or certifying medical necessity (including tests ordered pursant to consult)

Question 34

The Stark Law referral does not include

Answer 34

personally performed services

Question 35

Stark law referals does include

Answer 35

“incident to” services

Question 36

Exceptions to Stark Law-Compensation

Answer 36

physician recruitment, payments by physician, charitable donations by physician, a “set in advance” flat amount of aggregate compensation

Question 37

Sanctions for Non-Compliance: who is reposnible for imposing claims liability

Answer 37

Center for Medicare and Medicaid Services (“CMS”)

Question 38

Sanctions for non-compliance: who is responsible for imposing penailites for knowing violations

Answer 38

Office of the Inspector General

Question 39

** AKS is an

Answer 39

intent based criminal statute

Question 40

** Stark is an

Answer 40

Strict liability civil statute

Question 41

*** Non-compliance with an AKS Safe harbor is (violation or not necessarily)

Answer 41

Not necessarilty violation

Question 42

**non compliance with Stark

Answer 42

is ALWAYS a violation

Question 43

_____ only applies where a physician referral is involved and ONLY to Medicare and Medicaid

Answer 43

Stark

Question 44

____ is applies in a broader scope

Answer 44

AKS

Question 45

Compliance with a Stark exception equals compliance with an AKS safe harbor

Answer 45

False. Compliance with Stark does not necesssarily equal compliance with an AKS but some Stark exceptions are condition upon there being no AKS