Exam 4 Flashcards
As the Compliance Officer in your organization, the first step you should take when you discover evidence of a violation of the law is to:
Inform & consult with the organization’s legal counsel exists; if not, inform the highest executive available or known
Realtors or “whistle-blowers” who sue under the False Claims Act’s Qui-Tam provision can recieve up to what percentage of any amount recovered from the successful prosecution of the case
30%
A physician may, without breaking any laws, recieve money from a manufacturer of medical devices as an inducement to use that manufacturer’s medical device if that medical device is paid for by Medicare and the physician perscribes that device to his patients
false
A payment to a doctor by a medical device manufacturer for using a device made by that manufacturer in a procedure on a patient where the patient paid for the device & the procedure with his own money would be a violation of the Federal Anti-kickback statute
false
A physician may, without breaking any laws, refer a medicare patient to a home health agency that is owned by his wife who Bill’s Medicare for those home services & not be in violation of the Physician Self-Refereal Law
false
According to the OIG’s recommendations & the Federal Sentencing Guidelines, if an organization has a person designated to serve as the focal point for or is in charge of compliance activities, that will satisfy one element in establishing an adequate compliance program
true
An orthopedic physician, Dr. Hyde, who accepts Medicare payments for treatment for Mrs. Smith may, without breaking any laws, refer Mrs. Smith to an internal imaging clinic which Dr. Hyde owns if that internal imaging clinic bills Medicare for services provided to Mrs. Smith based on the referral by Dr. Hyde
false
Education of employees of a health care organization, which bills Medicare, on the requirements of ethical & legal issues regarding Medicare participation is not an essential part of the compliance program
false
The OIG recommends organizations have an individual who has access to the governing body in order to provide information to the governing body about compliance issues
true
The Federal Anti-Kickback Statute applies to those people who pay for referrals, as well as those people who receive the kickback for the referral, if any money relating to the subject of the kickback comes from Medicare or other Federal healthcare payment programs
true
There are no criminal penalties for violation of the Federal Anti-kickback statute
false
Written policies & procedures are not necessary for a small organization’s compliance program; they are only necessary for large healthcare organizations, such as hospitals & large group practices
false
Which of the following Federal Acts, which we have studied in this class, prohibits the submission of false or fraudulent claims for payment to the U.S. Government
false claims act
What does the Federal Ant-kickback Statute prohibit:
Offering, or receiving, anything of value to induce, or reward, referrals of Federal Healthcare program business
How many “essential elements” are there in an OIG’s recommended compliance program:
7
Relative to what we have studied in this class, what does PHI stand for?
Protected Health Information
There are two parts (or rules) to HIPAA. What are they?
privacy and security
In reference to the False Claims Act, a “realtor” is:
The person who is the plaintiff in a law suit via the qui-tam provisions of the False Claims Act
Regular audits of a billing department, or processes, in a doctor’s office are not required as part of a viable compliance program
false
Which of the first 10 amendments to the U.S. Constitution, that we reviewed in class covering criminal procedure, prohibits the government from convicting a person two times for the same offense?
5th amendment
