CCT - Certified Compliance Technician Key Federal Regulations Questions and Answers — Questions and Answers
Question 1: A hospital's emergency department provides a medical screening exam to an individual who complains of severe abdominal pain but then refuses to provide further treatment after discovering the individual is uninsured. Which of the following federal regulations has the hospital most likely violated?
- Health Insurance Portability and Accountability Act (HIPAA)
- Stark Law (Physician Self-Referral Law)
- Emergency Medical Treatment and Labor Act (EMTALA) (Correct answer)
- False Claims Act (FCA)
Correct answer: Emergency Medical Treatment and Labor Act (EMTALA)
EMTALA requires Medicare-participating hospitals with emergency departments to screen and treat the emergency medical conditions of patients in a non-discriminatory manner, regardless of their ability to pay. Refusing to provide stabilizing treatment for an emergency medical condition based on insurance status is a direct violation of this act.
Question 2: A medical device company offers a physician a lavish, all-expenses-paid vacation in exchange for the physician agreeing to exclusively use their company's brand of pacemakers for all Medicare patients. This arrangement would most likely be a violation of which federal statute?
- Anti-Kickback Statute (AKS) (Correct answer)
- Clinical Laboratory Improvement Amendments (CLIA)
- Health Insurance Portability and Accountability Act (HIPAA)
- Emergency Medical Treatment and Labor Act (EMTALA)
Correct answer: Anti-Kickback Statute (AKS)
The Anti-Kickback Statute (AKS) is a federal criminal law that prohibits the knowing and willful payment of 'remuneration' to induce or reward patient referrals or the generation of business involving any item or service payable by federal health care programs (e.g., Medicare). The vacation is considered remuneration intended to induce referrals.
Question 3: Under the False Claims Act, a private individual with knowledge of fraud against the government can file a lawsuit on behalf of the United States. What is this provision commonly called?
- Safe Harbor Provision
- Qui Tam Provision (Correct answer)
- Relator Exemption
- Stark Exception
Correct answer: Qui Tam Provision
The False Claims Act contains a 'qui tam' provision, which allows a private person, known as a 'relator,' to file a lawsuit on behalf of the government and potentially receive a percentage of any recovered funds.
Question 4: A physician owns a local imaging center and refers all of her Medicare patients needing MRI scans to her own facility. This practice is most directly addressed by which of the following regulations?
- Anti-Kickback Statute (AKS)
- Health Information Technology for Economic and Clinical Health (HITECH) Act
- Stark Law (Physician Self-Referral Law) (Correct answer)
- Clinical Laboratory Improvement Amendments (CLIA)
Correct answer: Stark Law (Physician Self-Referral Law)
The Stark Law, or Physician Self-Referral Law, prohibits physicians from referring Medicare or Medicaid patients for designated health services (DHS), such as imaging, to an entity with which the physician or an immediate family member has a financial relationship, unless a specific exception applies.
Question 5: Which of the following is NOT a patient right granted under the HIPAA Privacy Rule?
- The right to demand deletion of their entire medical record for any reason. (Correct answer)
- The right to access and obtain a copy of their protected health information (PHI).
- The right to request an amendment to their PHI if they believe it is inaccurate.
- The right to receive an accounting of disclosures of their PHI.
Correct answer: The right to demand deletion of their entire medical record for any reason.
While the HIPAA Privacy Rule grants patients several rights, including the right to access, amend, and receive an accounting of disclosures of their PHI, it does not provide an absolute right to have their entire medical record deleted. There are legal and medical requirements for retaining records for a certain period.
Question 6: The Clinical Laboratory Improvement Amendments (CLIA) categorize laboratory tests based on their complexity. Which of the following is the category for the simplest tests with a low risk of incorrect results?
- High complexity
- Moderate complexity
- Provider-performed microscopy
- Waived (Correct answer)
Correct answer: Waived
CLIA categorizes tests into three main levels of complexity: waived, moderate, and high. Waived tests are simple procedures with a low risk for erroneous results, such as certain rapid strep tests or urine pregnancy tests, and are subject to the least amount of regulatory oversight.
CCT - Certified Compliance Technician Key Federal Regulations Questions and Answers
A hospital's emergency department provides a medical screening exam to an individual who complains of severe abdominal pain but then refuses to provide further treatment after discovering the individual is uninsured.
Which of the following federal regulations has the hospital most likely violated?