CPHRM Regulatory Compliance 2 — Questions and Answers
Question 1: Which federal agency enforces the Emergency Medical Treatment and Labor Act (EMTALA)?
- The Joint Commission
- Centers for Medicare & Medicaid Services (CMS) (Correct answer)
- Department of Justice
- Occupational Safety and Health Administration
Correct answer: Centers for Medicare & Medicaid Services (CMS)
CMS enforces EMTALA, which requires hospitals to provide emergency medical screening and stabilization regardless of a patient's ability to pay.
Question 2: Under OSHA's Bloodborne Pathogens Standard, employers must offer hepatitis B vaccination to at-risk employees at:
- The employee's expense within 30 days of hire
- No cost to the employee within 10 days of hire (Correct answer)
- The employee's expense after 90 days of hire
- No cost after completing a 6-month probationary period
Correct answer: No cost to the employee within 10 days of hire
OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) requires employers to offer hepatitis B vaccination at no cost to employees within 10 working days of initial assignment to tasks with occupational exposure.
Question 3: A hospital's compliance program discovers that a physician has been upcoding evaluation and management services. The FIRST step under federal guidelines should be:
- Immediately report to the OIG
- Conduct an internal investigation to determine scope (Correct answer)
- Terminate the physician's privileges
- Notify the state medical board
Correct answer: Conduct an internal investigation to determine scope
Federal compliance guidance recommends conducting a thorough internal investigation to determine the nature and extent of the problem before taking further action.
Question 4: The Stark Law (Physician Self-Referral Law) primarily prohibits physicians from referring Medicare patients to entities:
- In which they hold any professional license
- In which they have a financial relationship, absent an exception (Correct answer)
- That are not accredited by The Joint Commission
- That employ non-physician practitioners
Correct answer: In which they have a financial relationship, absent an exception
The Stark Law prohibits physician referrals for designated health services to entities in which the physician or an immediate family member has a financial relationship, unless a specific exception applies.
Question 5: Which accreditation standard requires hospitals to have a formal process for identifying and managing sentinel events?
- CMS Conditions of Participation
- The Joint Commission's National Patient Safety Goals
- The Joint Commission's Sentinel Event Policy (Correct answer)
- OSHA General Duty Clause
Correct answer: The Joint Commission's Sentinel Event Policy
The Joint Commission's Sentinel Event Policy requires accredited organizations to identify, report, conduct root cause analysis, and implement action plans for sentinel events.
Question 6: Under the False Claims Act, the 'qui tam' provision allows:
- CMS to directly audit hospital billing records
- Private individuals to file lawsuits on behalf of the government and share in recovered damages (Correct answer)
- The OIG to impose mandatory exclusions without a hearing
- Hospitals to self-disclose billing errors without penalty
Correct answer: Private individuals to file lawsuits on behalf of the government and share in recovered damages
The qui tam provision of the False Claims Act allows whistleblowers (relators) to file lawsuits on behalf of the government and receive 15-30% of recovered funds.
Question 7: A hospital risk manager learns that a state survey found deficiencies in its infection control practices. The facility must submit a Plan of Correction (PoC) within:
- 10 days of receiving the survey report
- 30 days of receiving the statement of deficiencies (Correct answer)
- 60 days of the exit conference
- 90 days after CMS notification
Correct answer: 30 days of receiving the statement of deficiencies
CMS requires facilities to submit a Plan of Correction within 10 calendar days of receiving the Statement of Deficiencies (Form CMS-2567), though the PoC implementation timeline may extend longer.
CPHRM Regulatory Compliance 2
Which federal agency enforces the Emergency Medical Treatment and Labor Act (EMTALA)?