CPRP Credentialing, Compliance, and Legal Questions and Answers — Questions and Answers
Question 1: A hospital is recruiting a physician who currently practices in another state. The physician holds a medical license and a DEA registration in their current state. To legally prescribe controlled substances at the new hospital, what must the physician do regarding their DEA registration?
- Transfer their existing DEA registration to the new practice address.
- Use their current DEA registration, as it is a federal credential valid in any state.
- Obtain a new, separate DEA registration for the state in which the new hospital is located. (Correct answer)
- Apply for a temporary waiver from the DEA to prescribe while the new state license is pending.
Correct answer: Obtain a new, separate DEA registration for the state in which the new hospital is located.
The Drug Enforcement Administration (DEA) requires a practitioner to have a separate DEA registration for each state in which they prescribe controlled substances. A DEA registration is based on the practitioner's state license, and its authority is limited to that state. Therefore, moving to a new state to practice requires obtaining a new, state-specific DEA registration.
Question 2: A hospital must report an adverse action against a physician's clinical privileges to the National Practitioner Data Bank (NPDB). Which of the following scenarios would trigger this mandatory reporting requirement?
- A 20-day precautionary suspension of privileges pending a peer review investigation.
- A letter of counseling issued to the physician regarding their charting habits.
- A professional review action that restricts the physician's privileges for more than 30 days. (Correct answer)
- The physician voluntarily resigns from the medical staff for personal reasons unrelated to any investigation.
Correct answer: A professional review action that restricts the physician's privileges for more than 30 days.
According to the Health Care Quality Improvement Act (HCQIA), hospitals and other healthcare entities are required to report to the NPDB any professional review action that adversely affects a physician's clinical privileges for a period longer than 30 days. Shorter suspensions or administrative actions like counseling do not meet the reporting threshold.
Question 3: What was the primary purpose for the enactment of the Health Care Quality Improvement Act of 1986 (HCQIA)?
- To establish national standards for physician compensation and fair market value.
- To provide legal immunity for good-faith peer review activities and establish the National Practitioner Data Bank. (Correct answer)
- To regulate the use of telemedicine and electronic health records across state lines.
- To create the federal Anti-Kickback Statute and define safe harbors for physician recruitment.
Correct answer: To provide legal immunity for good-faith peer review activities and establish the National Practitioner Data Bank.
The HCQIA was enacted primarily to encourage good-faith professional peer review by providing qualified immunity to those who participate in it. A second major component of the act was the creation of the National Practitioner Data Bank (NPDB) to prevent practitioners with a history of malpractice or adverse actions from moving from state to state without disclosure.
Question 4: A hospital enters into a Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG). Which of the following is a core obligation the hospital must undertake as part of the CIA?
- Divest from all physician-owned distributorships within one year.
- Merge its compliance department with the legal department.
- Prohibit the employment of individuals excluded from federal healthcare programs.
- Reduce its physician recruitment incentives by 50% for the duration of the agreement. (Correct answer)
Correct answer: Reduce its physician recruitment incentives by 50% for the duration of the agreement.
A typical Corporate Integrity Agreement requires the healthcare entity to implement a robust compliance program over a multi-year period (usually five years). A key provision of this is screening all current and future employees and contractors to ensure none are excluded from participating in federal healthcare programs, such as Medicare and Medicaid.
Question 5: Which of the following is a key distinction between the federal Anti-Kickback Statute (AKS) and the Stark Law?
- The Stark Law applies only to hospital-physician relationships, while the AKS applies to all healthcare providers.
- The AKS requires proof of specific intent to induce referrals, whereas the Stark Law is a strict liability statute. (Correct answer)
- Violations of the Stark Law carry criminal penalties, while AKS violations are purely civil.
- The AKS pertains only to designated health services (DHS), while the Stark Law covers any service paid for by federal programs.
Correct answer: The AKS requires proof of specific intent to induce referrals, whereas the Stark Law is a strict liability statute.
The Anti-Kickback Statute is an intent-based criminal statute, meaning a prosecutor must prove that a party knowingly and willfully offered or received remuneration to induce referrals. In contrast, the Stark Law is a strict liability civil statute, meaning intent is irrelevant; if a prohibited financial relationship exists and an exception is not met, the law is violated.
Question 6: Under the Stark Law's physician recruitment exception, a hospital can provide financial incentives to a physician joining a local private practice. What is a critical requirement for this arrangement to be compliant?
- The recruited physician must refer at least 50% of their patients to the recruiting hospital.
- The financial assistance must be structured as a loan with a market-rate interest.
- The arrangement must be set forth in a written agreement and the remuneration cannot be based on the volume or value of anticipated referrals. (Correct answer)
- The physician must agree to serve on a hospital committee for a minimum of two years.
Correct answer: The arrangement must be set forth in a written agreement and the remuneration cannot be based on the volume or value of anticipated referrals.
The Stark Law's physician recruitment exception has several strict requirements. Among the most critical are that the entire arrangement must be documented in a signed written agreement, and any remuneration provided (such as an income guarantee) cannot take into account the volume or value of actual or anticipated referrals from the physician to the hospital.
CPRP Credentialing, Compliance, and Legal Questions and Answers
A hospital is recruiting a physician who currently practices in another state.
The physician holds a medical license and a DEA registration in their current state.
To legally prescribe controlled substances at the new hospital, what must the physician do regarding their DEA registration?