NHI Healthcare Regulations & Compliance 2 — Questions and Answers
Question 1: Which federal law prohibits healthcare providers from knowingly submitting false claims to Medicare or Medicaid?
- HIPAA
- False Claims Act (Correct answer)
- Anti-Kickback Statute
- Stark Law
Correct answer: False Claims Act
The False Claims Act (FCA) imposes liability on individuals and companies who defraud the federal government by submitting false or fraudulent claims for payment.
Question 2: A patient requests an amendment to their medical record, claiming an entry is inaccurate. Under HIPAA, the covered entity must respond within how many days?
- 30 days
- 45 days
- 60 days (Correct answer)
- 90 days
Correct answer: 60 days
HIPAA requires covered entities to respond to amendment requests within 60 days, with a possible 30-day extension if notice is provided.
Question 3: Which organization accredits hospitals and healthcare organizations and has 'deemed status' from CMS for Medicare certification?
- OSHA
- The Joint Commission (TJC) (Correct answer)
- AHRQ
- AHA
Correct answer: The Joint Commission (TJC)
The Joint Commission holds deemed status from CMS, meaning TJC-accredited facilities are considered to meet Medicare Conditions of Participation.
Question 4: Under the Occupational Safety and Health Act, employers must provide a workplace free from recognized hazards under which doctrine?
- Respondeat superior
- General Duty Clause (Correct answer)
- Safe harbor provision
- Corporate compliance mandate
Correct answer: General Duty Clause
The General Duty Clause of the OSH Act requires employers to provide a workplace free from recognized hazards likely to cause death or serious physical harm.
Question 5: A healthcare worker accidentally views a celebrity patient's records out of curiosity without a clinical reason. This is best described as:
- An incidental disclosure
- A required disclosure
- A HIPAA privacy violation (Correct answer)
- A permissible use
Correct answer: A HIPAA privacy violation
Accessing a patient's PHI without a legitimate work-related reason violates the HIPAA minimum necessary standard and constitutes a privacy violation.
Question 6: The Consolidated Omnibus Budget Reconciliation Act (COBRA) primarily protects employees by:
- Guaranteeing minimum wage in healthcare jobs
- Allowing continuation of group health insurance after leaving employment (Correct answer)
- Setting standards for Medicare reimbursement
- Requiring employers to offer health insurance
Correct answer: Allowing continuation of group health insurance after leaving employment
COBRA allows employees and their dependents to continue group health insurance coverage for a limited period after losing employment or experiencing other qualifying events.
Question 7: Which regulatory body enforces workplace safety standards and investigates work-related injuries and illnesses in healthcare settings?
- CMS
- FDA
- OSHA (Correct answer)
- DEA
Correct answer: OSHA
The Occupational Safety and Health Administration (OSHA) enforces workplace safety standards, including bloodborne pathogen standards critical to healthcare settings.
NHI Healthcare Regulations & Compliance 2
Which federal law prohibits healthcare providers from knowingly submitting false claims to Medicare or Medicaid?