RHIT - Registered Health Information Technician Healthcare Compliance and Regulations 2 — Questions and Answers
Question 1: What is the primary purpose of the False Claims Act (FCA) in healthcare?
- To regulate pharmaceutical pricing
- To prevent and penalize the submission of false or fraudulent claims to government programs (Correct answer)
- To establish hospital building codes
- To manage healthcare worker licensing
Correct answer: To prevent and penalize the submission of false or fraudulent claims to government programs
The False Claims Act prohibits knowingly submitting false claims to the government for payment.
The FCA allows penalties including treble damages and per-claim fines. The qui tam provision allows private citizens to file lawsuits on behalf of the government.
Question 2: Which federal regulation protects the confidentiality of substance abuse treatment records?
- HIPAA Privacy Rule only
- 42 CFR Part 2 (Correct answer)
- The Affordable Care Act
- EMTALA
Correct answer: 42 CFR Part 2
42 CFR Part 2 provides heightened confidentiality protections for substance abuse treatment records, more restrictive than HIPAA.
42 CFR Part 2 requires patient consent for nearly all disclosures including for treatment, prohibits re-disclosure, and prevents use in criminal proceedings against the patient.
Question 3: A hospital receives a subpoena duces tecum for a patient's medical records. What does this require?
- The hospital must appear in court to testify
- The hospital must produce the specified documents or records (Correct answer)
- The patient must sign a consent form
- The hospital must delete the records
Correct answer: The hospital must produce the specified documents or records
A subpoena duces tecum is a court order requiring the production of specified documents or records.
HIM professionals must verify the subpoena's validity, determine if records are included in the legal health record, and check whether a court order is additionally required.
Question 4: What is the purpose of the OIG Work Plan in healthcare compliance?
- To schedule building maintenance
- To outline the government's planned areas of focus for audits and enforcement in healthcare (Correct answer)
- To manage employee schedules
- To define patient treatment protocols
Correct answer: To outline the government's planned areas of focus for audits and enforcement in healthcare
The OIG Work Plan identifies areas of focus for audit and investigation activities.
The OIG Work Plan helps compliance officers identify areas of increased scrutiny and proactively audit those areas. Focus areas commonly include E/M coding accuracy, modifier usage, and telehealth billing.
Question 5: Under the Anti-Kickback Statute, which arrangement is prohibited?
- A hospital offering continuing education to staff
- A physician receiving payment from a laboratory in exchange for patient referrals (Correct answer)
- A hospital providing free flu vaccinations
- A physician group sharing overhead expenses
Correct answer: A physician receiving payment from a laboratory in exchange for patient referrals
The Anti-Kickback Statute prohibits exchanging anything of value to induce or reward referrals for federally reimbursable services.
The AKS is a criminal statute with safe harbors for legitimate arrangements including personal services, fair market value rentals, employee compensation, and certain investments.
Question 6: What is required when a covered entity uses a business associate to perform functions involving PHI?
- Nothing, business associates have no HIPAA obligations
- A Business Associate Agreement (BAA) specifying permitted uses and safeguards for PHI (Correct answer)
- The covered entity must hire the business associate as an employee
- The business associate must obtain HIPAA certification
Correct answer: A Business Associate Agreement (BAA) specifying permitted uses and safeguards for PHI
HIPAA requires a BAA before sharing PHI with a business associate.
BAAs must specify permitted uses, required safeguards, breach notification obligations, and termination provisions. The HITECH Act made business associates directly liable for certain HIPAA provisions.
RHIT - Registered Health Information Technician Healthcare Compliance and Regulations 2
What is the primary purpose of the False Claims Act (FCA) in healthcare?