Regulatory Compliance and Government Oversight Questions and Answers Flashcards
6 cards from real CHC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Regulatory Compliance and Government Oversight Questions and Answers flashcards as text
Which federal agency publishes the OIG Work Plan that healthcare compliance officers use to prioritize audit areas each year?
Answer: Office of Inspector General (OIG)
The OIG publishes its annual Work Plan to identify areas of focus for audits and investigations in Medicare and Medicaid programs.
What is the primary purpose of the OIG's List of Excluded Individuals and Entities (LEIE)?
Answer: To identify parties excluded from participating in federal healthcare programs
The LEIE identifies individuals and entities excluded from participation in Medicare, Medicaid, and other federal healthcare programs due to fraud, abuse, or other disqualifying conduct.
A Corporate Integrity Agreement (CIA) is typically entered into between a healthcare entity and which agency?
Answer: OIG
CIAs are negotiated between the OIG and healthcare providers as a condition of settling False Claims Act cases, requiring ongoing compliance obligations.
Under the Stark Law (42 U.S.C. § 1395nn), which of the following best describes a 'designated health service'?
Answer: Specific services including clinical laboratory and physical therapy that trigger the self-referral prohibition
Stark Law designates specific health services such as clinical laboratory, physical therapy, radiology, and others where physician self-referral to entities with a financial relationship is prohibited.
Which statute imposes criminal and civil penalties for knowingly submitting false claims to federal healthcare programs?
Answer: False Claims Act
The False Claims Act (31 U.S.C. §§ 3729–3733) imposes liability on persons who knowingly present false or fraudulent claims for payment to the federal government.
What does 'safe harbor' mean in the context of the Anti-Kickback Statute?
Answer: Specific arrangements that are protected from prosecution under the AKS
Safe harbors under the AKS are regulatory exceptions that protect certain business arrangements from prosecution if they meet specific criteria.