Healthcare Compliance Laws Flashcards
7 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 7 Healthcare Compliance Laws flashcards as text
Under a Corporate Integrity Agreement (CIA), which reporting obligation is typically imposed on a healthcare organization?
Answer: Annual reports to the OIG documenting compliance program activities
CIAs typically require covered entities to submit annual reports to the OIG documenting their compliance program activities, claims audits, training completion, and any reportable events discovered during the year.
The AKS safe harbor for personal services and management contracts requires that compensation be set in advance and be consistent with what standard?
Answer: Fair market value and not determined based on referral volume
Under the personal services safe harbor, aggregate compensation must be set in advance, be consistent with fair market value, and must not be determined in a manner that accounts for the volume or value of referrals.
Which Affordable Care Act provision created the first federal requirement to screen and re-screen providers and suppliers before enrolling them in Medicare and Medicaid?
Answer: Section 6401 — Provider Screening and Other Enrollment Requirements
ACA Section 6401 established categorical screening levels (limited, moderate, high) and mandated that CMS and states screen all providers and suppliers upon enrollment and periodically thereafter.
A physician receives free tickets to a sporting event from a medical device company. Under the AKS, the primary risk is that these tickets may constitute what?
Answer: Remuneration intended to induce referrals or purchases
Providing gifts of value to physicians can constitute remuneration under the AKS if given with the intent to induce or reward referrals of items or services reimbursable by federal healthcare programs.
Under the HIPAA Breach Notification Rule, when must a covered entity notify HHS of a breach affecting fewer than 500 individuals?
Answer: No later than 60 days after the end of the calendar year in which the breach occurred
For breaches affecting fewer than 500 individuals, covered entities must notify HHS no later than 60 days after the end of the calendar year in which the breach occurred, via the HHS online log.
The Sunshine Act (Open Payments program) requires manufacturers of drugs, devices, and biologicals to report transfers of value to physicians and teaching hospitals to which agency?
Answer: The Centers for Medicare and Medicaid Services
The Physician Payments Sunshine Act requires applicable manufacturers and group purchasing organizations to report payments and transfers of value to covered recipients to CMS, which publishes the data publicly.
Which term describes a compliance program component that enables employees to report suspected violations confidentially without fear of retaliation?
Answer: Hotline or anonymous reporting mechanism
An anonymous hotline or reporting mechanism is a core element of an effective compliance program, allowing employees to report concerns confidentially and reducing fear of retaliation.