Healthcare Fraud and Abuse 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 Fraud and Abuse flashcards as text
Under the Stark Law, which of the following is a permissible financial relationship between a physician and a designated health service (DHS) entity?
Answer: A compensation arrangement that meets the fair market value exception
Stark Law allows financial relationships if they meet specific statutory exceptions, including the fair market value compensation exception.
Which federal agency primarily investigates and prosecutes healthcare fraud under the False Claims Act?
Answer: The Department of Justice (DOJ)
The Department of Justice prosecutes False Claims Act cases, though the OIG investigates and the DOJ litigates civil and criminal FCA violations.
A hospital discovers that a physician has been receiving free office space from the hospital in exchange for referrals. This most likely violates which law?
Answer: Anti-Kickback Statute
Receiving free office space in exchange for referrals constitutes remuneration linked to referral volume, which violates the Anti-Kickback Statute.
Which element distinguishes 'fraud' from 'abuse' in healthcare compliance?
Answer: The intentional, knowing, or reckless nature of the conduct
Fraud requires intentional or knowing deception, whereas abuse involves practices that are inconsistent with sound fiscal, business, or medical practices but may lack specific intent.
Under the False Claims Act, what is the minimum per-claim civil penalty range (approximately) for a false claim submitted to the government?
Answer: $13,000 to $27,000
FCA civil penalties are adjusted annually for inflation; as of recent updates, the per-claim penalty range is approximately $13,000 to $27,000 per false claim.
A medical equipment supplier bills Medicare for 'motorized wheelchairs' but delivers standard manual wheelchairs. This is an example of:
Answer: Upcoding
Upcoding involves billing for a higher-cost or more intensive service or item than was actually provided, such as billing for a motorized wheelchair when only a manual one was supplied.
The 'safe harbor' regulations under the Anti-Kickback Statute are important because they:
Answer: Describe arrangements that will not be prosecuted as kickbacks even if they technically involve remuneration
AKS safe harbors protect specified arrangements from prosecution because, while they may involve remuneration, they are unlikely to cause the types of abuses the statute was designed to prevent.