Whistleblower Protections and Reporting Mechanisms Flashcards

Under which laws are healthcare employees protected from retaliation for reporting fraud or patient safety concerns to federal authorities?

Answer: False Claims Act and ACA Section 1558

The False Claims Act's anti-retaliation provision and ACA Section 1558 together protect employees who report healthcare fraud or safety concerns from adverse employment actions.

What is the purpose of the 'public disclosure bar' under the False Claims Act?

Answer: To prevent qui tam suits based on publicly available information unless the relator is the original source

The public disclosure bar prevents qui tam suits based on information already in the public domain—such as in news reports or prior audits—unless the relator is the original source of that information.

An employee who suffers retaliation for reporting healthcare compliance concerns under certain federal statutes may file a complaint with which agency within 180 days of the retaliatory action?

Answer: Occupational Safety and Health Administration (OSHA)

For several federal whistleblower statutes, including those covering healthcare, OSHA investigates anti-retaliation complaints, which typically must be filed within 180 days of the retaliatory act.

Which of the OIG's seven elements of an effective compliance program specifically addresses reporting mechanisms?

Answer: Element 4: Open lines of communication

Element 4 of the OIG's seven elements calls for open lines of communication, including hotlines and anonymous reporting channels, so employees can report concerns without fear of retaliation.

What is 'reverse false claims' liability under the False Claims Act?

Answer: Liability for knowingly avoiding or concealing an obligation to repay money owed to the government

Reverse false claims involve knowingly concealing or failing to return an identified obligation to pay money to the government, such as retaining Medicare overpayments.

Under the ACA's 60-day rule, what must a healthcare provider do upon identifying a Medicare or Medicaid overpayment?

Answer: Report and return the overpayment to the government within 60 days

The ACA's 60-day rule requires providers to both report and return identified overpayments within 60 days; failure to do so can constitute a False Claims Act violation.

Which of the following scenarios constitutes prohibited retaliation under the False Claims Act's anti-retaliation provisions?

Answer: Demoting an employee shortly after they reported billing irregularities to the compliance office

Demoting an employee as a direct consequence of their protected reporting activity—reporting billing irregularities—constitutes prohibited retaliation under the FCA's anti-retaliation provisions.