CHC Healthcare Compliance Laws 2 — Questions and Answers
Question 1: Under the Anti-Kickback Statute (AKS), which element must the government prove to establish a criminal violation?
- The defendant received payment in excess of fair market value
- The defendant acted with willful intent to induce or reward referrals (Correct answer)
- The arrangement lacked a written contract
- The referral resulted in a Medicare overpayment
Correct answer: The defendant acted with willful intent to induce or reward referrals
The AKS requires proof that the defendant acted knowingly and willfully to offer, pay, solicit, or receive remuneration to induce or reward referrals of federal healthcare program business.
Question 2: Which Stark Law exception applies when a hospital employs a physician and pays fair market value compensation for identifiable services?
- Personal services exception
- In-office ancillary services exception
- Bona fide employment exception (Correct answer)
- Isolated transactions exception
Correct answer: Bona fide employment exception
The bona fide employment exception under Stark Law protects employment arrangements where the physician provides identifiable services, compensation is consistent with fair market value, and the arrangement is commercially reasonable.
Question 3: The False Claims Act's qui tam provision allows which party to file a lawsuit on behalf of the government?
- OIG investigators
- Private individuals known as relators (Correct answer)
- State attorneys general
- CMS compliance officers
Correct answer: Private individuals known as relators
Qui tam provisions allow private individuals (relators or whistleblowers) to file suits on behalf of the government and receive a portion of any recovery.
Question 4: EMTALA requires hospitals with emergency departments to provide which minimum level of service to all patients who present?
- Full treatment until the patient is cured or stabilized
- A medical screening examination regardless of ability to pay (Correct answer)
- Admission to the hospital if any emergency condition is suspected
- Transfer to a facility accepting Medicaid within two hours
Correct answer: A medical screening examination regardless of ability to pay
EMTALA mandates that hospitals provide an appropriate medical screening examination to any individual who comes to the emergency department requesting examination or treatment, regardless of payment status.
Question 5: Under HIPAA's Minimum Necessary standard, covered entities must limit disclosures of PHI to what extent?
- Only the amount needed to satisfy a signed patient authorization
- The minimum amount reasonably necessary to accomplish the intended purpose (Correct answer)
- Information explicitly listed in the Notice of Privacy Practices
- Data fields approved annually by HHS
Correct answer: The minimum amount reasonably necessary to accomplish the intended purpose
The Minimum Necessary standard requires covered entities to make reasonable efforts to limit PHI use, disclosure, and requests to the minimum necessary to accomplish the intended purpose.
Question 6: Which law prohibits a physician from making referrals for designated health services to entities in which the physician has a financial relationship, absent an applicable exception?
- Anti-Kickback Statute
- Stark Law (Correct answer)
- False Claims Act
- Civil Monetary Penalties Law
Correct answer: Stark Law
The Physician Self-Referral Law (Stark Law) prohibits physicians from referring Medicare or Medicaid patients for designated health services to entities with which the physician has a financial relationship unless a specific exception applies.
Question 7: The Civil Monetary Penalties Law (CMPL) authorizes the OIG to impose penalties for which of the following conduct?
- Failing to file a Medicare cost report on time
- Submitting a claim for services not medically necessary (Correct answer)
- Exceeding the 24-hour emergency hold limit under state law
- Hiring a physician who lacks board certification
Correct answer: Submitting a claim for services not medically necessary
The CMPL authorizes the OIG to impose civil monetary penalties for submitting false or fraudulent claims, including claims for services that are not medically necessary.
CHC Healthcare Compliance Laws 2
Under the Anti-Kickback Statute (AKS), which element must the government prove to establish a criminal violation?