CHC Remedial Measures and Discipline 2 — Questions and Answers
Question 1: When a compliance investigation concludes that an employee violated policy unintentionally due to inadequate training, the MOST appropriate remedial measure is:
- Immediate termination to deter future violations
- Mandatory retraining and closer supervision (Correct answer)
- Formal written warning with no follow-up
- Referral to the OIG for voluntary disclosure
Correct answer: Mandatory retraining and closer supervision
Unintentional violations stemming from training gaps are best addressed through mandatory retraining and enhanced supervision rather than punitive termination.
Question 2: A compliance officer discovers a physician has been upcoding claims for 18 months. Under the OIG's voluntary disclosure guidance, the organization should:
- Quietly refund overpayments without notifying the OIG
- Report to the OIG Self-Disclosure Protocol and cooperate fully (Correct answer)
- Wait until the False Claims Act statute of limitations expires
- Issue an internal written warning and monitor future claims
Correct answer: Report to the OIG Self-Disclosure Protocol and cooperate fully
The OIG Self-Disclosure Protocol is the appropriate channel when an organization identifies potential fraud that it wishes to resolve proactively.
Question 3: Which element is MOST critical when documenting disciplinary actions to protect the organization in future legal proceedings?
- Recording the supervisor's personal opinion of the employee
- Documenting specific policy provisions violated and evidence supporting the finding (Correct answer)
- Using informal notes rather than official HR forms
- Omitting dates to preserve employee privacy
Correct answer: Documenting specific policy provisions violated and evidence supporting the finding
Precise documentation of the specific policy violated and supporting evidence creates a defensible record if the discipline is later challenged.
Question 4: An organization's corrective action plan submitted to the OIG following a self-disclosure should include all of the following EXCEPT:
- Root cause analysis of the violation
- Steps taken to prevent recurrence
- Repayment amount and calculation methodology
- Names of all patients whose records were reviewed (Correct answer)
Correct answer: Names of all patients whose records were reviewed
Corrective action plans address systemic fixes and repayment details; disclosing individual patient names is not a standard OIG requirement.
Question 5: Under the Federal Sentencing Guidelines, which factor MOST reduces an organization's culpability score after a compliance violation is discovered?
- Having a large legal department
- Self-reporting the offense to appropriate authorities (Correct answer)
- Filing a motion to suppress evidence
- Delaying cooperation until after an audit
Correct answer: Self-reporting the offense to appropriate authorities
The Federal Sentencing Guidelines provide culpability score reductions for self-reporting, full cooperation, and acceptance of responsibility.
Question 6: A compliance hotline report alleges that a manager is retaliating against an employee who raised a billing concern. The compliance officer's FIRST action should be to:
- Notify the manager immediately so they can prepare a response
- Assess whether the allegation warrants a formal investigation before taking any action (Correct answer)
- Terminate the manager pending investigation
- Advise the reporting employee to seek external legal counsel
Correct answer: Assess whether the allegation warrants a formal investigation before taking any action
The compliance officer must first triage the allegation to determine its credibility and scope before launching a formal investigation or taking employment action.
Question 7: Which disciplinary principle requires that employees in similar roles who commit comparable violations receive comparable sanctions?
- Progressive discipline
- Proportionality
- Consistency (Correct answer)
- Due process
Correct answer: Consistency
Consistency requires that the organization apply discipline equitably across similarly situated employees to avoid claims of discrimination or favoritism.
CHC Remedial Measures and Discipline 2
When a compliance investigation concludes that an employee violated policy unintentionally due to inadequate training, the MOST appropriate remedial measure is: