CHC Remedial Measures and Discipline 3 — Questions and Answers
Question 1: A healthcare organization learns that a billing coder submitted false claims but passed all internal audits. The BEST long-term corrective measure is:
- Terminate the coder and take no further action
- Strengthen audit methodologies to detect the type of falsification discovered (Correct answer)
- Rely on external auditors exclusively going forward
- Suspend all claim submissions for 90 days
Correct answer: Strengthen audit methodologies to detect the type of falsification discovered
When internal controls fail to detect fraud, the corrective measure must directly address the audit gap that allowed the misconduct to persist.
Question 2: Which of the following BEST describes a 'corporate integrity agreement' (CIA) in the context of remedial measures?
- A voluntary internal policy adopted after a risk assessment
- A binding settlement with the OIG requiring compliance program enhancements and monitoring (Correct answer)
- An agreement between two competing healthcare entities
- A state licensure requirement for new hospitals
Correct answer: A binding settlement with the OIG requiring compliance program enhancements and monitoring
A CIA is a formal agreement with the OIG that imposes specific compliance obligations and independent review as a condition of continued participation in federal healthcare programs.
Question 3: During a compliance investigation, legal counsel invokes attorney-client privilege over certain documents. The compliance officer should understand that privilege:
- Protects all documents created during an investigation regardless of author
- Covers communications between attorney and client made for the purpose of legal advice (Correct answer)
- Can be asserted by the compliance officer independently without attorney involvement
- Automatically applies to all compliance committee meeting minutes
Correct answer: Covers communications between attorney and client made for the purpose of legal advice
Attorney-client privilege applies specifically to confidential communications between a licensed attorney and their client made for purposes of obtaining legal advice.
Question 4: An employee subject to discipline has the right to 'due process' in a healthcare compliance context. This PRIMARILY means:
- The employee must be given a jury trial before any discipline is imposed
- The employee receives notice of allegations and an opportunity to respond before final action (Correct answer)
- The employee can veto the disciplinary outcome
- All discipline must be reviewed by the state medical board
Correct answer: The employee receives notice of allegations and an opportunity to respond before final action
Due process in the employment context means the employee is informed of the specific allegations and given a meaningful opportunity to respond before discipline is finalized.
Question 5: A compliance officer is designing a corrective action plan after an overpayment is identified. Which component is MOST important to include to satisfy CMS expectations?
- A plan to contest the overpayment finding in federal court
- Identification of the root cause and systemic controls to prevent recurrence (Correct answer)
- A commitment to hire additional physicians to offset financial loss
- A media statement minimizing the significance of the overpayment
Correct answer: Identification of the root cause and systemic controls to prevent recurrence
CMS expects corrective action plans to identify root causes and implement systemic controls that will prevent similar overpayments in the future.
Question 6: Under the 60-day rule established in the ACA, once an organization has identified an overpayment it must report and return it within:
- 30 days of identification
- 60 days of identification (Correct answer)
- 90 days of identification
- 180 days of identification
Correct answer: 60 days of identification
The ACA's 60-day rule requires that identified Medicare and Medicaid overpayments be reported and returned within 60 days of quantification.
Question 7: When disciplining a licensed clinical professional for a compliance violation, the organization should also consider:
- Whether the violation triggers mandatory reporting to the relevant state licensing board (Correct answer)
- Whether the employee's salary should be reduced retroactively
- Whether all prior performance reviews should be destroyed
- Whether the employee can be enrolled in a clinical research study
Correct answer: Whether the violation triggers mandatory reporting to the relevant state licensing board
Many states require healthcare organizations to report certain practitioner misconduct to licensing boards, creating an obligation beyond internal discipline.
CHC Remedial Measures and Discipline 3
A healthcare organization learns that a billing coder submitted false claims but passed all internal audits.
The BEST long-term corrective measure is: