CHC Remedial Measures and Discipline 4 — Questions and Answers
Question 1: A compliance officer is reviewing a case where a nurse submitted false time records. The investigation is complete and discipline is warranted. Which sequence reflects BEST practice?
- Discipline first, then investigate to confirm findings
- Investigate thoroughly, document findings, consult HR and legal, then impose proportional discipline (Correct answer)
- Issue termination immediately upon allegation to protect the organization
- Refer all cases to law enforcement before taking internal action
Correct answer: Investigate thoroughly, document findings, consult HR and legal, then impose proportional discipline
Best practice requires completing a thorough investigation and consulting HR and legal before imposing discipline to ensure fairness, accuracy, and legal defensibility.
Question 2: Which of the following is an example of a SYSTEMIC remedial measure rather than an individual disciplinary measure?
- Terminating the employee who submitted false claims
- Issuing a written warning to a supervisor
- Revising the billing policy and retraining the entire coding department (Correct answer)
- Placing an individual employee on a performance improvement plan
Correct answer: Revising the billing policy and retraining the entire coding department
Systemic remedial measures address organizational processes and controls, whereas individual disciplinary measures target the specific wrongdoer.
Question 3: An IRO (Independent Review Organization) engaged under a CIA is PRIMARILY responsible for:
- Filing criminal charges against employees who violate the CIA
- Conducting independent reviews of claims and operations to verify compliance program effectiveness (Correct answer)
- Replacing the organization's internal audit department entirely
- Negotiating settlement terms on behalf of the OIG
Correct answer: Conducting independent reviews of claims and operations to verify compliance program effectiveness
An IRO conducts objective, independent reviews as required by the CIA to provide the OIG with assurance that the organization's compliance program is functioning effectively.
Question 4: A compliance investigation finds that a vendor, not an employee, caused the billing error. The MOST appropriate remedial step is to:
- Ignore the finding because only employees can be disciplined
- Review and strengthen vendor contracts, oversight procedures, and potentially terminate the vendor relationship (Correct answer)
- Transfer liability to the vendor through a retroactive indemnification clause
- File a False Claims Act whistleblower suit against the vendor
Correct answer: Review and strengthen vendor contracts, oversight procedures, and potentially terminate the vendor relationship
When a vendor causes compliance failures, the organization must address its own oversight controls and the vendor relationship to prevent recurrence.
Question 5: Under the OIG's compliance program guidance, effective discipline programs must be applied to:
- Only frontline staff and coders
- All levels of the organization, including senior management and executives (Correct answer)
- Physicians only, because they generate billing
- Temporary contractors who are not W-2 employees
Correct answer: All levels of the organization, including senior management and executives
The OIG emphasizes that compliance programs lose credibility if discipline is not applied consistently at all organizational levels, including leadership.
Question 6: Which of the following actions would MOST likely be considered an aggravating factor when determining the severity of discipline for a compliance violation?
- The employee self-reported the violation before it was discovered
- The employee cooperated fully with the investigation
- The employee concealed evidence and continued the conduct after warnings (Correct answer)
- The employee had no prior disciplinary history
Correct answer: The employee concealed evidence and continued the conduct after warnings
Concealment and continuation of misconduct after warnings are classic aggravating factors that justify more severe discipline than the underlying violation alone.
Question 7: A compliance officer wants to ensure that disciplinary policies align with the Stark Law and Anti-Kickback Statute requirements. This means discipline policies should address:
- Only HIPAA privacy violations
- Referral arrangements, financial relationships with referral sources, and remuneration to or from physicians (Correct answer)
- Exclusively billing and coding errors
- Only violations reported through the external hotline
Correct answer: Referral arrangements, financial relationships with referral sources, and remuneration to or from physicians
Discipline policies must encompass violations of the Stark Law and Anti-Kickback Statute, which regulate financial arrangements and referrals in federal healthcare programs.
CHC Remedial Measures and Discipline 4
A compliance officer is reviewing a case where a nurse submitted false time records.
The investigation is complete and discipline is warranted.
Which sequence reflects BEST practice?