CHC Remedial Measures and Discipline 5 — Questions and Answers
Question 1: When an organization decides to exclude an individual from participation in its operations following a compliance violation, it must first check the:
- State tax records for outstanding liens
- OIG List of Excluded Individuals and Entities (LEIE) and SAM.gov (Correct answer)
- Employee's social media profiles
- Medicare Advantage plan enrollment database
Correct answer: OIG List of Excluded Individuals and Entities (LEIE) and SAM.gov
Before and after any employment or contracting action, organizations must screen against the LEIE and SAM.gov to ensure they do not employ or contract with federally excluded parties.
Question 2: A 'root cause analysis' conducted as part of a corrective action plan should PRIMARILY answer which question?
- Who is personally liable for the violation?
- Why did the violation occur and what systemic conditions enabled it? (Correct answer)
- How much revenue was lost due to the violation?
- Which competitor organization has the same problem?
Correct answer: Why did the violation occur and what systemic conditions enabled it?
Root cause analysis identifies the underlying systemic or process failures that allowed a violation to occur, enabling targeted corrective actions.
Question 3: An employee alleges that they were wrongfully terminated in retaliation for reporting a compliance concern. Under the False Claims Act's anti-retaliation provisions, the employee may:
- Only seek reinstatement but not back pay
- Seek reinstatement, double back pay, and attorneys' fees (Correct answer)
- Only file a complaint with the state labor board
- Seek unlimited punitive damages without proof of harm
Correct answer: Seek reinstatement, double back pay, and attorneys' fees
The FCA's anti-retaliation provision (31 U.S.C. § 3730(h)) allows prevailing employees to recover reinstatement, double back pay, and attorneys' fees.
Question 4: During a compliance audit, it is discovered that a department head had prior knowledge of ongoing billing fraud but failed to act. The MOST appropriate discipline for the department head is:
- A verbal reminder of compliance obligations with no formal record
- Discipline commensurate with their supervisory responsibility for failing to act, potentially including termination (Correct answer)
- Transfer to a different department where billing is not performed
- No action, because they did not personally submit false claims
Correct answer: Discipline commensurate with their supervisory responsibility for failing to act, potentially including termination
Supervisors who knowingly fail to stop ongoing fraud share culpability and should face discipline proportional to their failure of oversight responsibility.
Question 5: A corrective action plan is MOST effective when it includes which of the following mechanisms?
- A one-time review with no follow-up monitoring
- Defined milestones, accountability assignments, and ongoing monitoring to verify implementation (Correct answer)
- Delegation of all corrective actions to the accused employee
- A commitment to disclose future violations only if material in amount
Correct answer: Defined milestones, accountability assignments, and ongoing monitoring to verify implementation
Effective corrective action plans assign accountability, set measurable milestones, and include ongoing monitoring to confirm that controls have been successfully implemented.
Question 6: Which of the following BEST describes 'progressive discipline' as used in healthcare compliance programs?
- Immediately terminating employees at the first sign of misconduct
- Applying escalating sanctions starting with counseling and increasing to termination for repeated or serious violations (Correct answer)
- Reducing discipline severity each time a violation occurs to encourage reporting
- Applying identical sanctions regardless of violation severity or employee history
Correct answer: Applying escalating sanctions starting with counseling and increasing to termination for repeated or serious violations
Progressive discipline applies graduated sanctions — from counseling to written warnings to termination — proportional to violation severity and the employee's disciplinary history.
Question 7: After completing a self-disclosure to the OIG Self-Disclosure Protocol, the organization should expect the OIG to:
- Immediately exclude the organization from Medicare and Medicaid
- Acknowledge receipt, conduct its own review, and negotiate a settlement that may include a multiplier on the overpayment (Correct answer)
- Automatically waive all penalties without further review
- Refer the matter to the DOJ for criminal prosecution in all cases
Correct answer: Acknowledge receipt, conduct its own review, and negotiate a settlement that may include a multiplier on the overpayment
The OIG reviews self-disclosures and typically negotiates a settlement requiring repayment at a multiplier (often 1.5×), which is lower than standard False Claims Act exposure.
CHC Remedial Measures and Discipline 5
When an organization decides to exclude an individual from participation in its operations following a compliance violation, it must first check the: