Regulatory Compliance Flashcards
7 cards from real CPHRM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Regulatory Compliance flashcards as text
The Deficit Reduction Act of 2005 requires hospitals receiving more than $5 million annually in Medicaid payments to provide employees with information about:
Answer: The False Claims Act and whistleblower protections
The Deficit Reduction Act requires affected entities to educate employees about the federal and applicable state False Claims Acts, whistleblower protections, and the entity's policies for detecting and preventing fraud.
Under HIPAA's Breach Notification Rule, a covered entity must notify affected individuals of a breach of unsecured PHI within:
Answer: 60 days of discovery
The HIPAA Breach Notification Rule requires covered entities to notify affected individuals without unreasonable delay and no later than 60 days following discovery of a breach.
A hospital's compliance program must include which element identified in the OIG's seven elements of an effective compliance program?
Answer: Ongoing monitoring and auditing of compliance risks
OIG's seven elements include: written standards, compliance officer/committee, training, communication channels, auditing/monitoring, disciplinary guidelines, and response to detected offenses — ongoing auditing and monitoring is one of the seven.
A hospital employee reports to the compliance hotline that their supervisor instructed them to alter patient records to avoid a deficiency citation. This situation MOST immediately implicates:
Answer: CMS Conditions of Participation record integrity requirements and potential obstruction
Altering medical records to conceal deficiencies violates CMS CoPs record integrity requirements and could constitute obstruction of a federal health care program audit, carrying significant legal consequences.
The primary risk management concern with a hospital's non-compete agreements for employed physicians is:
Answer: Antitrust implications and interference with patient access to care
Overly broad non-compete agreements for physicians raise antitrust concerns and can impair patient access to care, drawing FTC and state attorney general scrutiny.
Under the CMS Hospital Conditions of Participation, a hospital must have a written policy addressing patient rights. Which right must be explicitly addressed?
Answer: The right to receive care in a safe setting and be free from all forms of abuse
CMS CoPs §482.13 explicitly requires hospitals to have a patient rights process that includes the right to receive care in a safe setting and to be free from all forms of abuse or harassment.
A compliance officer reviewing a physician arrangement discovers the compensation is above fair market value. The MOST significant legal risk this creates is:
Answer: Violation of the Anti-Kickback Statute and potentially the Stark Law
Compensation above fair market value is a hallmark indicator of improper remuneration under the Anti-Kickback Statute and may also fail a Stark Law compensation exception, exposing the hospital to significant False Claims Act liability.