HCA 302 Final Exam | Questions and Answers FCA PROHIBITIONS: Knowing submission of ____claims for payment False FCA PROHIBITIONS: Knowing use of false records or statements to ________ support such claims Support FCA PROHIBITIONS: Knowing and improprer retention of money ______ or belonging to fe...
FCA PROHIBITIONS: Knowing submission of ____claims for payment
False
FCA PROHIBITIONS: Knowing use of false records or statements to ________ support
such claims
Support
FCA PROHIBITIONS: Knowing and improprer retention of money ______ or belonging
to federal government.
Owed
FCA PROHIBITIONS: Conspiring with others to _____ any of these acts
Commit
Stark Prohibition
"...If a Physician (or an immediate family member of such physician) has a financial
relationship with an entity..., then the physician may not make a referral to the entity for
the furnishing of designated health services for which payment otherwise may be
made." under Medicare (also applicable to Medicaid).
Safe Harbor Examples
-Investment Interests
- Space or Equipment rental
- Sale of practice
-referral services
-warranties
-employees
-group purchasing organizations
-waiver of coinsurance and deductible
Two Information Protected by Privacy Rule
-All "individually identifiable health information" held or transmitted by a covered entity
or its business associate, in any form or media, whether electronic, paper, or oral. This
is called "protected health information" (PHI).
-No restrictions on use or disclosure of information that does not identify an individual.
Under the PPACA of 2010, ________ programs are mandatory.
Compliance
The following are sources of the inquiry for potential investigations
, -Center for Medicare and Medicaid Services
-Office of the Inspector General (DHHS)
-Office of Civil Rights (DHHS)
-Department of Justice
-Solicitor's Office (DOL)
-State attorneys general
-The Joint Commission
Benefits of a Compliance Program (I)
Prerequisite to Medicare program participation
Benefits of a Compliance Program (I)
Demonstrates good corporate citizenship
Benefits of a Compliance Program (I)
Method for eliminating misconduct and illegal behavior
Benefits of a Compliance Program (I)
Clearinghouse for information on legal and payor requirements
Benefits of a Compliance Program (I)
Encourages employees to report misconduct
Benefits of a Compliance Program (I)
Protocol for investigating and resolving misconduct
Benefits of a Compliance Program (II)
Reduced exposure to a wide range of civil and criminal legal penalties
Benefits of a Compliance Program (II)
Enhanced public image and reputation
Benefits of a Compliance Program (II)
Required improvement in operations
Benefits of a Compliance Program (II)
Insight into employee attitudes and behavior
Benefits of a Compliance Program (II)
Ability to react to reports of misconduct
Benefits of a Compliance Program (II)
Better cooperation among health care entities
Benefits of a Compliance Program (II)
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