Exam (elaborations)
COMPLIANCE 101 QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
- Course
- Institution
COMPLIANCE 101 QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
[Show more]
Content preview
COMPLIANCE 101 QUESTIONS ANDANSWERS WITH SOLUTIONS 2024
compliance program - ANSWER prevention, detection, collaboration, and enforcement
Effective compliance program - ANSWER must be an ongoing process and commitment to an ethical way
of conducting business
Office of Inspector General and Justice Department - ANSWER is responsible for enforcing the rules and
regulations under the Medicare and Medicaid laws outline as part of the SSA by CMS.
Benefits of compliance program addressed by OIG - ANSWER safeguards the organizations' legal
responsibility to abide by applicable laws and regulations.
Corporate Integrity Agreement (CIA) - ANSWER government imposed compliance program
Why compliance programs are essential - ANSWER prevent paybacks, probation, government designed
programs, exclusion, reduce threat of lawsuits from whistleblowers (qui tam).
OIG Top 10 reasons to implement a compliance program - ANSWER demonstrates a strong commitment
to honesty and responsible corporate relations, reinforces employees sense of right and wrong, fulfill
legal duty to payers, cost effective, more accurate view of what is going on, quality of care to clients,
provides procedures to promptly correct misconduct, mitigate any sanction imposed by government.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) - ANSWER a criminal offense to
submit claims based on incorrect codes or medically unnecessary services, and government has the
power to exclude an organization from Medicare/caid and other govt programs.
Balanced Budget Act of 1997 - ANSWER three strikes and your out clause , requiring permanent
expulsion if found guilty of fraud a third time.
False Claims Act (FCA) - ANSWER empowers the govt to investigate and bring civil action in fraud cases.
Implemented in Civil War to control price gouging.
, Qui tam - ANSWER is a whistleblower who brings the fraud to light.
A whistleblower can receive a % of the govt's total award - ANSWER 15-25% if DOJ assumes the case or
25-30% if DOJ declines
To avoid lengthy and expensive litigation, an organization can negotiate a ____________with the govt
admits no fault or liability but does submit to a govt plan for corrective action. - ANSWER CIA
Length of CIAs - ANSWER 3-5 yrs with some lasting up to 8 yrs
1984 Congress enacted Sentencing reform act which includes FSG - ANSWER act designed to correct
inequities in federal sentencing and give guidance for assessing fines and methods for calculation of
culpability score.
The culpability score - ANSWER calculation of the degree of blame or guilt used to determine fines,
restitution, forfeiture, and probation.
If an upper level employee has participated in or was willfully ignorant of an offense, - ANSWER the
likelihood of culpability score will be increased.
If an organization reports a violation promptly, - ANSWER the culpability score may be mitigated.
An aggravating factor in FSG - ANSWER is that the organization has had a repeated offense
A mitigating factor for FSG - ANSWER is that the organization cooperated with the govt investigators
2010 FSG amendment changes includes way to further reduce culpability scores: - ANSWER C&E
program has responsibility- to report directly to board or appropriate subgroup, to detected offense
before external discovery, prompt reporting, no one with OP responsibility participated in, condoned, or
was willfully ignorant of the offense.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Performance. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $13.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
75323 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now