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CHCO practice questions

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Question 1Compliance program structure, governance, and the OIG seven elements

Which of the following is one of the seven elements of an effective compliance program described in OIG guidance?

  1. Facility construction schedules
  2. Internal monitoring and auditing Correct answer.
  3. Annual shareholder return targets
  4. Physician advertising campaigns

Explanation

OIG guidance identifies internal monitoring and auditing as a core element of an effective compliance program. Organizations are expected to conduct ongoing monitoring and periodic audits to detect and correct noncompliance. The other listed items are business or operational activities, not compliance program elements.

Question 2Compliance program structure, governance, and the OIG seven elements

A hospital wants a document that states its commitment to ethical conduct and guides daily behavior for all workforce members. Which document should it adopt?

  1. A patient satisfaction survey
  2. A quarterly budget report
  3. A code of conduct Correct answer.
  4. A vendor purchase agreement

Explanation

Written standards of conduct are a foundational element and articulate expectations for all workforce members. They provide the basis for training, reporting, and discipline. A code should be adopted by leadership and communicated widely.

Question 3Compliance program structure, governance, and the OIG seven elements

Under the program administration element, what role should a health care organization designate to oversee the compliance program day to day?

  1. A public relations director
  2. An external marketing consultant
  3. A compliance officer Correct answer.
  4. A volunteer patient advocate

Explanation

Program administration calls for a designated compliance officer responsible for daily operations of the program. The officer should have defined authority, adequate resources, and direct access to the governing body. This structure supports accountability and independence.

Question 4Compliance program structure, governance, and the OIG seven elements

Which group should receive compliance training under an effective program?

  1. Only members of the finance team and auditors
  2. All workforce members and governing body Correct answer.
  3. Only newly hired clinicians and nurses
  4. Only the compliance department staff and managers

Explanation

Training and education should reach all workforce members, including leadership and the governing body where appropriate. Content should be tailored and refreshed periodically. Training only selected groups leaves risks unaddressed.

Question 5Compliance program structure, governance, and the OIG seven elements

What is a key characteristic of a compliance reporting hotline?

  1. It allows anonymous reporting and prohibits retaliation Correct answer.
  2. It is available only during the organization's annual audit week
  3. It routes all incoming calls to the marketing department
  4. It requires callers to identify themselves in a signed writing

Explanation

Open lines of communication should allow workforce members to report concerns without fear, including anonymously where permitted. The organization should publicize the hotline and prohibit retaliation against good-faith reporters. These features encourage early detection of problems.

Question 6Compliance program structure, governance, and the OIG seven elements

A manager who violates a compliance policy is treated the same as a frontline employee who commits the same violation. Which element does this best illustrate?

  1. Marketing materials review
  2. Discipline and enforcement Correct answer.
  3. Annual risk assessment and planning
  4. External financial statement audit

Explanation

The enforcement and discipline element requires consistent and appropriate consequences for violations, regardless of position. Equal treatment demonstrates leadership commitment and deters misconduct. Discipline should be documented and applied under published standards.

Question 7Compliance program structure, governance, and the OIG seven elements

After an internal investigation confirms a billing error that led to overpayment, what should the organization do as part of responding to detected offenses?

  1. Wait for the next fiscal year's external audit cycle
  2. Destroy the supporting records after the investigation closes
  3. Transfer the employee to a different department without review
  4. Correct the error and repay the overpayment Correct answer.

Explanation

Responding to detected offenses includes investigating, correcting the problem, and returning overpayments within applicable timeframes. The organization should also identify root causes and revise controls to prevent recurrence. Documentation of the response is important.

Question 8Compliance program structure, governance, and the OIG seven elements

What is a governing body's core responsibility regarding the compliance program?

  1. Exercise reasonable oversight and receive regular compliance reports Correct answer.
  2. Delegate all compliance oversight permanently to an outside vendor
  3. Personally conduct every billing audit and investigation
  4. Approve marketing materials for each clinic and service line

Explanation

The governing body is responsible for reasonable oversight of the compliance program and should receive regular reports on risk and program performance. It does not need to perform audits itself, but it must ask questions and act on significant issues. Oversight duties cannot be permanently delegated away.

Question 9Compliance program structure, governance, and the OIG seven elements

What is the typical role of a compliance committee in a health care organization?

  1. Negotiate all managed care contracts on behalf of the organization
  2. Set the organization's clinical treatment protocols for all patients
  3. Replace the governing body's fiduciary duties and oversight responsibilities
  4. Advise the compliance officer and coordinate across departments Correct answer.

Explanation

A compliance committee typically provides interdisciplinary advice, reviews risk and policy issues, and helps coordinate compliance activities. It supports the compliance officer but does not replace the governing body or clinical leadership. Clear charter and reporting lines are important.

Question 10Compliance program structure, governance, and the OIG seven elements

To preserve independence, how should a compliance officer typically report?

  1. Only to the human resources manager
  2. With direct access to the governing body Correct answer.
  3. To an outside billing vendor
  4. To the sales director who sets revenue targets

Explanation

Compliance officers should have sufficient authority and direct access to the governing body or its audit/compliance committee. This reporting line helps preserve independence from operational pressures. Reporting solely to management with conflicting incentives can weaken the program.

Question 11Compliance program structure, governance, and the OIG seven elements

How should a compliance program use a risk assessment?

  1. Once at startup and then left unchanged for years
  2. To replace all written policies and procedures
  3. Only after a government investigation or subpoena
  4. Periodically to prioritize audits and resources Correct answer.

Explanation

A risk assessment should be periodic and updated as operations, regulations, and risks change. It guides auditing, training, and resource allocation toward higher-risk areas. It complements, rather than replaces, written policies.

Question 12Compliance program structure, governance, and the OIG seven elements

What practice keeps compliance policies and procedures current?

  1. Updating only when a new employee is hired
  2. Reviewing them regularly and revising for changes Correct answer.
  3. Approving them once and filing them permanently
  4. Letting each department use informal unwritten rules

Explanation

Policies and procedures should be reviewed on a scheduled basis and revised when laws, regulations, or operations change. Version control, approvals, and communication help ensure staff follow the current rules. Informal unwritten practices undermine consistency.

Question 13Compliance program structure, governance, and the OIG seven elements

How should compliance training be designed for different roles?

  1. Focused only on the organization's social media policy
  2. Delivered only in a single annual lecture
  3. Tailored to each role's risks and duties Correct answer.
  4. Identical for every role regardless of duties

Explanation

Training should be risk-based and tailored to the duties of each role, such as billing, clinical, or management staff. Completion should be documented and content refreshed. General training alone may not address specific compliance risks.

Question 14Compliance program structure, governance, and the OIG seven elements

A nurse reports a suspected billing fraud to the compliance hotline and is later reassigned to unfavorable shifts. What should the compliance program do?

  1. Investigate and protect the reporter Correct answer.
  2. Ask the nurse to withdraw the report
  3. Treat the reassignment as unrelated without review
  4. Refer the nurse to marketing

Explanation

Non-retaliation is essential to open communication, and retaliation allegations must be investigated and remedied. Workforce members should be protected when they report in good faith. Retaliation can deter future reporting and increase compliance risk.

Question 15Compliance program structure, governance, and the OIG seven elements

Which statement best distinguishes monitoring from auditing?

  1. Monitoring is always performed by external accounting firms
  2. Monitoring is ongoing; auditing is periodic and independent Correct answer.
  3. They are identical terms that can be used interchangeably
  4. Auditing is informal continuous review, while monitoring is annual

Explanation

Monitoring is generally ongoing, day-to-day oversight by management, while auditing is a periodic, systematic, and often independent review. Both are part of internal monitoring and auditing. Using both helps detect issues at different levels.

Question 16Compliance program structure, governance, and the OIG seven elements

Why should a health care organization screen employees and contractors against the OIG List of Excluded Individuals/Entities?

  1. To decide which employees receive annual bonuses
  2. To satisfy marketing partnership goals for the system
  3. To evaluate the credit scores of job applicants
  4. To avoid hiring excluded persons Correct answer.

Explanation

Screening against the OIG LEIE helps prevent employment or contracting with individuals or entities excluded from federal health care programs. Organizations should screen at hire and periodically thereafter. A match requires review and appropriate action.

Question 17Compliance program structure, governance, and the OIG seven elements

What should a corrective action plan include after a compliance failure is identified?

  1. A public relations campaign and press release only
  2. Root cause analysis, owners, deadlines, and follow-up Correct answer.
  3. A written guarantee that no further review is needed
  4. Immediate destruction of the investigation files

Explanation

A corrective action plan should identify the root cause, assign responsible owners, set deadlines, and include follow-up testing to confirm the fix. It should be documented and monitored to completion. This closes the loop after a compliance failure.

Question 18Compliance program structure, governance, and the OIG seven elements

Why should a compliance program document its training, audits, investigations, and corrective actions?

  1. To show the program is implemented and effective Correct answer.
  2. To avoid communicating with the governing body
  3. To replace the need for a designated compliance officer
  4. To increase the volume of paper files in the department

Explanation

Documentation provides evidence that training, auditing, investigations, and corrective actions actually occurred. It supports assessments of program effectiveness and continuous improvement. It does not replace the compliance officer or governing body oversight.

Question 19Compliance program structure, governance, and the OIG seven elements

What type of information should the governing body receive about the compliance program?

  1. Only favorable publicity summaries and press clippings
  2. Regular reports on risks, investigations, and trends Correct answer.
  3. Individual patient treatment records and billing files
  4. Only the annual operating and capital budget

Explanation

The governing body should receive regular, meaningful reports on compliance risks, investigations, trends, and program effectiveness. This information enables informed oversight and decisions. Individual patient records are not appropriate for routine board review.

Question 20Compliance program structure, governance, and the OIG seven elements

How can a small physician practice apply the OIG seven elements with limited resources?

  1. It must hire a full-time compliance staff of ten
  2. It can tailor elements to its size and risk Correct answer.
  3. It cannot have a compliance program
  4. It should ignore billing risks

Explanation

OIG guidance recognizes that compliance programs should be tailored to the size, resources, and risk profile of the organization. A small practice can use part-time or shared resources while still addressing all seven elements. Ignoring risk is never appropriate.

Question 21Compliance program structure, governance, and the OIG seven elements

Which approach best evaluates whether a compliance program is effective in practice?

  1. Measure only the number of hotline calls received each year
  2. Count only the number of pages in the policy manual
  3. Rely solely on the compliance officer's personal opinion
  4. Use audits, hotline trends, training data, and culture surveys Correct answer.

Explanation

Effectiveness is best assessed through multiple indicators, including audit results, reporting trends, training completion, culture surveys, and corrective action follow-up. These measures show whether the program is working in practice. Documents and call counts alone are incomplete.

Question 22Compliance program structure, governance, and the OIG seven elements

A compliance officer also serves as the organization's chief financial officer and reports only to the CEO. What is the primary governance concern?

  1. The officer is unable to attend committee meetings
  2. Conflicting duties may undermine independence and objectivity Correct answer.
  3. The officer has an excessive amount of clerical and administrative support
  4. The officer lacks any access to the organization's financial data

Explanation

Combining compliance with significant operational or financial authority, and reporting only to the CEO, can create conflicts of interest. Independence is supported by direct access to the governing body and clear authority. The concern is objectivity, not clerical support or data access.

Question 23Compliance program structure, governance, and the OIG seven elements

A hospital identifies an overpayment from a federal health care program. What is the compliance program's most appropriate response?

  1. Quantify it, repay timely, and prevent recurrence Correct answer.
  2. Delay repayment until the next audit
  3. Offset it against unrelated underpayments without any analysis
  4. Refund it only if the patient complains

Explanation

An identified overpayment should be investigated, quantified, and repaid within applicable timeframes. The organization should also perform root cause analysis and strengthen controls to prevent recurrence. Documentation of the quantification and repayment is important.

Question 24Compliance program structure, governance, and the OIG seven elements

In a multi-hospital system, how should compliance governance be structured?

  1. Compliance should report only to facility marketing leaders
  2. A system officer coordinates liaisons and reports to a board committee Correct answer.
  3. Each facility should operate without common standards or shared oversight
  4. Only the parent board's finance committee should discuss compliance issues

Explanation

A system-wide compliance function can set common standards while local liaisons address facility-specific risks. Reporting to a board-level committee preserves oversight and escalation. Clear authority and communication across entities are essential.

Question 25Compliance program structure, governance, and the OIG seven elements

OIG guidance emphasizes that an effective compliance program should do what beyond preventing fraud?

  1. Promote quality of care and an ethical culture Correct answer.
  2. Replace clinical quality programs entirely
  3. Eliminate the need for all internal controls
  4. Guarantee increased revenue for every service line

Explanation

OIG guidance emphasizes that effective compliance programs should promote quality of care and a culture of ethics, not merely prevent fraud. They supplement internal controls and clinical quality efforts. Compliance is not a revenue guarantee or a replacement for other programs.

Question 26Compliance program structure, governance, and the OIG seven elements

Which of the following is one of the seven elements of an effective compliance program described by the OIG?

  1. A marketing and public relations plan
  2. A shareholder dividend policy
  3. Written standards and policies Correct answer.
  4. Annual audited financial statements

Explanation

The OIG's seven elements begin with written policies and procedures, including standards of conduct that state the organization's commitment to compliance. Financial statements, marketing plans, and dividend policy are corporate matters unrelated to compliance program structure.

Question 27Compliance program structure, governance, and the OIG seven elements

Which action best demonstrates leadership's commitment to the compliance program?

  1. Leaders modeling and speaking about compliance Correct answer.
  2. Allowing managers to waive policies when convenient
  3. Delegating compliance duties to outside counsel
  4. Limiting compliance updates to the annual report

Explanation

Leadership commitment, often called tone at the top, is shown when executives visibly follow the rules and communicate expectations consistently. Delegating all duties externally, limiting communication, or permitting informal waivers signals that compliance is not a genuine priority.

Question 28Compliance program structure, governance, and the OIG seven elements

Written standards of conduct should apply to which group?

  1. Only the billing department's own staff
  2. Every workforce member and agent Correct answer.
  3. Only the executive leadership team
  4. Only licensed clinical personnel

Explanation

Standards of conduct must bind everyone who acts for the organization, including employees, contractors, agents, and volunteers. Limiting them to billing staff, executives, or clinicians leaves other actors outside the program's reach.

Question 29Compliance program structure, governance, and the OIG seven elements

When should a newly hired employee first receive compliance training?

  1. Within one year of hire
  2. Only after a violation occurs
  3. Only after the compliance officer approves a written request
  4. At orientation or shortly after hire Correct answer.

Explanation

New workers should receive compliance training at orientation or soon after starting so they understand expectations before performing regulated tasks. Waiting for a violation, a request, or a full year leaves the organization exposed during the employee's early work.

Question 30Compliance program structure, governance, and the OIG seven elements

Which feature most encourages employees to use a compliance hotline?

  1. A policy that reports are shared with the whole department
  2. Anonymous, confidential reporting available at all times Correct answer.
  3. A single mailbox checked monthly by the marketing team
  4. A requirement to sign each report and disclose it to managers

Explanation

Hotlines work best when callers can report anonymously and confidentially at any time without fear of identification. Requiring signatures, sharing reports broadly, or slow review by an unrelated team discourages reporting and weakens detection.

Question 31Compliance program structure, governance, and the OIG seven elements

To protect objectivity, who should conduct an internal compliance audit of a department?

  1. A close colleague of the department manager
  2. The employee who processes the department's claims
  3. An auditor outside the function being reviewed Correct answer.
  4. The manager of the department being audited

Explanation

Auditors should be independent of the activity they review so findings are objective and not influenced by supervisory or personal relationships. Auditing one's own work or a colleague's work weakens the assurance the audit is meant to provide.

Question 32Compliance program structure, governance, and the OIG seven elements

An effective compliance committee should be composed mainly of whom?

  1. External consultants without ongoing duties
  2. Only the compliance officer and an assistant
  3. Cross-functional leaders from key operating areas Correct answer.
  4. Rank-and-file staff chosen by lottery

Explanation

A compliance committee should draw leaders from clinical, financial, legal, and operational areas who can coordinate compliance across the organization. Consultants without ongoing duties, randomly selected staff, or a two-person group cannot provide sustained cross-functional oversight.

Question 33Compliance program structure, governance, and the OIG seven elements

How should an organization's disciplinary guidelines support the compliance program?

  1. They should apply only to employees below the manager level
  2. They should be published in advance and applied consistently Correct answer.
  3. They should leave each manager free to set any penalty
  4. They should be kept secret so staff cannot anticipate penalties

Explanation

Disciplinary guidelines should be communicated in advance and applied consistently across all levels so employees know the consequences of violations. Secrecy, unlimited manager discretion, and uneven application undermine fairness and deterrence.

Question 34Compliance program structure, governance, and the OIG seven elements

Before contracting with a billing vendor, what should a compliance program do?

  1. Wait until the first claim is submitted, then review
  2. Skip review because vendors are not covered by the program
  3. Rely on the vendor's own marketing materials
  4. Assess the vendor's compliance history and require compliance terms Correct answer.

Explanation

Vendors that perform billing or other federally reimbursed functions are first-tier entities that should be screened and bound by compliance obligations before contracting. Deferring review or relying on marketing materials leaves billing risk unmanaged.

Question 35Compliance program structure, governance, and the OIG seven elements

Which practice best integrates compliance into management accountability?

  1. Including compliance results in managers' evaluations and pay Correct answer.
  2. Assigning compliance duties solely to the compliance department
  3. Posting the code of conduct in break rooms once a year
  4. Reviewing compliance only when an external audit occurs

Explanation

Linking compliance results to performance evaluations and compensation makes managers personally accountable for behavior in their units. Periodic posting, audit-only review, or shifting all duties to compliance staff does not create that accountability.

Question 36Compliance program structure, governance, and the OIG seven elements

A health system's board never receives compliance reports, and the compliance officer has no direct channel to the board. Which governance weakness does this most directly represent?

  1. Overreliance on anonymous hotline reports
  2. Weak board oversight and reporting lines Correct answer.
  3. An overly broad definition of the compliance program's scope
  4. Excessive auditing of high-risk billing areas

Explanation

The governing body must receive regular compliance information, and the compliance officer needs a direct reporting channel to it. Without these, the board cannot exercise oversight, escalate concerns, or make informed resource decisions, regardless of auditing or hotline activity.

Question 37Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

Which federal statute creates civil liability for knowingly presenting, or causing to be presented, a false or fraudulent claim for payment to the United States?

  1. The False Claims Act Correct answer.
  2. The Stark Law
  3. The Anti-Kickback Statute
  4. The Civil Monetary Penalties Law

Explanation

The False Claims Act imposes civil liability on any person who knowingly presents, or causes to be presented, a false or fraudulent claim for payment to the federal government. It also reaches conspiracies to violate the Act and certain reverse false claims. The other statutes address different conduct, such as referral payments or self-referral.

Question 38Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

Under the False Claims Act, what share of the recovery may a qui tam relator receive if the government intervenes in the action?

  1. 25 to 30 percent
  2. 15 to 25 percent Correct answer.
  3. 5 to 10 percent
  4. 10 to 15 percent

Explanation

If the government intervenes, the relator generally receives between 15 and 25 percent of the proceeds of the action or settlement. If the government declines to intervene, the relator's share is generally 25 to 30 percent. The court may reduce the award in limited circumstances.

Question 39Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

Which remedies are available in a False Claims Act case?

  1. Double damages plus a single civil penalty
  2. Treble damages with no civil penalty
  3. Actual damages only
  4. Treble damages plus a per-claim civil penalty Correct answer.

Explanation

A defendant under the False Claims Act is liable for three times the government's damages plus a civil penalty for each false claim. The per-claim penalty is adjusted annually for inflation. Actual damages alone or double damages do not reflect the statutory formula.

Question 40Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

The False Claims Act defines 'knowingly' to include which standard?

  1. Actual knowledge or ordinary negligence
  2. Ordinary negligence or a good-faith error
  3. Actual knowledge only
  4. Actual knowledge, deliberate ignorance, or reckless disregard Correct answer.

Explanation

The False Claims Act defines knowingly to include actual knowledge, deliberate ignorance of the truth or falsity of information, and reckless disregard of the truth or falsity of information. Congress expressly provided that no proof of specific intent to defraud is required. Ordinary negligence or a good-faith error does not satisfy the standard.

Question 41Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

A hospital submits Medicare claims that comply with all coverage rules but violates a minor claims-formatting instruction. Under the materiality standard, which showing is most important to False Claims Act liability?

  1. A competitor also violated the same rule
  2. The hospital received payment for the services
  3. The formatting rule appears in a regulation
  4. The violation influenced the government's payment decision Correct answer.

Explanation

Materiality requires that a statutory, regulatory, or contractual violation be material to the government's payment decision to support False Claims Act liability. A minor formatting violation that does not affect payment is unlikely to be material. Materiality is a fact-specific inquiry, not a bright-line rule.

Question 42Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

A provider identifies a Medicare overpayment but keeps the funds for eight months without reporting or returning them. Which False Claims Act theory best fits?

  1. Reverse false claim Correct answer.
  2. Implied false certification
  3. Express false certification
  4. Qui tam retaliation

Explanation

A reverse false claim arises when a person knowingly uses a false record or statement to conceal, avoid, or decrease an obligation to pay money to the government. An identified overpayment creates such an obligation, and retaining it may violate the False Claims Act. The 60-day overpayment rule reinforces the duty to report and return.

Question 43Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

Which statement best describes the core prohibition of the federal Anti-Kickback Statute?

  1. It bars negligent billing errors for federal health care programs
  2. It bars knowingly offering remuneration to induce federal health care referrals Correct answer.
  3. It bars failure to report overpayments within 60 days
  4. It bars physician self-referral regardless of intent

Explanation

The Anti-Kickback Statute prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce referrals of items or services payable by a federal health care program. It applies to direct and indirect payments and does not require a completed referral. Intent and remuneration are central elements.

Question 44Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

A laboratory pays a referring physician fair market value for legitimate consulting services, but one purpose of the arrangement is to encourage referrals. How does the 'one purpose' test apply?

  1. The arrangement violates the Anti-Kickback Statute if any purpose is to induce referrals Correct answer.
  2. The arrangement is lawful because a written contract exists
  3. The arrangement is lawful because the payment is fair market value
  4. The arrangement violates the Anti-Kickback Statute only if referrals are the sole purpose

Explanation

Under the one-purpose test, a payment violates the Anti-Kickback Statute if at least one purpose of the arrangement is to induce referrals, even if other legitimate purposes exist. Fair market value and a written contract do not cure an improper purpose unless a safe harbor applies. The statute is not limited to arrangements where referrals are the sole purpose.

Question 45Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

Which combination best satisfies the Anti-Kickback Statute personal services and management contracts safe harbor?

  1. Signed one-year agreement, advance fair market value pay, no referral-based compensation Correct answer.
  2. A written agreement of any duration with compensation above fair market value that rewards the contractor for volume growth
  3. An oral agreement with compensation based on a percentage of collections and terminable at will by either party without cause
  4. A signed agreement of at least one year with compensation set in advance but adjusted each month by the number of referrals generated

Explanation

The personal services safe harbor requires a signed written agreement covering all services, a term of at least one year, compensation set in advance at fair market value, and compensation not determined by the volume or value of referrals. The arrangement must also be commercially reasonable and not exceed what is reasonably necessary. Oral agreements, at-will terms, and volume-based pay do not satisfy the safe harbor.

Question 46Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

A device manufacturer gives a hospital a 20 percent discount but does not disclose it in writing, and the hospital does not report the discount on its Medicare cost report. What is the effect under the Anti-Kickback Statute discount safe harbor?

  1. The discount is protected because discounts are always permissible
  2. The safe harbor is unavailable because disclosure and accurate reporting are required Correct answer.
  3. The safe harbor is unavailable only if the discount exceeds fair market value
  4. The discount is protected because it is below 25 percent

Explanation

The discount safe harbor requires that the discount be disclosed in writing and accurately reflected in the buyer's claims or cost reports. Without disclosure and proper reporting, the discount is not protected and may be treated as remuneration. The size of the discount alone does not determine safe harbor protection.

Question 47Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

Which consequence can result from an Anti-Kickback Statute violation involving a federal health care program?

  1. No consequence if the remuneration is repaid voluntarily
  2. Exclusion from federal programs and civil monetary penalties Correct answer.
  3. A state licensing sanction only, with no federal exposure
  4. A warning letter only, with no financial exposure

Explanation

An Anti-Kickback Statute violation can lead to exclusion from federal health care programs, civil monetary penalties, and criminal liability. Repayment of the remuneration does not automatically eliminate those consequences. The government may pursue administrative, civil, and criminal remedies.

Question 48Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

For purposes of the Anti-Kickback Statute, what does 'remuneration' include?

  1. Only payments made under a written contract
  2. Only direct cash payments
  3. Only payments that exceed fair market value
  4. Anything of value, in cash or in kind, directly or indirectly Correct answer.

Explanation

Remuneration under the Anti-Kickback Statute includes anything of value, whether in cash or in kind, and whether direct or indirect. It can include free goods, waived obligations, below-market services, and other benefits. The statute is not limited to direct cash payments.

Question 49Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

The Stark Law principally prohibits which arrangement?

  1. A physician's referral of Medicaid services to a group practice that employs the physician
  2. A physician's referral of Medicare designated health services to an entity with which the physician has a financial relationship, absent an exception Correct answer.
  3. A hospital's purchase of supplies from a vendor that offers a discount, absent a safe harbor
  4. Any provider's referral of any service to any entity, regardless of payer, absent an exception

Explanation

The Stark Law prohibits a physician from referring Medicare designated health services to an entity with which the physician, or an immediate family member, has a financial relationship, unless a statutory or regulatory exception applies. It also prohibits the entity from billing for those services. Its scope is defined by physician referrals, designated health services, and Medicare payment.

Question 50Healthcare regulatory framework: False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties

Which types of physician financial relationships are addressed by the Stark Law?

  1. Ownership or investment interests and compensation arrangements Correct answer.
  2. Referral relationships only
  3. Ownership or investment interests only
  4. Compensation arrangements only

Explanation

Stark defines a financial relationship as an ownership or investment interest in an entity or a compensation arrangement with the entity. These categories cover both direct and indirect relationships. If a relationship exists and no exception applies, the referral is prohibited.