HCCA CHC New Study Set Questions And
Verified Detailed Answers
Deficit Reduction Act of 2005-ANSWER The organizations receiving more than $5 million
in Medicaid funds have to provide education on the False Claims Act.
Corporate Integrity Agreement (CIA) - ANSWER A compliance program required by the
government, which is characterized by substantial government oversight and
independent expert involvement in the organization's compliance activities and usually
must be accepted as part of the settlement of fraud and abuse investigation. Negotiated
primarily between the OIG and the health care entity.
Seven Elements of a Compliance Program - ANSWER 1. Standards of Conduct
2. Oversight & Resources
3. Education & Training
4. Auditing and Monitoring
5. Consistent and appropriate discipline
6. Reporting Processes
7. Response and Prevention of Problems
LEIE List of Excluded Individuals - ANSWER A list of individuals and organizations that
are excluded from participating/billing the federal healthcare program ie. Medicare.
This list is updated monthly and it is the responsibility of the organization to check their
list of physicians, employees, etc. against this to prevent a violation of the False Claims
Act.
Medicare Cost Report - ANSWER A report that contains provider information such as
facility characteristics, utilization data, cost and charges by the cost center. If
administrator's or business associate pay appears on this that is excluded from the
LEIE, it may be liable as a FCA.
, 5 to 50 Years - ANSWER Mandatory Exclusion (felony) length
Up to 5 Years - ANSWER Permissive exclusion (misdemeanor) length
State Medicaid Exclusion List - ANSWER State Version of LEIE, also screened monthly
False Claims Act - ANSWER Prohibits anyone from knowingly presenting or causing to
be presented a false or fraudulent claim for payment to the government.
Anti-Kickback Law - ANSWER Prohibits soliciting, receiving, offering, or paying of any
remuneration directly or indirectly in cash or in kind as consideration in exchange that
are payable by a federal Healthcare program.
Anti-Kickback Safe Harbors ANSWER 1. Referrals made as part of an employment or
professional services agreement
2. Payments made for the lease equipment or of office space
3. Certain payments made for the purposes of health practitioner recruitment.
Stark Law ANSWER Part of OBRA, bans physicians from referring lab specimens or
other DHS to any entity with which the physician has a financial relationship.
Balance Budget Act - ANSWER Legislation containing major reform of Medicare and
Medicaid programs especially in the areas of home health and patient transfers. It
mandates permanent exclusion from participation in federally funded healthcare
programs of those convicted of three healthcare related crimes.
HITECH ANSWER Enacted as part of ARRA, HITECH is a law that is aimed at
incentivizing healthcare providers to adopt health information technology in a manner
that establishes electronic health records in a standardized way that protects patient's
private health information.
HIPAA - ANSWER Comprehensive legislation that provides for the continuation of health
coverage for unemployed workers who have lost their jobs or are between jobs. It also
Verified Detailed Answers
Deficit Reduction Act of 2005-ANSWER The organizations receiving more than $5 million
in Medicaid funds have to provide education on the False Claims Act.
Corporate Integrity Agreement (CIA) - ANSWER A compliance program required by the
government, which is characterized by substantial government oversight and
independent expert involvement in the organization's compliance activities and usually
must be accepted as part of the settlement of fraud and abuse investigation. Negotiated
primarily between the OIG and the health care entity.
Seven Elements of a Compliance Program - ANSWER 1. Standards of Conduct
2. Oversight & Resources
3. Education & Training
4. Auditing and Monitoring
5. Consistent and appropriate discipline
6. Reporting Processes
7. Response and Prevention of Problems
LEIE List of Excluded Individuals - ANSWER A list of individuals and organizations that
are excluded from participating/billing the federal healthcare program ie. Medicare.
This list is updated monthly and it is the responsibility of the organization to check their
list of physicians, employees, etc. against this to prevent a violation of the False Claims
Act.
Medicare Cost Report - ANSWER A report that contains provider information such as
facility characteristics, utilization data, cost and charges by the cost center. If
administrator's or business associate pay appears on this that is excluded from the
LEIE, it may be liable as a FCA.
, 5 to 50 Years - ANSWER Mandatory Exclusion (felony) length
Up to 5 Years - ANSWER Permissive exclusion (misdemeanor) length
State Medicaid Exclusion List - ANSWER State Version of LEIE, also screened monthly
False Claims Act - ANSWER Prohibits anyone from knowingly presenting or causing to
be presented a false or fraudulent claim for payment to the government.
Anti-Kickback Law - ANSWER Prohibits soliciting, receiving, offering, or paying of any
remuneration directly or indirectly in cash or in kind as consideration in exchange that
are payable by a federal Healthcare program.
Anti-Kickback Safe Harbors ANSWER 1. Referrals made as part of an employment or
professional services agreement
2. Payments made for the lease equipment or of office space
3. Certain payments made for the purposes of health practitioner recruitment.
Stark Law ANSWER Part of OBRA, bans physicians from referring lab specimens or
other DHS to any entity with which the physician has a financial relationship.
Balance Budget Act - ANSWER Legislation containing major reform of Medicare and
Medicaid programs especially in the areas of home health and patient transfers. It
mandates permanent exclusion from participation in federally funded healthcare
programs of those convicted of three healthcare related crimes.
HITECH ANSWER Enacted as part of ARRA, HITECH is a law that is aimed at
incentivizing healthcare providers to adopt health information technology in a manner
that establishes electronic health records in a standardized way that protects patient's
private health information.
HIPAA - ANSWER Comprehensive legislation that provides for the continuation of health
coverage for unemployed workers who have lost their jobs or are between jobs. It also
