What are some of the consequences for non-compliance, fraudulent, or unethical
behavior?
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All of the above: Disciplinary action, termination of employment, exclusion
from participating in all Federal health care programs.
ACA Section 1557 rules for disability concern
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policies and procedures, physical access, and communication.
, You are in charge of paying claims submitted by providers. You notice a certain
diagnostic provider ("Doe Diagnostics") requested a substantial payment for a large
patient group. Many of these claims are for a certain procedure. You review the same
type of procedure for other diagnostic providers and realize Doe Diagnostics' claims
far exceed any other provider you reviewed. What should you do?
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Consult with your immediate supervisor for next steps or contact the
compliance department (via compliance hotline, Special Investigations Unit
[SIU], or other mechanism)
Some of the laws governing Medicare Part C and D fraud, waste, and abuse (FWA)
include the Health Insurance Portability and Accountability Act (HIPAA), the Civil
False Claims Act, the Anti-Kickback Statute, and the Criminal Health Care Fraud
Statute.
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True
Which entity enforces Section 1557 for programs that receive funding from and are
administered by HHS?
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The Office of Civil Rights (OCR) of HHS.
behavior?
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All of the above: Disciplinary action, termination of employment, exclusion
from participating in all Federal health care programs.
ACA Section 1557 rules for disability concern
Give this one a try later!
policies and procedures, physical access, and communication.
, You are in charge of paying claims submitted by providers. You notice a certain
diagnostic provider ("Doe Diagnostics") requested a substantial payment for a large
patient group. Many of these claims are for a certain procedure. You review the same
type of procedure for other diagnostic providers and realize Doe Diagnostics' claims
far exceed any other provider you reviewed. What should you do?
Give this one a try later!
Consult with your immediate supervisor for next steps or contact the
compliance department (via compliance hotline, Special Investigations Unit
[SIU], or other mechanism)
Some of the laws governing Medicare Part C and D fraud, waste, and abuse (FWA)
include the Health Insurance Portability and Accountability Act (HIPAA), the Civil
False Claims Act, the Anti-Kickback Statute, and the Criminal Health Care Fraud
Statute.
Give this one a try later!
True
Which entity enforces Section 1557 for programs that receive funding from and are
administered by HHS?
Give this one a try later!
The Office of Civil Rights (OCR) of HHS.
