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Medical Law, Ethics, And Compliance
Questions and Answers 2026 Latest Update
Audit controls Ans: The mechanisms that record and examine
activity in information systems
Audit controls are an important feature of safeguarding PHI
because they are used to ensure appropriate access to and use of
PHI.
False Claim Act (FCA) Ans: billing for medical services that were
not provided.
anti-kickback statue (AKS) Ans: medical providers financially
benefitting from referrals
Physician Self-Referral Law (Stark Law) Ans: This law states that
physicians are not allowed to refer patients to a practitioner with
whom they have a financial relationship. the law also prohibits the
referred practitioner from presenting claims to Medicare. The
Center for Medicare and Medicaid Services (CMS) has oversight
responsibilities for this law.
Social Security Act Ans: guaranteed retirement payments for
enrolled workers beginning at age 65; set up federal-state system
of unemployment insurance and care for dependent mothers and
children, the handicapped, and public health
United states criminal code Ans: protection with public behavior
© 2025 All rights reserved
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Surprise act Ans: protection form unknown medical bills
Office of the Inspector General (OIG) Ans: The OIG maintains a
hotline for reporting abuse, fraud, and waste; also offers a self-
disclosure protocol to report potential unintended fraud. An
example is when an organization discovers a billing or coding
practice is wrong and needs to address the issues caused by claims
already submitted or paid.
Medicare Ans: A federal program of health insurance for persons
65 years of age and older as well as those with certain chronic
conditions or disabilites
Medicaid Ans: A federal and state assistance program that pays
for health care services for people with a lower income and helps
provide healthcare services at a little or no cost
Medicare Part A Ans: Inpatient coverage, home health, hospice.
Also defines limits of Medicare usage
Medicare Part B Ans: The part of the Medicare program that pays
for
fee-for-service
physician services
outpatient hospital services durable medical equipment
and other services and supplies.
Medicare Part C Ans: Part C Medicare Advantage plans usually
include additional benefits beyond Part A and Part B. While these
© 2025 All rights reserved
Medical Law, Ethics, And Compliance
Questions and Answers 2026 Latest Update
Audit controls Ans: The mechanisms that record and examine
activity in information systems
Audit controls are an important feature of safeguarding PHI
because they are used to ensure appropriate access to and use of
PHI.
False Claim Act (FCA) Ans: billing for medical services that were
not provided.
anti-kickback statue (AKS) Ans: medical providers financially
benefitting from referrals
Physician Self-Referral Law (Stark Law) Ans: This law states that
physicians are not allowed to refer patients to a practitioner with
whom they have a financial relationship. the law also prohibits the
referred practitioner from presenting claims to Medicare. The
Center for Medicare and Medicaid Services (CMS) has oversight
responsibilities for this law.
Social Security Act Ans: guaranteed retirement payments for
enrolled workers beginning at age 65; set up federal-state system
of unemployment insurance and care for dependent mothers and
children, the handicapped, and public health
United states criminal code Ans: protection with public behavior
© 2025 All rights reserved
, 2 | Page
Surprise act Ans: protection form unknown medical bills
Office of the Inspector General (OIG) Ans: The OIG maintains a
hotline for reporting abuse, fraud, and waste; also offers a self-
disclosure protocol to report potential unintended fraud. An
example is when an organization discovers a billing or coding
practice is wrong and needs to address the issues caused by claims
already submitted or paid.
Medicare Ans: A federal program of health insurance for persons
65 years of age and older as well as those with certain chronic
conditions or disabilites
Medicaid Ans: A federal and state assistance program that pays
for health care services for people with a lower income and helps
provide healthcare services at a little or no cost
Medicare Part A Ans: Inpatient coverage, home health, hospice.
Also defines limits of Medicare usage
Medicare Part B Ans: The part of the Medicare program that pays
for
fee-for-service
physician services
outpatient hospital services durable medical equipment
and other services and supplies.
Medicare Part C Ans: Part C Medicare Advantage plans usually
include additional benefits beyond Part A and Part B. While these
© 2025 All rights reserved
