Page | 1
CPCO Chapter 9 - Investigations and the Legal
Process Questions and Verified Answers
HITECH revisions significantly increased the penalty amounts the Secretary may
impose for violations of______________?
Ans: Hipaa
During an internal investigation, what is the next step after the regulatory scope
and applicability are researched?
Ans: Draft an audit protocol
When there is notice of an investigation, employees must know that it is against
policy to __________.
Ans: Alter, destroy or remove any documentation from a patient's medical record
Employees should be told that if they are questioned in an investigation they
should always what?
Ans: Stick to the facts and don't speculate
Attorney-client privilege protects communications that you have with your
attorney and ___________?
Ans: Attorney-client work-product
What does the term RAT-STATS represent?
Ans: Free statistical software used to select a random sample for audit
Employees should be told that if they are questioned in an investigation they
have the right to what?
Ans: Request an attorney
What is it called when the OIG waives its exclusion authority concurrent with
resolution of monetary liability under the False Claims Act and the CMP Law?
Ans: CIA
, Page | 2
States may also offer CIAs to providers with a history of________ as an alternative
to exclusion from the Medicaid program.
Ans: Program integrity issues
When drafting audit protocol in an internal investigation it should be carefully
worded and tied back to the regulatory scope and applicability research. If an
attorney does not draft the protocol, one should review it for language. Why?
Ans: The government or opposing party may obtain a copy
The Signatory page includes the signatures of the provider representatives
(counsel and the Compliance Officer and/or president), as well as the _______.
Ans: Representative from the OIG
CMS relies on a number of program contractors to identify and respond to fraud,
abuse, and improper payments in the Medicare and Medicaid programs. These
contractors are charged with protecting the programs ___________?
Ans: integrity
The OIG defines the term "reportable event" in its CIA by noting that it could be:
Ans: A substantial overpayment;
b. A matter that a reasonable person would consider a probable violation of
criminal, civil, or administrative laws applicable to any federal healthcare
program for which penalties or exclusion may be authorized;
c. The employment of or contracting with an ineligible person (as defined in the
CIA); or
d. The filing of a bankruptcy petition.
A search warrant, State or federal (or both) allows the agents the right to what?
Ans: to enter and seize document
Typically, document reviews are done ________, and the government will ask for
______.
Ans: Electronically, electronic files
CPCO Chapter 9 - Investigations and the Legal
Process Questions and Verified Answers
HITECH revisions significantly increased the penalty amounts the Secretary may
impose for violations of______________?
Ans: Hipaa
During an internal investigation, what is the next step after the regulatory scope
and applicability are researched?
Ans: Draft an audit protocol
When there is notice of an investigation, employees must know that it is against
policy to __________.
Ans: Alter, destroy or remove any documentation from a patient's medical record
Employees should be told that if they are questioned in an investigation they
should always what?
Ans: Stick to the facts and don't speculate
Attorney-client privilege protects communications that you have with your
attorney and ___________?
Ans: Attorney-client work-product
What does the term RAT-STATS represent?
Ans: Free statistical software used to select a random sample for audit
Employees should be told that if they are questioned in an investigation they
have the right to what?
Ans: Request an attorney
What is it called when the OIG waives its exclusion authority concurrent with
resolution of monetary liability under the False Claims Act and the CMP Law?
Ans: CIA
, Page | 2
States may also offer CIAs to providers with a history of________ as an alternative
to exclusion from the Medicaid program.
Ans: Program integrity issues
When drafting audit protocol in an internal investigation it should be carefully
worded and tied back to the regulatory scope and applicability research. If an
attorney does not draft the protocol, one should review it for language. Why?
Ans: The government or opposing party may obtain a copy
The Signatory page includes the signatures of the provider representatives
(counsel and the Compliance Officer and/or president), as well as the _______.
Ans: Representative from the OIG
CMS relies on a number of program contractors to identify and respond to fraud,
abuse, and improper payments in the Medicare and Medicaid programs. These
contractors are charged with protecting the programs ___________?
Ans: integrity
The OIG defines the term "reportable event" in its CIA by noting that it could be:
Ans: A substantial overpayment;
b. A matter that a reasonable person would consider a probable violation of
criminal, civil, or administrative laws applicable to any federal healthcare
program for which penalties or exclusion may be authorized;
c. The employment of or contracting with an ineligible person (as defined in the
CIA); or
d. The filing of a bankruptcy petition.
A search warrant, State or federal (or both) allows the agents the right to what?
Ans: to enter and seize document
Typically, document reviews are done ________, and the government will ask for
______.
Ans: Electronically, electronic files
