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HCCA - CHPC Study Questions (MASTER FLASHCARDS) Final EXAM LATEST GRADED A NEW VERSIO

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HCCA - CHPC Study Questions (MASTER FLASHCARDS) Final EXAM
LATEST GRADED A NEW VERSION

What is the purpose of HIPAA? - CORRECT ANSWER • Protect PHI from unauthorized
disclosure/use;
• Prevent fraud, waste and abuse (via Administrative Simplification);
• Make health insurance portable under ERISA;
• Move health care onto a nationally standardized electronic billing platform

Ref. https://quizlet.com/6202453/hcca-chpc-overview-flash-cards/
More on HIPAA: https://www.hhs.gov/hipaa/index.html

HIPAA resides in which CFR section? - CORRECT ANSWER 45 CFR sections 164.102 through
164.534
How long does the Privacy Rule state that a practice or covered entity needs to retain medical
records?
a. Five years
b. Not stated
c. Six years
d. Seven years - CORRECT ANSWER b. Not stated

The Privacy Rule does not include medical record retention requirements and covered entities
may destroy such records at the time permitted by state or other applicable law.
Note: practice question from AAPC CPCO Ch5

The Privacy Rule does not restrict the use or disclosure of _______________, which neither
identifies nor provides a reasonable basis to identify an individual.
a. non-protected health information (non-PHI)

,b. reverse PHI
c. regulated PHI
d. de-identified health information - CORRECT ANSWER d. de-identified health information.

Ref. https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-
identification/index.html

Protected health information (PHI) is considered de-identified by HIPAA Privacy Rule standards
by:
a. absence of actual knowledge by the covered entity that the remaining information could be
used alone or in combination with other information to identify the individual
b. removal of only patient name and date of birth
c. a formal determination by a qualified expert
d. the removal of 18 specified individual identifiers
e. A, C and D
f. All of the answers - CORRECT ANSWER e. A, C and D

Why develop a Compliance Program? - CORRECT ANSWER - Promotes a culture of ethical behavior and
commitment to compliance with the law

- Aids in preventing and detecting wrong-doing

- Provides "safe" mechanisms for reporting and seeking help in getting it right the first time

- Raises awareness of organizations expectations

- Positive impact on corporate reputation/culture; public image

When did the US Federal Sentencing Guidelines come into effect? - CORRECT ANSWER November 1,
1991

,What does the US Federal Sentencing Guidelines deal in? - CORRECT ANSWER Control sentencing of
organizations for most federal criminal violations and sentencing credit for "effective programs to
prevent and detect violations of law"

The board of directors and corporate officers have a ________ to protect the company against
unreasonable risks and to maintain compliance oversight. - CORRECT ANSWER Fiduciary duty

Per the In re Caremark International Inc. Derivative Litigation, directors have a duty of care that includes:
- CORRECT ANSWER Monitoring and having current knowledge of risks. Directors should prescribe
compliance programs that are reasonably designed to provide senior management and the Board with
time and accurate information to reach informed decisions concerning compliance with the law.

How is it determined on how much one should investigate? - CORRECT ANSWER Need to investigate
enough to gauge the credibility of the allegation and to advise the client as soon as possible.

- reliable and credible advice

- documentary evidence

Investigation roadmap: - CORRECT ANSWER 1. Identify potential issues

2. Identify individuals likely to have information

3. Identify potentially relevant documents and institute document "holds"

4. Identify individuals best suited to conduct the investigation

5. Prepare an investigation plan - more serious -> more detailed

Advantages of outside counsel? - CORRECT ANSWER - Bolster application of attorney-client work
products

- Preserves independence of investigation

- Likely more familiar with government enforcement

- May be more familiar with applicable laws

Advantages of internal counsel? - CORRECT ANSWER - More familiar with internal policies

- More credibility within the organization

- May be more familiar with laws and regulations for day-to-day operations

, - Assist with document gathering

What does attorney-client privilege protect? - CORRECT ANSWER Communications between an
attorney and client. (more difficult to demonstrate with internal counsel)

- Intent to be confidential

- Made for legal advice (not business)

- Confidentiality has not been waived by disclosures to third parties

What is the Upjohn Warning? - CORRECT ANSWER Also known as a corporate Miranda warning,
states that employees must be advised that legal counsel represents the company, not the employees
individually, and what they say may not be kept private.

What are the most common liabilities of the False Claims Act (FCA)? - CORRECT ANSWER - Knowingly
presenting, or causing to be presented, to the government a false or fraudulent claim for payment.

- Knowingly making, using, or causing to be made or used, a false record or statement material to get a
false or fraudulent claim paid.

- Conspiring to violate the False Claims Act

- Knowingly making, using, or causing to be made or used, a false record or statement material to an
obligation to pay or transmit money or property to the Government, or knowingly concealing or avoiding
or decreasing an obligation to pay or transmit money or property to the government.

How does the government define the term knowing/knowingly? - CORRECT ANSWER - Had actual
knowledge of the information

- Acted in deliberate ignorance of the truth or falsified information

- Acted in reckless disregard of the truth

(No proof or specific intent to defraud is required)

What is a Qui Tam suit? - CORRECT ANSWER "Whistle Blowing"

Allows individuals (Relator) to file a lawsuit on behalf of the government for FCA violations.

- Relator can share in the judgment against the entity

- Incentivizes Relators with a % (10-30%) of the recovery money

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