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Compliance 101 Exam Questions and Answers 100% Pass
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Compliance 101 Exam Questions and Answers 100% Pass compliance program - prevention, detection, collaboration, and enforcement Effective compliance program - must be an ongoing process and commitment to an ethical way of conducting business Office of Inspector General and Justice Department - ...

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  • December 23, 2024
  • 13
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • compliance 101 exam questions and answers 100 pas

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  • Medicare certifications
  • Medicare certifications

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KatelynWhitman

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Compliance 101 Exam Questions and Answers
100% Pass


compliance program - ✔✔prevention, detection, collaboration, and enforcement


Effective compliance program - ✔✔must be an ongoing process and commitment to an ethical way of

conducting business


Office of Inspector General and Justice Department - ✔✔is responsible for enforcing the rules and

regulations under the Medicare and Medicaid laws outline as part of the SSA by CMS.


Benefits of compliance program addressed by OIG - ✔✔safeguards the organizations' legal responsibility

to abide by applicable laws and regulations.


Corporate Integrity Agreement (CIA) - ✔✔government imposed compliance program


Why compliance programs are essential - ✔✔prevent paybacks, probation, government designed

programs, exclusion, reduce threat of lawsuits from whistleblowers (qui tam).


OIG Top 10 reasons to implement a compliance program - ✔✔demonstrates a strong commitment to

honesty and responsible corporate relations, reinforces employees sense of right and wrong, fulfill legal

duty to payers, cost effective, more accurate view of what is going on, quality of care to clients, provides

procedures to promptly correct misconduct, mitigate any sanction imposed by government.


Health Insurance Portability and Accountability Act of 1996 (HIPAA) - ✔✔a criminal offense to submit

claims based on incorrect codes or medically unnecessary services, and government has the power to

exclude an organization from Medicare/caid and other govt programs.




Created by Katelyn Whitman © 2025, All Rights Reserved. 100% PASS GUARANTEE

, 2|Page


Balanced Budget Act of 1997 - ✔✔three strikes and your out clause , requiring permanent expulsion if

found guilty of fraud a third time.


False Claims Act (FCA) - ✔✔empowers the govt to investigate and bring civil action in fraud cases.

Implemented in Civil War to control price gouging.


Qui tam - ✔✔is a whistleblower who brings the fraud to light.


A whistleblower can receive a % of the govt's total award - ✔✔15-25% if DOJ assumes the case or 25-30%

if DOJ declines


To avoid lengthy and expensive litigation, an organization can negotiate a ____________with the govt

admits no fault or liability but does submit to a govt plan for corrective action. - ✔✔CIA


Length of CIAs - ✔✔3-5 yrs with some lasting up to 8 yrs


1984 Congress enacted Sentencing reform act which includes FSG - ✔✔act designed to correct inequities

in federal sentencing and give guidance for assessing fines and methods for calculation of culpability

score.


The culpability score - ✔✔calculation of the degree of blame or guilt used to determine fines, restitution,

forfeiture, and probation.


If an upper level employee has participated in or was willfully ignorant of an offense, - ✔✔the likelihood

of culpability score will be increased.


If an organization reports a violation promptly, - ✔✔the culpability score may be mitigated.


An aggravating factor in FSG - ✔✔is that the organization has had a repeated offense


A mitigating factor for FSG - ✔✔is that the organization cooperated with the govt investigators




Created by Katelyn Whitman © 2025, All Rights Reserved. 100% PASS GUARANTEE

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