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HCA 302 Final Exam | Questions and Answers
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HCA 302 Final Exam | Questions and Answers FCA PROHIBITIONS: Knowing submission of ____claims for payment False FCA PROHIBITIONS: Knowing use of false records or statements to ________ support such claims Support FCA PROHIBITIONS: Knowing and improprer retention of money ______ or belonging to fe...

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  • August 20, 2024
  • 10
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • HCA 302
  • HCA 302

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HCA 302 Final Exam


FCA PROHIBITIONS: Knowing submission of ____claims for payment
False

FCA PROHIBITIONS: Knowing use of false records or statements to ________ support
such claims
Support

FCA PROHIBITIONS: Knowing and improprer retention of money ______ or belonging
to federal government.
Owed

FCA PROHIBITIONS: Conspiring with others to _____ any of these acts
Commit

Stark Prohibition
"...If a Physician (or an immediate family member of such physician) has a financial
relationship with an entity..., then the physician may not make a referral to the entity for
the furnishing of designated health services for which payment otherwise may be
made." under Medicare (also applicable to Medicaid).

Safe Harbor Examples
-Investment Interests
- Space or Equipment rental
- Sale of practice
-referral services
-warranties
-employees
-group purchasing organizations
-waiver of coinsurance and deductible

Two Information Protected by Privacy Rule
-All "individually identifiable health information" held or transmitted by a covered entity
or its business associate, in any form or media, whether electronic, paper, or oral. This
is called "protected health information" (PHI).

-No restrictions on use or disclosure of information that does not identify an individual.

Under the PPACA of 2010, ________ programs are mandatory.
Compliance

The following are sources of the inquiry for potential investigations

, -Center for Medicare and Medicaid Services
-Office of the Inspector General (DHHS)
-Office of Civil Rights (DHHS)
-Department of Justice
-Solicitor's Office (DOL)
-State attorneys general
-The Joint Commission

Benefits of a Compliance Program (I)
Prerequisite to Medicare program participation

Benefits of a Compliance Program (I)
Demonstrates good corporate citizenship

Benefits of a Compliance Program (I)
Method for eliminating misconduct and illegal behavior

Benefits of a Compliance Program (I)
Clearinghouse for information on legal and payor requirements

Benefits of a Compliance Program (I)
Encourages employees to report misconduct

Benefits of a Compliance Program (I)
Protocol for investigating and resolving misconduct

Benefits of a Compliance Program (II)
Reduced exposure to a wide range of civil and criminal legal penalties

Benefits of a Compliance Program (II)
Enhanced public image and reputation

Benefits of a Compliance Program (II)
Required improvement in operations

Benefits of a Compliance Program (II)
Insight into employee attitudes and behavior

Benefits of a Compliance Program (II)
Ability to react to reports of misconduct

Benefits of a Compliance Program (II)
Better cooperation among health care entities

Benefits of a Compliance Program (II)

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