29 Questions
What is the primary purpose of the penalties imposed under the CMPL?
To deter fraudulent or improper activities and recover funds
Which agency has the authority to enforce the CMPL?
Office of Inspector General (OIG) within the Department of Health and Human Services (HHS)
What is the outcome of non-compliance discovered during investigations and audits?
Civil monetary penalties may be applied
What type of activities are addressed by the CMPL?
A wide range of specific violations, including submitting false claims and illegal kickbacks
What is the outcome of settling allegations of violations under the CMPL?
Entities agree to corrective actions, financial settlements, or other terms
What healthcare activities are subject to the CMPL?
A range of healthcare activities, including false claims and fraud
What is the significance of the Caremark International Derivative Litigation in the context of Board oversight responsibilities?
It makes the Board responsible for implementing a system to gather information on the company's efforts to prevent and detect fraud and abuse.
What is essential for making a compliance program work, according to the text?
Management buy-in and support.
How should compliance officers communicate with physicians, according to the text?
By discussing both business and clinical aspects of an issue.
What is the significance of involving physicians early in the compliance process?
It builds trust and cultivates early adopters and enthusiasts.
What is the primary factor in determining the value of a compliance program in any settlement, according to the text?
The government's interpretation of the organization's commitment to good corporate citizenship.
What is a critical factor in determining the staffing needs of a compliance department, according to the text?
The size, setting, and culture of the organization.
Who can access an individual's PHI to conduct an assessment of a physician's coding and documentation?
A physician's compliance staff
When is a CE required to disclose PHI without individual permission?
When the Secretary of the Department of Health and Human Services requests it
What is the third method a CE may use or disclose PHI without requiring permission from the individual?
Public Interest
What is the purpose of a CE disclosing PHI to the Secretary of the Department of Health and Human Services?
To investigate an allegation of privacy violation
Do the privacy regulations require a CE to use or disclose PHI for purposes in the public interest?
No, they are not required to do so
What is the primary purpose of conducting a risk assessment in a compliance program?
To identify and prioritize risks in the organization
What is essential for the Compliance Officer to possess?
A trusted and well-respected reputation in the organization
What should be reviewed periodically to assess new risks and mitigation plans?
The risk list
What is the purpose of developing an annual compliance report?
To build support for the compliance department
What is the acronym that represents the ongoing evaluation process of a compliance program?
P-D-C-A
What should be identified in the compliance department to ensure its success?
A realistic number of goals
What is the primary purpose of the 'Check' stage in the Plan – Do – Check – Act approach?
To review lessons learned from preliminary attempts
What is the key characteristic of a successful compliance program?
It is tailored to fit the organization
What is the most important aspect of communication in a compliance program?
Having an open-door policy
How often should a compliance program be reviewed?
At least annually
What is the primary purpose of the 'Act' stage in the Plan – Do – Check – Act approach?
To decide how to incorporate lessons learned with what still needs to be done
What is the significance of the 'Plan' stage in the Plan – Do – Check – Act approach?
It involves looking into the compliance program and discussing next steps
Test your knowledge of the Medicare Program Law, including its applicability to healthcare activities, penalties for violations, and enforcement agencies. Learn about the laws and regulations governing Medicare program compliance.
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