Compliance with Medicare Program Law (CMPL)

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What is the primary purpose of the penalties imposed under the CMPL?

To increase funding for federal healthcare programs

To encourage compliance with federal healthcare program requirements

To punish violators of the CMPL

To deter fraudulent or improper activities and recover funds (correct)

Which agency has the authority to enforce the CMPL?

Office of Inspector General (OIG) within the Department of Health and Human Services (HHS) (correct)

Office of Medicare and Medicaid Services

Food and Drug Administration (FDA)

Centers for Disease Control and Prevention (CDC)

What is the outcome of non-compliance discovered during investigations and audits?

Civil monetary penalties may be applied (correct)

Entities are banned from participating in federal programs

Entities are exempt from program requirements

Civil monetary penalties are waived

What type of activities are addressed by the CMPL?

A wide range of specific violations, including submitting false claims and illegal kickbacks Signup and view all the answers

What is the outcome of settling allegations of violations under the CMPL?

Entities agree to corrective actions, financial settlements, or other terms Signup and view all the answers

What healthcare activities are subject to the CMPL?

A range of healthcare activities, including false claims and fraud Signup and view all the answers

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. Signup and view all the answers

What is essential for making a compliance program work, according to the text?

Management buy-in and support. Signup and view all the answers

How should compliance officers communicate with physicians, according to the text?

By discussing both business and clinical aspects of an issue. Signup and view all the answers

What is the significance of involving physicians early in the compliance process?

It builds trust and cultivates early adopters and enthusiasts. Signup and view all the answers

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. Signup and view all the answers

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. Signup and view all the answers

Who can access an individual's PHI to conduct an assessment of a physician's coding and documentation?

A physician's compliance staff Signup and view all the answers

When is a CE required to disclose PHI without individual permission?

When the Secretary of the Department of Health and Human Services requests it Signup and view all the answers

What is the third method a CE may use or disclose PHI without requiring permission from the individual?

Public Interest Signup and view all the answers

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 Signup and view all the answers

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 Signup and view all the answers

What is the primary purpose of conducting a risk assessment in a compliance program?

To identify and prioritize risks in the organization Signup and view all the answers

What is essential for the Compliance Officer to possess?

A trusted and well-respected reputation in the organization Signup and view all the answers

What should be reviewed periodically to assess new risks and mitigation plans?

The risk list Signup and view all the answers

What is the purpose of developing an annual compliance report?

To build support for the compliance department Signup and view all the answers

What is the acronym that represents the ongoing evaluation process of a compliance program?

P-D-C-A Signup and view all the answers

What should be identified in the compliance department to ensure its success?

A realistic number of goals Signup and view all the answers

What is the primary purpose of the 'Check' stage in the Plan – Do – Check – Act approach?

To review lessons learned from preliminary attempts Signup and view all the answers

What is the key characteristic of a successful compliance program?

It is tailored to fit the organization Signup and view all the answers

What is the most important aspect of communication in a compliance program?

Having an open-door policy Signup and view all the answers

How often should a compliance program be reviewed?

At least annually Signup and view all the answers

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 Signup and view all the answers

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 Signup and view all the answers