Risk Management and Compliance

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Questions and Answers

What is the primary purpose of a Code of Conduct in a Compliance Program?

To establish a disciplinary process for non-compliant employees

To provide a framework for ethical behavior and decision-making (correct)

To reduce the risk of False Claims Act violations

To monitor employee emails and phone calls

Which of the following is NOT a component of a Compliance Program's infrastructure?

Marketing Department (correct)

Compliance Officer

Written Policies and Procedures

Training and Education

Who is responsible for overseeing Compliance Program development?

Compliance Committee

Compliance Officer

Board of Directors (correct)

Legal Department

What is the primary goal of a Compliance Program's training and education element?

To provide training on Compliance Program policies and procedures Signup and view all the answers

Which of the following laws is most closely related to healthcare fraud and abuse?

False Claims Act Signup and view all the answers

What is the primary role of a Compliance Officer in a Compliance Program?

To investigate and report suspected non-compliance Signup and view all the answers

What is the primary purpose of a Compliance Program's effective lines of communication?

To facilitate reporting of suspected non-compliance Signup and view all the answers

Which of the following is a key element of a Compliance Program's infrastructure?

Written Policies and Procedures Signup and view all the answers

What is one key indicator of the board and senior leadership's commitment to compliance?

The appointment and support of a compliance officer Signup and view all the answers

Who should have the authority, stature, access, and resources necessary to lead an effective and successful compliance program?

The Compliance Officer Signup and view all the answers

What is the purpose of an effective compliance program?

To reduce and mitigate risk, provide patients safe and high-quality care, and save costs Signup and view all the answers

Who should devise a means of communicating and documenting interim policies and procedures to the relevant impacted individuals?

The entity Signup and view all the answers

What should be included in an entity's disclosure program?

A means for employees to contact the Compliance Officer or members of the Compliance Committee with questions about a policy or procedure Signup and view all the answers

What is the role of senior leadership in an effective compliance program?

To understand the value of the compliance program and be committed to its success Signup and view all the answers

Who are included in senior leadership?

The group of leaders who report directly to the CEO Signup and view all the answers

What is the purpose of an effective compliance officer?

To lead an effective and successful compliance program Signup and view all the answers

What is the primary focus of Element 5 in complying with Pharmaceutical Sales Law?

Enforcing Standards: Consequences and Incentives Signup and view all the answers

Which of the following is a key component of Element 6 in Pharmaceutical Sales Law compliance?

Risk Assessment, Auditing, and Monitoring Signup and view all the answers

What is the purpose of Element 7 in complying with Pharmaceutical Sales Law?

Developing Corrective Action Initiatives Signup and view all the answers

Which of the following is a key consideration for small entities in developing a compliance program?

Appointing a Compliance Contact Signup and view all the answers

What is the primary goal of a compliance program in relation to the Federal Anti-Kickback Statute?

Preventing fraud and abuse Signup and view all the answers

What is the purpose of reporting to the government in relation to the False Claims Act?

To self-report violations and avoid penalties Signup and view all the answers

Which of the following is a key aspect of Element 2 in complying with Pharmaceutical Sales Law?

Policies, Procedures, and Training Signup and view all the answers

What is the primary focus of healthcare fraud and abuse laws and regulations?

Preventing fraud and abuse in healthcare Signup and view all the answers

Study Notes

Compliance Program Infrastructure: The Seven Elements

Compliance programs should have a written code of conduct and compliance policies and procedures.
Compliance policies and procedures should be properly maintained.

Element 1—Written Policies and Procedures

Written policies and procedures are essential for a compliance program.
Policies and procedures should be reviewed, updated, and approved periodically.

Element 2—Compliance Leadership and Oversight

Compliance leadership and oversight are crucial for an effective compliance program.
A compliance officer should be designated to lead the compliance program.
The compliance officer should have authority, stature, access, and resources to lead a successful compliance program.
A compliance committee should be established to assist the compliance officer.
The board of directors should oversee compliance efforts.

Element 3—Training and Education

Training and education are vital for a compliance program.
Employees, contractors, and agents should receive regular compliance training.

Element 4—Effective Lines of Communication

Effective lines of communication are essential for a compliance program.
A disclosure program should be established for reporting compliance concerns.
Employees, contractors, and agents should be able to contact the compliance officer or compliance committee with questions or concerns.

Element 5—Enforcing Standards: Consequences and Incentives

Consequences for non-compliance should be established and enforced.
Incentives for compliance should be established and provided.

Element 6—Risk Assessment, Auditing, and Monitoring

Risk assessments should be conducted to identify compliance risks.
Auditing and monitoring should be conducted regularly to detect and prevent compliance violations.

Element 7—Responding to Detected Offenses and Developing Corrective Action Initiatives

Investigations should be conducted in response to detected offenses.
Reports should be made to the government as required.
Corrective action initiatives should be implemented to prevent future offenses.

Compliance Programs for Small Entities

Compliance programs for small entities should be tailored to their size and resources.
A compliance contact should be designated for small entities.
Policies, procedures, and training should be established for small entities.

Criminal Health Care Fraud Statute and HIPAA Privacy and Security Rules

The criminal health care fraud statute prohibits certain fraudulent activities.
The HIPAA privacy and security rules protect patient health information.

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Description

This quiz covers the elements of risk management, including enforcing standards, consequences, incentives, risk assessment, auditing, and monitoring. Test your knowledge of risk management principles and practices.