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Healthcare Compliance
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What is the name of the federal law that protects patient privacy?
HIPAA (Health Insurance Portability and Accountability Act)
If a director signs a contract with his brother's catering company without seeking multiple bids for best cost/services, it can be considered what?
Conflict of Interest
A "_________________" is protected under the False Claims Act Qui Tam provision to ensure safe reporting of false claims?
Whistleblower
Each program is audited within this many days?
90
Knowingly billing for a service that did not occur is an example of (Fraud/Waste/Abuse)f?
Fraud
Providing services that are not medically necessary is an example of (Fraud/Waste/Abuse)?
Waste
Failing to report/refund overpayments is an example of (Fraud/WasteAbuse)?
Abuse
When a service is being over-ordered/prescribed this is an example of (Fraud/Waste/Abuse)?
Waste
Relations between supervisors and line staff is critical to having cohesive teams. Therefore it is considered insubordination if an associate reports an issue to Lighthouse without notifying their supervisor (True/False)?
False
The False Claims Act requires a provider to report overpayments within how many days of discovery?
60
The most important time period to conduct a claims audit is within 1-3 days after the claims have been submitted to our payors (True/False)?
False
When investigating fraud we work with the Manage Care Org. and our licensing agent, the Office Human Services and Substance Abuse(True/False)?
False
Our audits are primarily focused on fee-for-service programs rather than per diem rate programs(True/False)?
True
The IRS requires that non-profit board members sign this form annually?
Conflict of Interest form
If we contract with a vendor to handle our client's information, this must be signed?
Business Associate Agreement
KidsPeace will be penalized if we do not provide an annual training on the Deficit Reduction Act and what other law?
False Claims Act
This type of background check is completed monthly to check whether an individual is prohibited from healthcare?
Exclusion Check
This document is completed annually and identifies all areas of focus for the coming year?
Compliance Plan
What is the agency that oversees all Compliance programs?
Office of Inspector General
What is our primary method to identify billing fraud?
Pre-billing Audits
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