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HIT 142 Quiz 4
HIT110 Quiz 4 Review
| Question | Answer |
|---|---|
| What are the most common forms of healthcare fraud and abuse related to the areas of false claims and billing practices? | Upcoding and unbundling |
| True or false? Healthcare fraud and abuse is the willful misrepresentation of facts to a government entity or third-party payer so that those facts appear legal and customary and result in some form of benefit, monetary or otherwise to the provider. | True |
| Lawsuits that allow private plaintiffs to sue on behalf of the U.S. government and receive a portion of the recovered funds if successful. | Qui tam actions |
| The business care and prudence expected from a person seeking to satisfy legal requirements under similar circumstances. | Reasonable diligence |
| An act or omission in which a covered entity or business associate knew, or by exercising reasonable diligence would have known, that the act or omission violated an administrative simplification provision. | Reasonable cause |
| Conscious, intentional failure or reckless indifference to the obligation to comply with the administrative simplification provision violated. | Willful neglect |
| Relators are also known as _________________. | whistle-blowers |
| When a healthcare provider submits separate bills or procedure codes for each component of a procedure instead of using the proper procedure code for the entire procedure resulting in a higher reimbursement rate. | unbundling |
| What might a healthcare provider enact to ensure the establishment of effective internal controls that promote adherence to the applicable local, state, and federal laws and regulations? | Compliance program |
| True or false? The streamlining and standardization of seemingly inefficient and nonuniform practices in healthcare industry is know as administrative simplification | True |
| When a physician is paid for referrals to another healthcare provider, it is called a ____________. | kickback |
| What are financial settlements involving written agreements that specify the rules of conduct to be followed to remedy healthcare fraud and abuse? | Corporate integrity agreements |
| Which governmental agencies is responsible for conducting civil, administrative, and criminal investigations of fraud associated with the federal Medicare and Medicaid programs? | Office of Inspector General (OIG) of the Department of Health and Human Services |
| An employee who is paid a salary as opposed to wages, exercises discretion in performing her work, is primarily responsible for managing a business or department, routinely manages others, and possesses the authority to hire and fire other employees. | Exempt employee |
| An employment arrangement that allows the employer to terminate the employee at any time and allows the employee to leave the employer at any time. | At-will employee |
| An individual who agrees to perform certain work according to her own means, manner, and methods of performance. | Independent contractor |
| Employee who work less than thirty hours per week. | Part-time employee |
| True or False? A statutory employee is one who has been designated by specific laws as subject to the tax-withholding requirements imposed upon employees. | True |
| A physical or mental impairment that substantially limits one or more of the major life activities of an employee. | Disability |
| Any change in work environment or in the manner in which things are customarily done that enables a qualified person with a disability to have equal employment opportunities. | Reasonable accommodation |
| Any workplace obstacle, physical or procedural, that prevents an employee from performing the duties of the job. | Workplace barrier |
| A specific accommodation that creates significant difficulty or expense for the employer. | Undue hardship |
| True or false? The Health Insurance Portability and Accountability Act(HIPAA) was the first effort at the federal level to address the misuse of genetic information by insurance companies | True |
| What federal legislation provides protections against the misuse of genetic information in both the employment and insurance contexts? | GINA |
| True or false? Discrimination in child birth leave is a form of sexual discrimination. | True |
| Incorporating ethics into an employee’s performance evaluation _____. | Encourages the employee to treat others with respect |
| An employer is permitted to terminate an employee who _____. | has been found guilty of a DUI |
Created by:
Prof Clark