Question 1

Which consists of audits implemented by DHHS that examines the billing practices of physicians at teaching hospitals with the focus on compliance with the Medicare rule affecting payment for physician services provided by residents and whether the level of the physician service was coded and billed properly?

Accepted Answer

The PATH (Physicians at Teaching Hospitals) audits are conducted by the Department of Health and Human Services (DHHS) to ensure compliance with Medicare rules regarding billing for physician services provided by residents in teaching hospitals.

Question 2

Which is a legal document containing a list of questions that must be answered in writing?

Accepted Answer

An interrogatory is a legal document containing a list of questions that one party sends to another party in a lawsuit, which must be answered in writing under oath.

Question 3

Which is the official document that contains new and changed Medicare policies and/or procedures that are to be incorporated into a specific CMS program manual?

Accepted Answer

Transmittals are the official documents used by CMS to communicate new and changed Medicare policies and procedures that need to be incorporated into specific CMS program manuals.

Question 4

Which is an order of the court that requires a witness to appear at a particular time and place to testify?

Accepted Answer

A subpoena is a legal document that orders a person to attend court to give testimony.

Question 5

Which prohibits physicians from referring Medicare patients to clinical laboratory services in which the physicians or their family members have a financial ownership/investment interest and/or compensation arrangement?

Accepted Answer

The Stark Law (Stark I) prohibits physicians from referring Medicare patients to clinical laboratory services in which they or their family members have a financial interest.

Question 6

Which is an abbreviation for the Latin phrase qui tam pro domino rege quam pro sic ipso in hoc parte sequitur, meaning "who as well for the king as for himself sues in this matter"?

Accepted Answer

"Qui tam" is the abbreviation for the Latin phrase "qui tam pro domino rege quam pro sic ipso in hoc parte sequitur," which refers to a legal action brought by a private individual on behalf of the government as well as for themselves.

Question 7

Which is the physician self-referral law that protects patients and federal health care programs from fraud and abuse by curtailing the corrupting influence of money on health care decisions?

Accepted Answer

The Federal Anti-Kickback Law is designed to prevent fraud and abuse in healthcare by prohibiting the exchange of remuneration for referrals for services covered by federal healthcare programs, thus protecting patients and ensuring healthcare decisions are not unduly influenced by financial incentives.

Question 8

Criminal law is __________ law (statute or ordinance) that defines crimes and their prosecution.

Accepted Answer

Criminal law is a type of public law because it involves the regulation of behavior and the enforcement of laws by the government.

Question 9

Which was implemented to protect the privacy of individuals identified in information systems maintained by federal government hospitals and to give individuals access to records concerning themselves?

Accepted Answer

The Privacy Act of 1974 was implemented to protect the privacy of individuals by regulating the collection, maintenance, use, and dissemination of personal information by federal agencies, including federal government hospitals. It also provides individuals with the right to access records about themselves.

Question 10

Because the diagnosis and procedure codes reported affect the DRG selected (and resultant payment), some hospitals engage in a practice called __________, which is the assignment of an ICD-10-CM diagnosis code that does not match patient record documentation, for the purpose of illegally increasing reimbursement.

Accepted Answer

Upcoding is the practice of assigning an ICD-10-CM diagnosis code that does not match patient record documentation to illegally increase reimbursement.

Question 11

Which requires Medicare administrative contractors to attempt the collection of overpayments received by a provider or beneficiary?

Accepted Answer

The Federal Claims Collection Act requires Medicare administrative contractors to attempt the collection of overpayments received by a provider or beneficiary.

Question 12

Which regulates fraud associated with military contractors selling supplies and equipment to the Union Army?

Accepted Answer

The False Claims Act was enacted during the Civil War to combat fraud by military contractors selling supplies and equipment to the Union Army.

Question 13

Civil law deals with all areas of the law that are not classified as __________ law.

Accepted Answer

Civil law deals with disputes between individuals or organizations, whereas criminal law involves cases where the government prosecutes someone for an act classified as a crime.

Question 14

Which is a legal newspaper published every business day by the National Archives and Records Administration (NARA), and is available in paper form, on microfiche, and online?

Accepted Answer

The Federal Register is a legal newspaper published every business day by the National Archives and Records Administration (NARA), containing government agency rules, proposed rules, and public notices.

Question 15

Federal and state __________ are laws passed by legislative bodies, such as federal Congress and state legislatures.

Accepted Answer

Statutes are laws that are formally written and enacted by legislative bodies, such as the federal Congress and state legislatures.

Question 16

Which is testimony under oath taken outside of court, such as at the physician's office?

Accepted Answer

A deposition is testimony taken under oath outside of court, often in a lawyer's office or another location, such as a physician's office.

Question 17

Court decisions establish standard use legal decisions that serve as authoritative rules or patterns in future similar cases. The legal term for standard is __________.

Accepted Answer

A precedent is a legal decision that serves as an authoritative rule or pattern in future similar cases.

Question 18

Which requires documents, such as a patient record, to be produced in court?

Accepted Answer

A subpoena duces tecum specifically requires the production of documents or records in court.

Question 19

Laws that are implemented as guidelines written by administrative agencies, such as CMS, are called __________.

Accepted Answer

Regulations are rules or directives made and maintained by an authority, such as administrative agencies like CMS, to implement and enforce laws.

Question 20

Court decisions that establish a standard create __________ law.

Accepted Answer

Court decisions that establish a standard create case law, which is law developed by judges through decisions in individual cases.

Quiz 5: Legal and Regulatory Issues