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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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Class 10 - CME Test

This is a multiple-choice test.  Input the best answer corresponding to the attached readings in the form below. The test questions associated with Class 10 are listed at the bottom of this page, below the test form.  Upon Completion of the CME Test please complete the Evaluation of this class and submit (See Evaluation link above).  

CME Test Class 10  --  form for test completion

Are you registered for this class?

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If you are registered, please use the following form to complete the test from the questions listed on the CME Test  Class 10 (below): 

1.    Dr. Jones has come up with a great idea to keep managed care from interfering with his practice of medicine.  He has decided to be a leader to ban together all healthcare providers in his town to keep managed care out or at least to agree together with all of the other providers on what the acceptable terms would be if managed care were allowed into their town.  What laws, if any, should Dr. Jones be particularly concerned about by this activity?  (Reference Class 10, "Antitrust")

Question 1 choices:

A B C D E 

A.   Dr. Jones should be concerned about "Any Willing Provider" type of laws.

B.   Dr. Jones should be concerned about at least antitrust type of laws.  He should make sure that he is not violating any of these type of laws.  The United States has certain laws governing monopolies and other issues that fall under the antitrust area.  Providers are subject to such antitrust laws and have tried to create certain laws to allow providers to organize in a manner that would otherwise be considered in violation of antitrust type of laws.

C.   Dr. Jones should be concerned about patient protection type of laws.

D.   Dr. Jones does not need to be concerned about violating any type of laws because managed care would interfere with his practice of medicine. 

E.   Dr. Jones should be concerned about confidentiality type of laws.

2.   According to the corresponding readings, when you hear the term fraud and abuse, what are some of the questions you should ask?  (Reference Class 10, "Fraud and Abuse")

Question 2 choices:

A B C D E  

1.    Are we talking criminal, civil, or a combination of both?

2.    Who are the parties involved?  From the government’s perspective there may be various agencies involved such as the: Office Inspector General (OIG), Federal Bureau Investigations (FBI), Department of Justice (DOJ), Internal Revenue Service (IRS), Health Human Service (HHS), Attorney General, Securities Exchange Commission (SEC), and others.

3.    Is it at the state or federal level or both?    

4.    What are the damages or penalties involved?  

A.   1 and 2

B.   2 and 3 

C.   3 and 4 

D.   1, 2, and 3

E.   1, 2, 3, and 4

3.   Why would the False Claims Act ("FCA") be considered  at the heart of the federal government’s Medicare fraud and abuse effort?  (Reference Class 10, "Fraud & Abuse" - "Fraud and Abuse Laws" - "Qui Tam Actions") 

Question 3 choices:

A B C D

A.   The False Claims Act deals with the Corporate Practice of Medicine Acts and because these are federal laws designating utilization procedures for HMOs, they are at the heart of the federal government’s Medicare fraud and abuse effort.

B.   The False Claims Act ("FCA") is considered at the heart of the federal government’s Medicare fraud and abuse effort because it is a criminal action with long sentences involved.

C.   The False Claims Act ("FCA") is considered at the heart of the federal government’s Medicare fraud and abuse effort because of the triple damages involved.

D.   All of the above.

E.   None of the above.

4.   Dr. Smith has come up with a new way to make more money real fast.  He has decided to change his billing procedures for Medicare and Medicaid patients.  He has implemented software that automatically adjusts his billing to a higher, more costly, level than the one he actually rendered.  What laws, if any, should Dr. Smith be concerned about by this activity?  (Reference Class 10, "Fraud & Abuse" - "Fraud and Abuse Laws")

Question 4 choices:

A B C D E  

A.   Dr. Smith does not need to be concerned about violating any type of laws because he has a right to run his medical practice in any manner he chooses.

B.   Among other things, Dr. Smith should be concerned about fraud and abuse related laws.  There are certain laws effecting providers dealing with, among other things, upcoding, overbilling, and billing for services not rendered for Medicare and Medicaid patients.

C.   Dr. Jones should be concerned about "Any Willing Provider" type of laws.

D.   All of the above.

E.   None of the above.

5.   According to the readings, list the penalties for violation of self referral Stark laws?   (Reference Class 10, "Self Referral")

Question 5 choices:

A B C D E 

A.   Denial of payment; Mandatory refund of any payments previously received.

B.   Civil money penalties of up to $15,000 per prohibited referral.

C.   Exclusion from the Medicare and Medicaid programs.

D.   "Circumvention schemes" are punishable by civil money penalties of up to $100,000 per scheme.

E.   All of the above.

6.   What is a "Silent PPO"?  (Reference Class 10, "States")

Question 6 choices :

A B C D E

A.   A silent PPO is an unauthorized entity using information that it has access to for its own benefit, such as a third party administrator having knowledge of provider's rates and automatically paying providers  lowest rates based on contracts not applicable to the services rendered.  In this example, many providers are not equipped to identify this problem of receiving reduced rates that they have not agreed upon because the provider has other contracts referring to that amount.  In this example, the third party administrator is acting like a hidden PPO, hence the term "Silent PPO". 

B.   A "Silent PPO" are federal laws designating utilization procedures for PPOs.

C.   A "Silent PPO" are federal laws designating utilization procedures for HMOs.

D.   All of the above.

E.   None of the above.

7.   What do the three countries Canada, West Germany, and United Kingdom, have in common in terms of providing health care to their country?  (Reference Class 10, "Other Countries" - "Healthcare Systems in Other Countries:)

Question 7 choices:

A B C D E

A.   These three countries, Canada, West Germany, and United Kingdom do not have anything in common in terms of healthcare coverage for their country.

B.   These three countries, Canada, West Germany, and United Kingdom all use the HMO system of providing care to their populations.

C.   These three countries, Canada, West Germany, and United Kingdom all use the PPO system of providing care to their populations.

D.   These three countries, Canada, West Germany, and United Kingdom, all provide universal health care coverage, guaranteeing to their populations financial access to medical services.

E.   None of the above.

8.   What are Qui tam cases?  (Reference Class 10, "Fraud & Abuse" - "Fraud and Abuse Laws" - "Qui Tam Actions") 

Question 8 choices:

A B C D

A.  Qui tam actions are criminal cases brought by the government on behalf of individuals.

B.   Qui tam cases are the last case at the end of each day that a judge presides over.

C.   The False Claims Act ("FCA") allows for private individuals to sue on behalf of the government. These cases are known as Qui tam actions.  These cases are commonly known as whistleblower cases. Typically, whistleblower cases are brought by disgruntled employees, or in divorce proceedings by a disgruntled spouse.

D.   All of the above.

E.   None of the above.

9.   What are the penalties for wrongful disclosure of individually identifiable health information under  the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA)?  (Reference Class 10, "HIPAA" - Health Insurance Portability and Accountability Act "HIPAA")

Question 9 choices:

A B C D E

A.  There are no penalties for wrongful disclosure of individually identifiable health information under HIPAA.

B.   Wrongful disclosure of individually identifiable health information penalties include a health care official can be fined up to $5,000 and imprisoned up to one year and if the wrongful disclosure is committed under false pretenses the potential fines are $100,000 and imprisonment of up to five years.

C.   HIPAA is a voluntary program and the wrongful disclosure of individually identifiable health information penalties are self-imposed sanctions.

D.   Wrongful disclosure of individually identifiable health information penalties under HIPAA is a written letter of apology to the affected party with a copy to the Secretary of State's Office.

E.   None of the above.

10.   According to the readings, what are many consultants telling physicians to do to protect themselves in terms of compliance plan issues?  (Reference Class 10, "Compliance Plans")

Question 10 choices:

A B C D E

A.    Delegate responsibilities wisely and be proactive - review regularly.

B.    Implement Compliance Program - Beef Up Internal Controls.

C.    Get involved - follow, be involved with new legislation.

D.  All of the above.

E.   None of the above.

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You will be notified of results upon receipt of registration and payment.  Thank you for taking this test.  Also, please submit Evaluation of this Class as specified at the top of this page.

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