Question

20.       Identify the federal law which promoted employer benefit programs and has been found to prohibit state law claims ( such as malpractice and negligence claims) against insurance companies that are part of an employer sponsored health plan.

21.       Identify three resources that providers can use to determine the scope of Medicare coverage for a particular service?

22.       What is a QIO?

23.       What is the statutory legal standard under the federal Anti-kickback Statute?

            a.         Malice aforethought

            b.         Knowing/willful

            c.         Malignant heart

            d.         Reckless

e.         Negligence

24.       What is the minimum mandatory prison sentence for a Stark law violation?

25.       What is a “designated health service”?

26.       What is a “safe harbor”?

27.       Identify any exceptions to the Stark law that apply to both compensation arrangements and ownership/investment interests?

28.       Identify two differences between the Stark law and the Anti-Kickback Statute:

29.       What purpose is served by the OIG’s Provider Self-Disclosure Protocol:

30.       What are the goals and benefits of a compliance plan?

Answer 1

20, Federal law benefts for employees in health - relate benefits ,it protect their rights, Anti - discrimination, providing employees with health insurance , and coverage, employee retirement income security Act( ERISA), family and medical leave Act etc..

21, Services should meet criteria by national coverage determination and local coverage determination..Three resources providers can get Medicare coverage for their services are

- inpatient admission treatment

- procudures done by Physician

- prescription drug

22, Quality improvement organization

It is a federal program for improving health quality for Medicare beneficiaries..

23, malice afore thought

Anti kickback statue for malice aforethought ( predetermination to do an unlawful act ..