Affordable Care Act
Per the ACA, this was expanded to non-Medicare eligible individuals under the age of 65 with income up to 133% of the federal poverty level based on modified adjusted gross income.
Medicaid
The three categories covered by Medicare.
People 65 and older, people with certain disabilities, and people with end-stage renal disease (ESRD).
Civil monetary penalties, criminal and civil liability, and exclusion from federal health care programs are penalties of this.
Fraud, waste and abuse of Medicare.
This is a condition that occurs during a patient's hospital stay that was not present on admission.
Hospital Acquired Condition (HAC) [now often called Hospital Acquired Infection (HAI)]
There are this many elements for an effective compliance program, per the OIG.
Seven
A service available in every state to help with enrollment in affordable medical insurance.
Health Insurance Exchange (sometimes called Health Insurance Marketplace)
This program helps to prevent fraud, waste and abuse of Medicaid and Children's Health Insurance Program (CHIP).
Medicaid Integrity Program (MIP)
To prevent fraud, waste and abuse of Medicare and Medicaid, this agency was created in 1976.
Office of Inspector General (OIG)
The DRA was created to reconcile the budget of what year?
2006
This act or law prohibits a physician from making a referral for certain designated health services payable Medicare and Medicaid to an entity in which the physician or an immediate family member has ownership.
Stark Law
The maximum age for a dependent to be covered by health insurance.
26
Knowingly billing for services, treatments or supplies not provided is an example of this.
Fraud
Periodic revalidation of provider enrollment and risk-based provider screening are methods used to prevent this.
Fraud, waste and abuse of Medicaid.
For purposes of DRA, this is the term used for individuals and companies providing health care services or supplies for Medicaid patients.
Contractor
This is the title of the individual typically charged with overseeing compliance and compliance programs in healthcare organizations.
Compliance Officer
The three primary goals of the ACA.
1) Make affordable health insurance available to more people,
2) Expand Medicaid program coverage,
3) Support innovative medical care delivery methods to lower health care costs.
This government law excludes certain individuals and entities from participation in federal and state healthcare programs.
Exclusion Statute
Performing data analysis and conducting investigations of potential fraud, waste and abuse is a function of this program.
Unified Program Integrity Contractor (UPIC)
The DRA is applicable to all health care providers receiving at least this much in Medicaid payments on an annual basis.
$5 million annually
Negligence, substandard or poor quality care, and medical errors are three major causes of this in healthcare.
Adverse events
This is made up of ten categories of health care coverage mandated by the ACA.
Essential Health Benefits
The Medicare part offered by private companies and also called a Medicare Advantage Plan.
Medicare Part C
This act protects the government from being overcharged or sold bad goods or services.
False Claims Act (FCA)
The five main topics to be covered by policy per the DRA.
1) Federal False Claims Act
2) Applicable state false claims laws
3) Administrative remedies for false claims
4) Comparable state laws about penalties for false claims and statements
5) Whistleblower protections
A system of payment for the operating costs of acute care hospital inpatient status under Medicare Part A.
Inpatient Prospective Payment System (IPPS)