Question

While completing a routine coding audit, the Health Information Management director notices that a treatment was billed as an outpatient, rather than an inpatient, procedure. The director is concerned that the incident has the potential for malpractice litigation.

Which federal violation was identified?
A.) False Claims Act
B.) HIPAA privacy rule
C.) Whistleblowers Protection Act
D.) Trade Commission false advertising rules

Answer 1

The correct federal violation identified is the False Claims Act which is designed to prevent and penalize healthcare-related fraudulent billing practices. The correct option is A.

Step-by-step explanation:

The federal violation identified when a treatment was billed as an outpatient procedure rather than an inpatient procedure, and which carries the potential for malpractice litigation, is the False Claims Act (A). This act is intended to prevent and penalize fraudulent billing practices in healthcare and other governmental contracts.

Since the incorrect billing could lead to potential overpayments by government programs such as Medicare or Medicaid, it might constitute a false claim, which is subject to penalties and fines under the False Claims Act. The Health Insurance Portability and Accountability Act (HIPAA) concerns patient privacy and the secure handling of health information but does not directly relate to the fraudulent billing question.

The Whistleblower Protection Act protects employees from retaliation for reporting misconduct, and the Trade Commission false advertising rules apply to the advertising of products, neither of which directly address the billing issue described. Hence, A is the correct option.