Argus HIPAA, Compliance, Fwa Test

Committing fraud, waste, or abuse can result in various consequences. Civil money penalties can be imposed, which involve monetary fines. Criminal convictions and fines can also be imposed, leading to legal consequences. Imprisonment is another possible consequence, where the individual may be sentenced to jail or prison. Lastly, committing fraud, waste, or abuse can result in exclusion from federal health care programs, which can impact the individual's ability to participate in these programs. Therefore, all of the options mentioned (Civil Money Penalties, Criminal Convictions/Fines, Imprisonment, Exclusion from federal health care programs) are potential consequences of committing fraud, waste, or abuse.

Under HIPAA, a member has the right to access their information, obtain an accounting of disclosures of their personal information, and correct or amend their information. This means that individuals have the right to view their own medical records, know who has accessed their information, and have the ability to update any inaccuracies or incomplete information in their records. These rights are important for maintaining privacy and control over personal health information.

The statement is true because Argus provides methods that prioritize confidentiality, anonymity, and non-retaliation. This means that individuals can report information or concerns without fear of their identity being revealed or facing any negative consequences. This approach encourages openness and honesty, allowing people to come forward with important information without fear of reprisal.

It is important to report potential misconduct, suspected fraud, waste, or abuse situations rather than keeping the information to oneself. Reporting such incidents helps in maintaining transparency, integrity, and accountability within an organization. By reporting, appropriate actions can be taken to address the issue and prevent further harm. Therefore, the correct answer is false, as it is necessary to inform the relevant authorities or individuals about such situations.

HIPAA, the Health Insurance Portability and Accountability Act, provides safeguards to prevent unauthorized access to protected health care information. This law sets standards for the privacy and security of individuals' health information and establishes penalties for violations. It requires healthcare providers, health plans, and healthcare clearinghouses to implement measures to protect the confidentiality, integrity, and availability of patients' information. HIPAA also gives individuals certain rights regarding their health information, such as the right to access and request amendments to their records. Overall, HIPAA aims to ensure the privacy and security of individuals' health information and prevent unauthorized access or disclosure.

The responsibility of identification, detection, and reporting of fraud, waste, and abuse lies with Argus vendors and all of the above, which includes the Claims and Customer Service staff, the Compliance Officer, and the Managers, Directors, CEO, or the Board of Directors. This means that all these individuals and entities have a role to play in ensuring that any fraudulent or wasteful activities are identified, detected, and reported appropriately.

The answer "All of the above" is correct because all three options mentioned - the past, present, or future physical or mental health or condition of a member, the provision of health care to a member, and the past, present, or future payment for the provision of health care to a member - are considered Protected Health Information (PHI). PHI is any information that relates to the individual's health status, healthcare services provided, or payment for those services, and is protected under the Health Insurance Portability and Accountability Act (HIPAA) to ensure privacy and security.

Conferences Calls is not one of the 7 core requirements of a Compliance Program. The core requirements include Written Standards of Conduct, High Level of Oversight, and Effective Lines of Communication. Conferences Calls, although they can be a useful tool for communication, are not specifically mentioned as a core requirement in a compliance program.

The correct answer is the Anti-Kickback Statute. The Anti-Kickback Statute is a federal law that prohibits the exchange of remuneration in return for referrals for services paid under federal health care programs. This law aims to prevent fraud and abuse in the healthcare system by prohibiting the offering or receiving of kickbacks, bribes, or other forms of remuneration in exchange for patient referrals. Violations of the Anti-Kickback Statute can result in criminal penalties, civil fines, and exclusion from federal healthcare programs. The Stark Law, HIPAA, and False Claims Act are separate laws that address different aspects of healthcare fraud and abuse.

When sending an email containing confidential or protected health information to an external party outside of Argus, it is necessary to include [encrypt] in the body or subject of the email. This indicates that the email should be encrypted to ensure the security and privacy of the information being transmitted. By including [encrypt], it ensures that the email is protected from unauthorized access and maintains the confidentiality of the sensitive data being shared.