Health and Human Services Professional Field Experience (D409)

Correct answer:

C. By allowing consumers to challenge charges that are false and avoid having delinquent charges added to their credit history

Explanation:

The Fair Credit Billing Act (FCBA) helps protect consumer credit ratings by allowing individuals to dispute inaccurate or fraudulent charges on their credit card statements. If a consumer formally disputes a charge within 60 days, the credit card issuer must investigate and cannot report the charge as delinquent while the investigation is ongoing. This prevents unjust negative marks from appearing on the consumer’s credit report, which helps maintain a healthy credit score.

Why other options are wrong:

A. By allowing consumers to decrease the total debt of their credit and keep the merchandise. The FCBA does not reduce a consumer’s total debt. It only helps resolve billing disputes and fraudulent charges. Consumers are still responsible for legitimate charges, even if they involve defective goods.

B. By allowing the consumer to create and establish their own credit score so they do not have to pay as much interest. The FCBA does not give consumers the ability to create or modify their own credit scores. Credit scores are determined by independent credit bureaus based on a variety of financial behaviors, such as payment history and debt levels. The FCBA only prevents unfair negative marks due to billing errors.

Correct answer: B. 20 years

Explanation:

Mail fraud involving schemes to defraud a health care benefit program is considered a serious federal crime, punishable by significant penalties. Under U.S. federal law, individuals convicted of this offense can face fines and imprisonment for up to 20 years. The severity of this punishment reflects the government's commitment to protecting health care programs from fraudulent activities that result in financial losses and harm to patients.

Why other options are wrong:

A. 15 years While 15 years is a substantial penalty, the actual maximum imprisonment for mail fraud related to health care benefit programs is 20 years. This higher sentence is meant to deter individuals from engaging in fraudulent activities that could undermine the integrity of health care systems.

C. 12 years There is no specific provision in federal law that sets the penalty for health care mail fraud at 12 years. The law clearly states that the maximum imprisonment term is 20 years, which is longer than the 12-year option.

D. 10 years Although some types of fraud-related offenses carry a 10-year penalty, mail fraud specifically targeting health care benefit programs has a harsher punishment. The correct maximum imprisonment period is 20 years, as outlined in federal statutes.

Correct answer: D. It is one of 15 executive offices in the Cabinet that reports directly to the President of the United States - part of the Executive Branch of the US Federal Government.

Explanation:

The US Department of Health and Human Services (HHS) is a federal agency responsible for public health, social services, and welfare programs. It is part of the Executive Branch and reports directly to the President as one of the 15 Cabinet-level departments. HHS oversees various agencies, including the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC).

Why other options are wrong:

A. It lobbies for tax breaks for all Americans.

HHS does not function as a lobbying entity. Its role is to develop and implement health policies rather than advocate for tax policy changes.

B. It was founded in 1948.

HHS was officially established in 1980 when the Department of Health, Education, and Welfare (HEW) was split into two separate departments: HHS and the Department of Education.

C. It pursues strong protective health and safety standards in the workplace.

Workplace safety falls under the jurisdiction of the Occupational Safety and Health Administration (OSHA), which is part of the Department of Labor, not HHS.

Correct answer: C. A physician knowingly submits claims to Medicare for medical services not provided

Explanation:

The FCA is designed to prevent fraudulent claims for federal funds, including Medicare and Medicaid payments. Knowingly submitting false claims for reimbursement—such as billing for services that were never provided—is a clear violation of the FCA and can result in severe penalties, including fines and exclusion from federal healthcare programs.

Why other options are wrong:

A. A provider accidentally uses wrong codes.

If a provider unintentionally submits incorrect codes, it is typically considered an error, not fraud. The FCA applies when there is intentional deception or reckless disregard for the truth.

B. A physician refers a beneficiary to a clinic where the physician has an investment interest.

This situation falls under the Stark Law, which prohibits physician self-referrals but does not necessarily constitute an FCA violation unless fraudulent billing is involved.

D. A provider receives cash for medical office space in exchange for referrals.

This scenario is a violation of the Anti-Kickback Statute, which prohibits financial incentives for patient referrals. While it is illegal, it is not specifically an FCA violation unless fraudulent claims are submitted as a result.

Correct answer: A. allows Americans to purchase health coverage that fits their budget and meets their needs.

Explanation:

The Health Insurance Marketplace, established under the Affordable Care Act (ACA), provides a platform where individuals and families can compare and purchase health insurance plans. The marketplace offers various coverage options based on income levels, with subsidies available to make insurance more affordable. It ensures that Americans have access to essential health benefits while promoting transparency and competition among insurance providers.

Why other options are wrong:

B. Created the Obamacare federal national health insurance program.

The term "Obamacare" is often used to refer to the Affordable Care Act, but the Health Insurance Marketplace is just one component of the ACA. It does not create a national health insurance program; instead, it provides a platform for purchasing private insurance.

C. Replaced other health insurance programs, such as private insurance.

The Health Insurance Marketplace did not replace private insurance or other health programs like Medicare and Medicaid. Instead, it provides a regulated system for individuals to purchase insurance from private providers, often with financial assistance.

D. Requires employers to offer group health insurance to all employees.

The ACA includes an employer mandate, but it only applies to businesses with 50 or more full-time employees. Small businesses and individuals can still access insurance through the marketplace, but employers are not universally required to provide coverage to all employees.

Correct answer:

D. Delivering nutritious meals to individuals who are homebound or unable to prepare their own meals.

Explanation:

Meals on Wheels is a community-based program designed to provide nutritious meals to individuals who are unable to shop for or prepare their own food due to age, illness, or disability. The service helps reduce food insecurity, promote independence, and support overall well-being for homebound individuals. In addition to meal delivery, many programs offer social interaction and wellness checks, further enhancing the quality of life for recipients.

Why other options are wrong:

A. Offering long-term residential care for elderly individuals. Meals on Wheels is a home-based service rather than a residential care program. Long-term residential care involves facilities such as nursing homes or assisted living, where individuals receive ongoing medical and personal care.

B. Providing short-term, emergency healthcare services in the home. Meals on Wheels focuses on nutrition rather than direct healthcare services. While the program may contribute to overall health, it does not provide emergency or medical care in the home.

C. Administering palliative care for individuals with a life expectancy of six months or less. Palliative care is specialized medical care for individuals with serious illnesses, often provided by healthcare professionals. Meals on Wheels does not offer medical services but rather ensures access to food for those who need assistance with meal preparation.

Correct answer: C. They enhance overall health and well-being by offering support to those in need.

Explanation:

Social services play a vital role in the mission of the Department of Health and Human Services (HHS) by providing essential support systems that improve the overall well-being of individuals and families. These services include financial assistance, healthcare access, food security, housing support, and child welfare programs. By addressing social determinants of health, social services help reduce poverty, improve quality of life, and ensure that individuals have the necessary resources to live healthier and more stable lives. The comprehensive approach taken by HHS ensures that vulnerable populations receive the aid they need to thrive.

Why other options are wrong:

A. They provide financial assistance only.

While financial assistance is an important component of social services, it is not the only type of support offered. Social services also include healthcare access, mental health support, child welfare programs, housing assistance, and education programs. Limiting social services to financial aid overlooks their broader impact on individuals and families.

B. They focus solely on healthcare privacy.

Although healthcare privacy is an important issue addressed by HHS, social services extend far beyond this area. Social services provide direct support through food programs, shelter assistance, employment services, and family support programs. Their primary goal is to enhance well-being, not just protect personal health information.

D. They are primarily concerned with disaster preparedness.

While disaster preparedness is a component of HHS programs, it is not the primary function of social services. Social services focus on addressing long-term social and economic challenges such as poverty, homelessness, healthcare access, and child welfare. Disaster response may be part of their scope, but it is not the main focus of social service programs.

Correct answer:

A. filing false claims to insurance companies

Explanation:

Healthcare fraud occurs when providers intentionally submit false or misleading information to insurance companies, Medicare, or Medicaid for financial gain. This can include billing for services not provided, exaggerating diagnoses, or performing unnecessary procedures to increase reimbursement. Fraudulent practices increase healthcare costs and reduce resources for legitimate patient care, making fraud prevention a priority in healthcare regulation.

Why other options are wrong:

B. not caring for the patient. While neglecting patient care is unethical and may be considered malpractice, it is not classified as fraud. Fraud specifically involves deceptive practices aimed at financial gain rather than poor or negligent care.

C. doing the right thing for the patient. This option is the opposite of fraud, as it suggests ethical behavior in healthcare. Fraud involves deceit and financial exploitation, whereas doing the right thing means upholding professional and moral responsibilities.

D. protecting the patient from harm. Protecting patients from harm aligns with ethical medical practice and patient safety standards. Healthcare fraud, on the other hand, is driven by financial motives rather than patient well-being.

Correct answer: D. QIOs are primarily concerned with reducing costs for services provided in SNFs.

Explanation:

Quality Improvement Organizations (QIOs) play a key role in ensuring high-quality healthcare services for Medicare beneficiaries. Their primary focus is on improving the quality of care, ensuring that services meet established medical standards, and protecting patient rights. They work with healthcare providers, such as skilled nursing facilities (SNFs), to enhance care quality rather than simply reducing costs.

Why other options are wrong:

A. Each SNF must have a memorandum of agreement (MOA) with a Quality Improvement Organization (QIO). This statement is correct. Skilled nursing facilities (SNFs) are required to have an MOA with a QIO to ensure compliance with Medicare quality standards and participate in quality improvement initiatives.

B. QIOs ensure that Medicare only pays for reasonable and necessary services. This statement is correct. One of the primary roles of QIOs is to review medical services and claims to verify that they are medically necessary and appropriate for Medicare reimbursement.

C. QIO reviews medical records to determine if service met standards and was medically necessary. This statement is correct. QIOs conduct medical record reviews to assess whether services provided were appropriate and met Medicare’s quality standards.