← Back to exam page

AHM-510 – Governance and Regulation

Loading demo links...

Showing 7–9 of 10 questions

Question 7

Antitrust laws can affect the formation, merger activities, or acquisition initiatives of a health plan. In the United States, the two federal agencies that have the primary responsibility for enforcing antitrust laws are the

Select an option, then click Submit answer.

  • ○

    Internal Revenue Service (IRS) and the Department of Justice (DOJ)
  • ○

    Office of Inspector General (OIG) and the Department of Defense (DOD)
  • ○

    Federal Trade Commission (FTC) and the Department of Labor (DOL)
  • ○

    Federal Trade Commission (FTC) and the Department of Justice (DOJ)
Question 8

There are several approaches to the interagency division of responsibility for managed care entity (MCE) oversight. In State M, the state Medicaid agency, the state department of health, and the state insurance department are all responsible for ensuring that quality improvement programs are in place among the same group of MCEs and that these programs meet each agency's rules and regulations for such programs. This information indicates that State M uses the approach known as the

Select an option, then click Submit answer.

  • ○

    Parallel model
  • ○

    Shared model
  • ○

    Concurrent model
  • ○

    PACE model
Question 9

There are several exceptions to the Ethics in Patient Referrals Act and its amendments (the Stark laws), which prohibit a physician from referring Medicare or Medicaid patients for certain designated services or supplies provided by entities in which the physician has a financial interest. Consider whether the situations described below qualify as exceptions to the Stark laws:

Situation A: Dr. Wong is a physician in the Marvel Health Plan's provider network and has a financial relationship with Marvel arising from the health plan's compensation for his services. Marvel is not a prepaid health plan.

Situation B: Dr. Ryder is a physician in the provider network of the Glen Health Plan, which is not a prepaid health plan. In situations of medical necessity, Dr. Ryder refers Glen patients to a physical therapy clinic that leases office space from him.

Situation C: Dr. Yost has a compensation arrangement with a health plan for providing health services under the Medicare+Choice program.

An arrangement that is exempt from the Stark laws is described in

Select an option, then click Submit answer.

  • ○

    All of these situations
  • ○

    Situations A and C only

  • ○

    Situation B only

  • ○

    Situation C only