Medicare Fraud, Waste, & Abuse exam solved 100% correct!!!

Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the purpose of payment. As part of this job, you use a process to verify the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis codes for certain individuals. What should you do? a.Do what your immediate supervisor asked you to do and adjust or add risk diagnosis codes b.Report the incident to the compliance department (via compliance hotline or other mechanism) c.Discuss your concerns with your immediate supervisor d.Call law enforcement - Report the incident to the compliance department (via compliance hotline or other mechanism) Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting fraud, waste, and abuse (FWA)? a.Civil Monetary Penalties b.Exclusion from participation in all Federal health care programs c.Deportatio - Deportation Which of the following requires intent to obtain payment and the knowledge the actions are wrong? a.Fraud b.Waste c.Abuse - Fraud A person drops off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 160. You review the prescription and have concerns about possible forgery. What is your next step? a.Call law enforcementb.Call the prescriber to verify the quantity c.Call the Sponsor's compliance department d.Fill the prescription for 160 e.Fill the prescription for 60 - Call the prescriber to verify the quantity