Exam (elaborations)
Preventing Fraud Abuse and Waste - exam 1 with answers 2024
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Preventing Fraud Abuse and Waste - exam 1 with answers 2024
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PreventingFraud
Abuse
and
Waste
-
exam
1
with
answers
2024
fraud
-
answer-intentional
deception
or
misrepresentation
that
a
person
makes
to
gain
a
benefit
to
which
they
are
not
entitled.
ex:
false
documentation.
fraud
results
in...
-
answer-overutilization
of
services
increased
costs
to
payors
unfair
competition
harm
to
pt.
government
resources
for
fighting
fraud
-
answer-fee
for
service
companies
significant
source
of
revenue
return
on
investment
for
the
health
care
fraud
and
abuse
control
program.
rules
for
SPT
-
answer-do
not
document
for
medicare
pt.
unless
your
CI
is
supervising
you
and
not
treating
another
pt.
CI
can
supervise
2
students
at
once
but
you
will
need
to
bill
for
group
therapy.
abuse
-
answer-payment
for
items
or
services
that
the
provider
has
not
intentionally
misrepresented
facts
to
obtain
payment.
ex:
billing
services
that
are
not
medically
necessary
for
pt.
waste
-
answer-incurring
unnecessary
costs
as
a
result
of
deficient
management
processes,
systems
or
controls.
ex:
duplication
of
services
knowing
-
answer-includes
actual
knowledge,
deliberate
ignorance
and
reckless
disregard
for
the
truth
or
falsity
of
the
information.
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