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What does CMS define as fraud? A) Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program B) Making true statements or accurate information to obtain a deserved benefit or payment fr$9.96
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What does CMS define as fraud? A) Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program B) Making true statements or accurate information to obtain a deserved benefit or payment fr
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What does CMS define as fraud? A) Making false st
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What Does CMS Define As Fraud? A) Making False St
What does CMS define as fraud?
A) Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a
federal healthcare program
B) Making true statements or accurate information to obtain a deserved benefit or payment from a
federal healthcare program
C) Ma...
CPMA Certification Study Guide 2024 Chapter 1
What does CMS define as fraud?
A) Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a
federal healthcare program
B) Making true statements or accurate information to obtain a deserved benefit or payment from a
federal healthcare program
C) Making unnecessary claims or requesting unnecessary services from a federal healthcare program
D) Making excessive claims or requesting excessive services from a federal healthcare program
Correct answer: A) Making false statements or misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program
What does CMS define as abuse?
A) An action that results in unnecessary costs to a federal healthcare program, either directly or
indirectly
B) An action that results in excessive costs to a federal healthcare program, either directly or indirectly
C) An action that results in unnecessary benefits to a federal healthcare program, either directly or
indirectly
D) An action that results in excessive benefits to a federal healthcare program, either directly or
indirectly
Correct answer: A) An action that results in unnecessary costs to a federal healthcare program, either
directly or indirectly
What is an example of fraud according to CMS?
A) Billing for services and/or supplies that were actually furnished or provided
B) Billing for services and/or supplies that were not furnished or provided
C) Billing for services at a higher level than necessary
, D) Billing for services at a lower level than necessary
Correct answer: B) Billing for services and/or supplies that were not furnished or provided
What is an example of abuse according to CMS?
A) Misusing codes on a claim
B) Charging excessively for services or supplies
C) Billing for services that were not medically necessary
D) Failure to maintain adequate medical records
Correct answer: C) Billing for services that were not medically necessary
What is the Federal False Claims Act (FCA)?
A) A law that allows individuals to bring civil actions on behalf of the US government for false claims
made to the federal government under a provision called qui tam
B) A law that prohibits individuals from bringing civil actions on behalf of the US government for false
claims made to the federal government under a provision called qui tam
C) A law that allows the US government to bring civil actions on behalf of individuals for false claims
made to the federal government under a provision called qui tam
D) A law that prohibits the US government from bringing civil actions on behalf of individuals for false
claims made to the federal government under a provision called qui tam
Correct answer: A) A law that allows individuals to bring civil actions on behalf of the US government for
false claims made to the federal government under a provision called qui tam
What is the Civil Monetary Penalties Law (CMPL)? ✔️A law tdhat states that any person is in violation if
he or she knowingly presents, or causes to be presented, a claim to any federal or state agency that the
Secretary of HHS determines :
* is for a medical service or other item or service that the person knows or should know was not
provided as claimed (upcoding,miscoding,etc.)
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