CDEO Chapter 3; Questions & Answers 100%
Pass
Documentation states that the patient had a "Status post hysterectomy. The
patient presents with a fever." Which of the following would be a compliant
question to query? Correct Answer-Do you know the cause of the fever?
Operation Restore Trust ...
CDEO Chapter 3; Questions & Answers 100%
Pass
Documentation states that the patient had a "Status post hysterectomy. The
patient presents with a fever." Which of the following would be a compliant
question to query? Correct Answer-Do you know the cause of the fever?
May 1995 Bill Clinton: 2 yr partnership of federal and state agencies, working
together to protect the healthcare trust funds through shared intelligence
coordinated enforcement, intended to enhance quality of care for program's
beneficiaries.
Program is not called Senior Medicare Patrol SMP
They work to combat fraud and abuse.
SMP Correct Answer-Senior Medicare Patrol
OIG Correct Answer-Office of Inspector General
AoA Correct Answer-Administration on Aging
FCA Correct Answer-False Claims Act
CMPL Correct Answer-Civil Money Penalties Law
, CDEO Chapter 3; Questions & Answers 100%
Pass
CMS Definition of Fraud Correct Answer-knowingly making false statements
or misrepresenting facts to obtain an undeserved benefit or payment from a
federal healthcare program
CMS Definition of Abuse Correct Answer-an action resulting in unnecessary
costs to a federal healthcare program either directly or indirectly
CMS Examples of Fraud Correct Answer-Billing for Services/Supplies that you
know were not furnished or provided
Altering claim forms and/or receipts to receive a higher payment amount
Billing for services at a level higher than provided or necessary
Misrepresenting the diagnosis to justify payment
Making referrals to certain designated services that are prohibited
CMS Examples of Abuse Correct Answer-Misusing codes on claims
Charging excessively for service or supplies
Billing for services that were not medically necessary
, CDEO Chapter 3; Questions & Answers 100%
Pass
Failure to maintain adequate medical or financial records
Improper billing practices
Billing Medicare patients a higher fee schedule than non-medicare patients
FCA Correct Answer-Federal
False Claims Act
Lincoln Law Correct Answer-False Claims Act, enacted 1863 to combat fraud
from suppliers of good to the Union Army during the Civil War
In 1943 amendments made it more difficult to bring action forward.
In 1986 Congress enacted an overhaul that generated new fraud investigations
and actions.
The Statute is in title 31, subtitle III, CH. 37, subchapter III, of the US code 31
U.S.C. 3729(a).1
Title 31 Statute's 7 Types of Conduct Correct Answer-that brings liability FCA
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