©THEBRIGHTSTARS 2024
CDEO Chapter 3 Exam Questions With
Revised Answers
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? - answer✔✔Do you
know the cause of the fever?
Operation Restore Trust - answer✔✔3 offices were involved: OIG, Healthcare Financing
Administration, AoA
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 - answer✔✔Senior Medicare Patrol
OIG - answer✔✔Office of Inspector General
AoA - answer✔✔Administration on Aging
FCA - answer✔✔False Claims Act
CMPL - answer✔✔Civil Money Penalties Law
CMS Definition of Fraud - answer✔✔knowingly making false statements or misrepresenting
facts to obtain an undeserved benefit or payment from a federal healthcare program
CMS Definition of Abuse - answer✔✔an action resulting in unnecessary costs to a federal
healthcare program either directly or indirectly
, ©THEBRIGHTSTARS 2024
CMS Examples of Fraud - 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 - answer✔✔Misusing codes on claims
Charging excessively for service or supplies
Billing for services that were not medically necessary
Failure to maintain adequate medical or financial records
Improper billing practices
Billing Medicare patients a higher fee schedule than non-medicare patients
FCA - answer✔✔Federal
False Claims Act
Lincoln Law - answer✔✔False Claims Act, enacted 1863 to combat fraud from suppliers of
good to the Union Army during the Civil War
, ©THEBRIGHTSTARS 2024
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 - answer✔✔that brings liability FCA
It states a person is liable who:
A) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or
approval;
B) Knowingly makes , uses, or causes to be made or used, a false record or statement material to
a false or fraudulent claim
Title 31 Statute's 7 Types of Conduct - answer✔✔C) Conspires to a violation of subparagraph
(A), (B), (E), (F), or (G);
D) Has posession, custody, or control of property or money used, or to be used, by the
government and knowingly delivers, or causes to be delivered , less than all of that money or
property;
Title 31 Statute's 7 Types of Conduct - answer✔✔E) Is authorized to make or deliver a document
certifying receipt of property used, or to be used, by the government, and intending to defraud
the government, makes or delivers the receipt without completely knowing that the information
on the receipt is true
F) Knowingly buys or receives as a pledge of an obligation or debt, public property from an
officer or employee of the government or a member of the Armed Forces, who lawfully may not
sell or pledge property
Title 31 Statute's 7 Types of Conduct - answer✔✔G) Knowingly makes, uses, or causes to be
made or used, a false record or statement material to an obligation to pay or transmit money or
CDEO Chapter 3 Exam Questions With
Revised Answers
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? - answer✔✔Do you
know the cause of the fever?
Operation Restore Trust - answer✔✔3 offices were involved: OIG, Healthcare Financing
Administration, AoA
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 - answer✔✔Senior Medicare Patrol
OIG - answer✔✔Office of Inspector General
AoA - answer✔✔Administration on Aging
FCA - answer✔✔False Claims Act
CMPL - answer✔✔Civil Money Penalties Law
CMS Definition of Fraud - answer✔✔knowingly making false statements or misrepresenting
facts to obtain an undeserved benefit or payment from a federal healthcare program
CMS Definition of Abuse - answer✔✔an action resulting in unnecessary costs to a federal
healthcare program either directly or indirectly
, ©THEBRIGHTSTARS 2024
CMS Examples of Fraud - 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 - answer✔✔Misusing codes on claims
Charging excessively for service or supplies
Billing for services that were not medically necessary
Failure to maintain adequate medical or financial records
Improper billing practices
Billing Medicare patients a higher fee schedule than non-medicare patients
FCA - answer✔✔Federal
False Claims Act
Lincoln Law - answer✔✔False Claims Act, enacted 1863 to combat fraud from suppliers of
good to the Union Army during the Civil War
, ©THEBRIGHTSTARS 2024
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 - answer✔✔that brings liability FCA
It states a person is liable who:
A) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or
approval;
B) Knowingly makes , uses, or causes to be made or used, a false record or statement material to
a false or fraudulent claim
Title 31 Statute's 7 Types of Conduct - answer✔✔C) Conspires to a violation of subparagraph
(A), (B), (E), (F), or (G);
D) Has posession, custody, or control of property or money used, or to be used, by the
government and knowingly delivers, or causes to be delivered , less than all of that money or
property;
Title 31 Statute's 7 Types of Conduct - answer✔✔E) Is authorized to make or deliver a document
certifying receipt of property used, or to be used, by the government, and intending to defraud
the government, makes or delivers the receipt without completely knowing that the information
on the receipt is true
F) Knowingly buys or receives as a pledge of an obligation or debt, public property from an
officer or employee of the government or a member of the Armed Forces, who lawfully may not
sell or pledge property
Title 31 Statute's 7 Types of Conduct - answer✔✔G) Knowingly makes, uses, or causes to be
made or used, a false record or statement material to an obligation to pay or transmit money or
